Management of back pain in pregnancy

Abstract

Back pain during pregnancy is a common problem experienced by many pregnant women. Physiological changes during pregnancy are a contributing factor for the development of back pain. Laxity of the sacroiliac joints causes instability and development of sacroiliac pain. The pain may be severe and can interfere with daily activities. Neurological examination is usually normal. A positive straight leg-rising test may indicate herniated disc, which is rare during pregnancy. Noncontrast magnetic resonance imaging is safe in pregnancy. To date, there are no identified adverse effects of the magnetic resonance on the developing fetus, but long-term effects need to be examined. Most back pain in pregnancy can be treated conservatively. Acetaminophen is the drug of choice to treat pain during pregnancy. Epidural steroid injection (ESI) may be considered in certain cases. Data in the literature are deficient regarding the use of ESI in pregnancy, but it appears to be safe based on expert clinical experience. More work is needed to examine the long-term effect of ESI on the mother and the fetus. Surgery is usually postponed until the postpartum period, unless there is progressive neurological deficits or cauda equina syndrome.