Postpartum Back Pain Research Articles

Knowledge About Epidural Analgesia Among Women in Al-Qassim Province of Saudi Arabia.

Epidural analgesia is one of the most effective and fast anesthesia techniques to relieve labor pain. The technique involves inserting a needle in the epidural space that covers the spinal cord, providing a full block of sensation in the lower part of the abdomen and the lower limbs that starts seconds to minutes after the administration, while the effects last for a couple of hours after. This study assessed women's knowledge of epidural analgesia in the Al-Qassim Province of Saudi Arabia. The study was conducted through a descriptive cross-sectional survey distributed among citizens of Qassim Province, Kingdom of Saudi Arabia, from October 2022 to February 2023. The respondents were selected randomly via social media advertising, and only women older than 18 were allowed to participate in the survey. Out of 520 responses, 483 met the study criteria. This study found significant associations between awareness levels of epidural analgesia and pregnancy history. Women who had previous histories reported epidural analgesia as the most effective means of pain control (p < 0.001), postpartum back pain as the major complication (p = 0.025), being used by the majority of other women (p = 0.022), and the potential for epidural analgesia to yield complications (p < 0.001). This means that other studies are required to explore more such associations to widen the scope of this field of study. This study highlights the mixed awareness levels of epidural analgesia among Saudi women from the Qassim area. The awareness provided by clinics or hospitals is limited, and further research is required to explore the awareness levels of epidural analgesia. Overall, the study highlights the need for a concerted effort by healthcare providers to improve the awareness and uptake of epidural analgesia in the Qassim area and beyond.

Association between history of childbirth and chronic, functionally significant back pain in later life

BackgroundBack pain is more prevalent among women than men. The association with sex could be related to pregnancy and childbirth, unique female conditions. This association has not been thoroughly evaluated.MethodsUsing a retrospective cohort design, we evaluated the relationship between history of childbirth on the prevalence and severity of functionally consequential back pain in 1069 women from a tertiary care pain management clinic. Interactions among preexisting, acute peripartum, and subsequent back pain were evaluated as secondary outcomes among the parous women using logistic and linear regression as appropriate.ResultsThe women who had given birth had a higher risk for functionally significant back pain compared to women who had not given birth (85% vs 77%, p < 0.001, Risk Ratio 1.11 [1.04-1.17]). The association was preserved after correction for age, weight, and race. Back pain was also more slightly severe (Numerical Rating Score for Pain 7[5-8] vs 6[5-7] out of 10, p = 0.002). Women who recalled severe, acute postpartum back pain had a higher prevalence of current debilitating back pain (89% vs 75%, Risk Ratio 1.19 (1.08-1.31), p = 0.001). Twenty-eight percent of acute postpartum back pain never resolved and 40% reported incomplete resolution.ConclusionsA history of pregnancy and childbirth is a risk factor for chronic functionally significant back pain in women. Severe acute postpartum back pain is a risk factor for future disability suggesting that the peripartum period may provide an important opportunity for intervention. Early recognition and management may mitigate future disability.Trial registrationThe study was registered with clinicaltrials.gov as “Association Between Chronic Headache and Back Pain with Childbirth” (NCT04091321) on 16/09/2019 before it was initiated.

Pengaruh Terapi Massage Effleurage Terhadap Nyeri Punggung Pada Ibu Hamil Trimester III

Back pain that occurs for a long time and is not treated immediately, can lead to long-term back pain, increasing the tendency for postpartum back pain, and chronic back pain that will be more difficult to treat or cure. Massage therapy is one of the non-pharmacological therapies that can reduce back pain for pregnant women, massage will reduce muscle tension and pain, increase mobility and improve blood circulation. Analyzing the effect of effleurage massage on back pain in third trimester pregnant women. The research method used is pre-experiment with a one-group pretest-posttest design approach. The population in this study were all pregnant women at Kaliwadas Health Center with a gestational age of 32 weeks and above in January - March 2022 totaling 42 populations, while the sample taken was 16 respondents. Hypothesis test using Mann Withney test. The level of back pain before being given Massage Effleurage therapy had an average of 2.56 and after being given Massage Effleurage therapy had an average of 1.87. This means that there is a decrease in the level of back pain after being given Massage Effleurage therapy of 0.69. The results of the Mann Withney test obtained the Asymp value. Sig. of 0.021, so Ha is accepted, which means it can be concluded that there is an effect of Massage Effleurage on back pain in third trimester pregnant women at Kaliwadas Health Center. There is an effect of Massage Effleurage on back pain in third trimester pregnant women at Kaliwadas Health Center.

