Back pain in pregnancy: 1-year follow-up of untreated cases

Abstract

IntroductionBack pain (BP) is one of the most frequent symptoms to appear during the last period of pregnancy and a high incidence has been described in several studies [2,6,7,9,14,17]. Since 1984 modern studies of BP also need to include patient-oriented assessment [23]. Self-administered questionnaires are the most common instruments to assess patient perspective in evaluating the clinical picture, and the usefulness of these instruments [20, 21] is widely accepted. BP during pregnancy has been quantitatively evaluated in some recent papers, but only a few studies analyzed the symptoms from a qualitative-quantitative point of view, using a validated patient-oriented tool [16,25].During 2001, we performed a study to assess the incidence and severity of BP during the last period of pregnancy, through a modern and comprehensive assessment of the patient's perspective [18]. That study demonstrated that the incidence of BP in pregnancy is high (about twothirds of our sample have BP symptoms), but most often BP causes only low-grade disability.Until now no multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available (multicenter studies are commonly accepted as providing a more representative sample). We performed the follow-up of the previous studied sample; consequently, we acquired data from a multicenter sample. We used a validated patient-oriented measurement, the Roland questionnaire, to obtain more comprehensive and consistent Abstract Back Pain (BP) is one of the most frequent symptoms during the last period of pregnancy, and high incidence has been described in several studies. Until now no wide, multicenter and prospective clinical studies on the natural course of BP after pregnancy have been available. We performed a multicenter follow-up study in a sample of pregnant women using the Italian validated version of the Roland questionnaire to assess the evolution of BP after pregnancy and identify prognostic factors. Each center had to re-evaluate at least 75% of the initially enrolled women, with latency of 1 year after delivery. At the follow-up, we acquired substantial clinical data concerning the post-delivery period. The evaluation of symptom evolution was based on the Roland questionnaire. At followup, 53% of re-evaluated women had no BP symptoms. Moreover, there was a significant improvement of patient-oriented assessment in women who suffered BP after delivery. With regard to the predictive factors, the presence of BP before pregnancy implied a 3.1-fold higher probability of improvement after delivery. In conclusion, women without history of BP before pregnancy and who complain of these symptoms during pregnancy require greater attention, because they have a lower possibility for improvement. Conversely, in women with a history of BP, pregnancy represents a transient period of worsening symptoms, probably due to the temporary para-physiological mechanical condition.

Is there a relationship between parity, pregnancy, back pain and incontinence?

“…Reported prevalence of back pain 1 to 6 years after pregnancy varies between 16 and 51% [2][3][4][5], and studies have reported that between 35 and 76% of pregnant women experience back pain [3,[5][6][7][8][9][10]. A recent systematic review of pregnancy-related lumbopelvic pain estimated prevalence to be 45.3%, with a reported range of 3.9 to 89.9% from studies considered to be of acceptable standard [11].…”

Effect of therapeutic exercises on pregnancy-related low back pain and pelvic girdle pain: Secondary analysis of a randomized controlled trial

“…Lumbopelvic pain usually resolves after delivery. However, 51% of women with pain during pregnancy report experiencing LBPP 1 year postpartum (10), and 20% of women report LBPP 3 years postpartum (11). It has been shown that a higher intensity of pain experienced during pregnancy indicates a worse prognosis after delivery (12).…”

Pregnancy related lumbo-pelvic pain: a prevalence study in a tertiary institute in Pondicherry, India

“…Disability in lumbar pelvic pain during pregnancy ranges from 21-81% median 28%. 17 It has been proposed that due to increased weight gain in pregnancy, shifting of the centre of gravity of the body anteriorly and stretching the abdominal muscles of accommodation the enlarging uterus causes muscle fatigue. In India the cultural habits of squatting, sleeping on flat firm surface is common; This maintains the spine in physiological position and may contribute to spontaneous realignment of minor malalignments of lumbo-pelvic joints.…”