The Efficacy of Lumbar Support on Pain, Disability, and Motor Control in Women With Postpartum Pelvic Girdle Pain: Protocol for a Randomized Controlled Trial.

BackgroundPregnancy-related posterior pelvic girdle pain (PPGP) is one of the most important clinical manifestations of postpartum back pain. Those affected often complain of discomfort during daily activities. It is hypothesized that altered motor control is associated with perceived pain. Pelvic support can regulate possible underlying altered motor control mechanisms and decrease pain. However, the influence of a lumbosacral orthosis, which is broader support that allows for a wider contact area and more skin sensory stimulation to restore proper motor function, has not yet been investigated in women with postpartum PPGP.ObjectiveThis study investigates the efficacy of broader lumbar support and narrower pelvic support on pain, proprioception, disability, and muscle strength in women with pregnancy-related PPGP.MethodsThis study will be a single-center, 3-armed, participant-blinded, randomized controlled trial. In total, 84 women diagnosed with pregnancy-related PPGP will be recruited and randomly assigned into 3 groups. Intervention groups A and B will receive pelvic and lumbar supports, respectively. Group C (control) will receive only a patient education leaflet containing advice on strengthening exercises, comfortable positions, and other practical information. The study outcomes are pain, effort score during the active straight leg raising test, maximum isometric hip flexion force, maximum isometric hip external rotation force, maximum isometric trunk rotation force, and joint position reproduction of hip abduction. The study outcomes will be measured at 4 time points: baseline (T1), immediately after the intervention (T2), 4 weeks following interventions began (at this time, the intervention period is completed) (T3), and 1 week after discontinuing the interventions (T4) to evaluate the possible lasting effects of wearing supports. Multivariate analysis of variance will be used to test between- and within-group differences.ResultsRecruitment for this study will be started in summer 2022 and is expected to be completed by the end of fall 2022.ConclusionsThis study will examine the efficacy of broader lumbar support as an early rehabilitative treatment for women receiving postpartum posterior pelvic pain support compared to those receiving a narrower pelvic support. We expect the broader lumbar support to impact pain management and disability better than the current narrower pelvic belt. Long-term follow-up studies will help determine whether such lumbosacral orthosis reduces pain and improves daily activities in women with pregnancy-related PPGP.Trial RegistrationIranian Registry of Clinical Trials IRCT20150210021034N11; https://www.irct.ir/trial/54808International Registered Report Identifier (IRRID)PRR1-10.2196/40553

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Preprocedural ultrasound for neuraxial blockade in nonobstetric patients. Should it be considered as a standard of care?

Imaging in Axial Spondyloarthritis: What is Relevant for Diagnosis in Daily Practice?

To explore how imaging may assist diagnosing axial spondyloarthritis in rheumatology practice. A diagnosis of axial spondyloarthritis is based on pattern recognition by synthesizing clinical, laboratory, and imaging findings. In health care settings providing low threshold access to advanced imaging, sacroiliac joint MRI is the preferred imaging modality in clinically suspected axial spondyloarthritis. In daily routine, the optimum protocol to assess suspected inflammatory back pain combines sacroiliac joint and spine MRI fitting a 30-min slot. Contextual assessment of concomitant structural and active MRI lesions is key to enhance diagnostic utility. In women with postpartum back pain suggestive of axial spondyloarthritis, recent reports advocate waiting 6-12 months after delivery before acquiring sacroiliac joint MRI. Major unmet needs are consistent MRI protocols, standardized training modules on how to evaluate axial MRI, and timely dissemination of imaging advances into mainstream practice both in rheumatology and in radiology. In rheumatology practice, MRI has become indispensable to help diagnose early axial spondyloarthritis. However, major gaps in training and knowledge transfer to daily care need to be closed.

Effectiveness of Specific Lumbar Stabilization Exercise for LBP among Postpartum Women: A Quasi-Experimental Study

Background: Postpartum back pain is common, with up to 75% of women experiencing back pain immediately following birth due to ligament laxity and postural changes. Besides the lack of pelvic floor muscles strength, urine leakage problem during coughing and sneezing also arises in this condition. The purpose of this study was to explore the effect of stabilization exercise (SE) and Kegel exercise. Objective: To evaluate the pain intensity in rest and different functional activities before and after introducing spinal stabilization exercises in postpartum women with low back pain and also find out the effect of Kegel exercise. Study Design: A Quasi-Experimental (one group) pretest-posttest design was used. Methodology: 27 patients who were fulfill inclusion criteria within this study period with postpartum low back pain, attended at Gynecological and Women's Health unit, CRP, Mirpur, Dhaka was purposively chosen to conduct the study. Spinal stabilization exercise was applied to the participants to find out the effectiveness of this exercise. Kegel exercise was also introduced who have urine leakage problem among 27 patients. Participants received the exercise for 45 minutes, 2 times a week &amp; total 6 weeks. Besides this they performed the exercises at home 5 times a day also. A numeric pain rating scale was used to measure pain intensity in different functional activities such as swiping, squatting, chair sitting, heavy weight lifting, walking, and journey by bus or rickshaw, and stair climbing. Pain score was analyzed by calculating the "Wilcoxon Signed Ranked Test". Results: Results showed that relative improvement occurs in all participants in the experimental group. Pain scores on numeric pain rating Scale on different functional activities such as during toilet sitting, stair climbing, walking, during weight lifting, were relatively reduced which was also statistically significant (p≤ .05). Participants who have a urine leakage problem also recover from this problem. Conclusions: Lumbar stabilization exercises has effect on reducing pain and improving functional activities, and to solve the urine leakage problem Kegel exercise effective.

Pengaruh Kompres Hangat terhadap Nyeri Punggung Ibu Hamil Trimester III di Puskesmas Sekernan Ilir Tahun 2020

Introduction Back pain is the most common complaint with a prevalence rate of 49%. Back pain that is not immediately treated, can cause long-term back pain, increase the tendency of post-partum back pain and chronic back pain that will be more difficult to treat or cure, that is, when the pain spreads to the pelvic region which causes difficulty walking and thus requires crutches or assistive devices. other way. PURPOSEQuantitative research with quasi-experimental design with one group pretest-posttest to determine the effect of Warm Compresses on Back Pain of Trimester III Pregnant Women in SekernanIlir Health Center in 2020. Methodsthe population is all Trimester III pregnant women in the work area of SekernanIlir Health Center up to January 2020 which totaling 296 people. Samples were 30 respondents. This research was conducted from January to March 2020. ResultsData analysis was carried out univariate and bivariate. The result of univariate analysis before giving a warm compress is moderate pain. The results of bivariate analysis showed that there was an effect of warm compresses on the level of back pain in third trimester pregnant women and p-value = 0.000 (p &lt;0.05). conclusionit is expected that the Puskesmas will provide knowledge to pregnant women about ways to reduce back pain in third trimester pregnant women, in addition to pharmacological treatment, it can also be done with non-pharmacological treatment, namely warm compresses

Obstetric Anesthetic Complications

Anesthesia-associated maternal mortality and complications continue to decline due to improvements in practice and ongoing research in the field of obstetric anesthesiology. This chapter covers key topics in obstetric anesthetic complications, including accidental dural puncture, post-dural puncture headache, general anesthesia-related complications, inadequate labor analgesia, high neural blockade, post-partum back pain, CNS infections, as well as neurological injury. This review contains 54 references. Keywords: accidental dural puncture, post-dural puncture headache, general anesthesia-related complications, inadequate labor analgesia, high neural blockade, postpartum back pain, CNS infections, neurological injury.

Epidural Analgesia and Back Pain after Labor.

Background and Objectives: The aim of this survey was to assess the impact of epidural analgesia on post-partum back pain in post-partum women. Materials and Methods: The questionnaire was completed by post-partum women during the first days after delivery. Six months later, the women were surveyed again. The response rate was 70.66%, a total of 212 cases were included in the statistical analysis. The statistical analysis of the data was conducted using SPSS®Results. Seventy-nine (37.26%) women received epidural analgesia, 87 (41.04%) intravenous drugs, and 46 (21.7%) women gave birth without anesthesia. The prevalence of post-partum back pain was observed in 24 (30.38%) women of the epidural analgesia group, in 24 (27.58%) subjects of the intravenous anesthesia group, and in 14 (30.43%) women attributed to the group of subjects without anesthesia. The correlation between post-partum back pain and the type of anesthesia was not statistically significant (p = 0.907). Six months later, the prevalence of back pain was found in 31.65% of women belonging to the epidural analgesia group, in 28.74% of women with intravenous anesthesia, and in 23.91% of women without anesthesia. The correlation between complaints of back pain six months after delivery and the type of anesthesia applied was not statistically significant (p = 0.654). Conclusions. The labor pain relief technique did not trigger the increased risk of back pain in the early post-partum period and six months after delivery.

Magnetic Resonance Imaging of the Sacroiliac Joints Indicating Sacroiliitis According to the Assessment of SpondyloArthritis international Society Definition in Healthy Individuals, Runners, and Women With Postpartum Back Pain

ObjectiveTo compare magnetic resonance images (MRIs) of the sacroiliac (SI) joints of healthy subjects and individuals with known mechanical strain acting upon the SI joints to those of patients with axial spondyloarthritis (SpA) and patients with chronic back pain.MethodsThree readers who had received standardized training and were blinded with regard to study group randomly scored MRIs of the SI joints of 172 subjects, including 47 healthy individuals without current or past back pain, 47 axial SpA patients from the Spondyloarthritis Caught Early (SPACE) cohort (with a previous MRI confirmed positive for sacroiliitis), 47 controls with chronic back pain (irrespective of MRI results) from the SPACE cohort, 7 women with postpartum back pain, and 24 frequent runners. MRIs were scored according to the Assessment of SpondyloArthritis international Society (ASAS) definition and Spondyloarthritis Research Consortium of Canada (SPARCC) index.ResultsOf the 47 healthy volunteers, 11 (23.4%) had an MRI positive for sacroiliitis, compared to 43 (91.5%) of 47 axial SpA patients and 3 (6.4%) of 47 patients with chronic back pain. Three (12.5%) of the 24 runners and 4 (57.1%) of the 7 women with postpartum back pain had a positive MRI. Using a SPARCC cutoff of ≥2 for positivity, 12 (25.5%) of 47 healthy volunteers, 46 (97.9%) of 47 positive axial SpA patients, 5 (10.6%) of 47 controls with chronic back pain, 4 (16.7%) of 24 runners, and 4 (57.1%) of 7 women with postpartum back pain had positive MRIs. Deep bone marrow edema (BME) lesions were not found in healthy volunteers, patients with chronic back pain, or runners, but were found in 42 (89.4%) of 47 positive axial SpA patients and in 1 (14.3%) of 7 women with postpartum back pain.ConclusionA substantial proportion of healthy individuals without current or past back pain has an MRI positive for sacroiliitis according to the ASAS definition. Deep (extensive) BME lesions are almost exclusively found in axial SpA patients.

Ultrasound-determined landmarks decrease pressure pain at epidural insertion site in immediate post-partum period.

Women have blamed epidurals for their post-partum back pain for decades. Survey-based studies have shown similar incidence of chronic back pain between women who delivered with epidurals compared to those who did not. However, epidural insertion site pain has yet to be evaluated by a quantitative measure: pressure pain threshold (PPT). Algometer measured PPT has been shown to be accurate and reproducible in acute, chronic, and postoperative pain studies. This study determines the effect of ultrasound-based landmarks on the PPT at the epidural insertion site in the post-partum period. Participants were randomized into either the ultrasound or sham groups. In addition, a non-randomized control group (no epidural) participated. Ultrasound of the lumbar region was used to mark mid intervertebral levels in the US group but not in the sham group. Epidural were placed using the marks in the US group or palpated bony landmarks in the sham group. PPT at each intervertebral space measured before and after the use of epidural. Epidural placement did significantly decreased PPT in US (68%) and US sham (79%) groups and less in the control group (21%). US group showed decreased PPT only at insertion site whereas US sham group also showed decreased PPT at insertion site and adjacent levels. We showed that epidural placed with ultrasound-determined landmarks not only improves the success of epidural placement but also minimizes the number of intervertebral levels with decreased PPT.

13. Septic Sacroilitis Mimicking an Inflammatory Spondyloarthropathy

Background: Post-partum back pain may herald the onset of an inflammatory arthritis or SpA. However, rarely a similar picture is seen with infection. Given that the treatment is immunosuppression vs antibiotics, correct diagnosis is extremely important. Methods: We present a lady with post-partum lower back pain and clinical and radiological features consistent with sacroiliitis who was found to have a multifocal septic arthritis. Results: A 40 year old woman presented 4 weeks post-partum with left hip and lower back pain. She had a healthy baby through a normal delivery after being induced at 40 weeks but had required an episiotomy. Approximately 12 h after delivery she developed left hip and lower back pain spreading to her left shoulder, wrist and hands with reduced range of movement. She then developed pain in her right shoulder, chest pain at the costochondral junctions and pain and swelling of her right knee. She reported ongoing vaginal bleeding since the birth of her child. Examination revealed a subtle swelling around the right sternoclavicular joint and second costochondral junction. Her lumbar spine was tender on movement and stressing her right sacroiliac joint provoked pain. Blood tests showed CRP 83, ESR >120, haemoglobin of 7.4, MCV 88, white cell count 5.6, neutrophils 4.4, lymphocytes 0.7 and platelets 283. MRI showed abnormal fluid signal within the right sternoclavicular joint space extending into the surrounding tissues, particularly the interclavicular recess and suprasternal notch and sub-chondral bony oedema. A large amount of abnormal fluid was present in the left sacroiliac joint extending into the surrounding tissues with pockets of fluid or pus within the paravertebral and left iliacus muscles and extensive bony oedema. A nuclear medicine bone scan showed marked uptake at the left sacroiliac joint and the right sternoclavicular joint. Synovial biopsies of her left sacroiliac and right sternoclavicular joints identified a fully sensitive Group B streptococcus. Due to penicillin allergy she was treated with i.v. ceftriaxone for 3 weeks, followed by 6 weeks of oral clindamycin. She had a good clinical response with resolution of the polyarthritis, back pain and inflammatory markers. ERPC showed retained products of conception that were evacuated. An MRI 6 months later showed a significant improvement of the inflammation previously seen. An echocardiogram was performed which excluded endocarditis. Conclusion: Recently there has been an increase in both the rates of adult native joint septic arthritis and Group B streptococcal disease in non-pregnant adults. Classically an acute monoarthritis, septic arthritis can present as oligoarthritis, or indeed sacroiliitis. Our patient’s multifocal Group B streptococcal septic arthritis was likely due to the retained products of conception as pre-natal screening had been negative. We highlight the importance of identifying such uncommon presentations in order to ensure correct treatment. Disclosure statement: The authors have declared no conflicts of interest.

Prevalence of low back pain experienced after delivery with and without epidural analgesia: A non-randomised prospective direct and telephonic survey.

Background and Aims:The most frequent concern of patients receiving epidural analgesia for labour pain relief is post-partum back pain. This survey was designed to assess the prevalence of post-partum backache with and without epidural analgesia among post-partum women.Methods:The study was conducted at a university teaching hospital and women presenting to labour room for labour and delivery formed the target population. A total of 482 women were recruited during the study period. Response rate was 95.4% and these cases were included in our statistical analysis. Two forms were designed for data collection before and after delivery; form I was filled by one of the investigators while form II was filled by a research assistant to prevent bias which included follow-up of back pain. The primary outcome variable was backache quantified with visual analogue scale score. Out of 460 women, 230 women received epidural analgesia for labour and 230 women had not.Results:The prevalence of post-partum back pain in epidural analgesia versus non epidural analgesia groups was 40.9% versus 40% on day one and 32.2% versus 35.2% after 1 week. However, after one and 3rd months follow-up, backache prevalence was less in epidural analgesia group (unadjusted odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.39-0.99) and (unadjustedd OR: 0.32; 95% CI: 0.15-0.69) respectively. The adjusted odd ratio was 0.59 at 1st month and 0.25 at 3rd month. There was no significant difference between the two groups in pain scores.Conclusion:There was no association between the epidural analgesia and post-partum back pain

SPECT/CT FINDINGS IN A LARGE COHORT WITH SACROILIAC JOINT INCOMPETENCE (SIJI)

Comprehensive clinical and SPECT/CT findings in 253 patients with an established diagnosis of SIJI are presented.MethodsAll patients with a clinically diagnosis of SIJI following the European guidelines for Pelvic Girdle...

FDG Uptake in Sacroiliac Joint Due to Osteitis Condensans Ilii Shown on PET/CT in a Patient With Breast Cancer

A 56-year-old woman with breast cancer underwent FDG PET/CT at follow-up. The PET images showed increased FDG uptake along right sacroiliac joint. The coregistered CT images showed diffuse sclerosis around the sacroiliac joints, but no bony destruction, periarticular erosion, or joint space narrowing. She had been complaining of intermittent lower back pain since her last pregnancy. The radiologic pictures and history of postpartum back pain were considered as typical characteristics for osteitis condensans ilii. This case reminds us that careful inspection of the coregistered CT images is important to avoid potential misinterpretation because of osteitis condensans ilii.

Study on the effectiveness of a test-dependent osteopathic treatment for women with persistent post partum back pain: A randomized controlled trial

Introduction: Chronic Low Back Pain (CLBP) is a very common complaint in the general population and it is often managed by physicians by conservative means. Osteopathic manipulative treatment (OMT) has been recently been demonstrated to be an effective method to reduce pain in patients suffering with CLBP. The objective of this study was to compare the effects of OMT with sham manipulative treatment (SMT) on patient’s self reported pain and disability. Design: This was a randomized controlled investigation Methods: For this study ninety-four patients were recruited from the Orthopedic Department, Bassini Hospital (Italy) in the period between September 2006 and March 2008. Patients were randomly assigned to either usual care plus OMT (n 1⁄4 44) or usual care plus SMT (n 1⁄4 50). The main outcome variables were the Oswestry Disability Index and a 10-cm visual analog scale (VAS) for overall back pain. Data were analyzed using a two-factor ANOVA for repeated measures with an a level set at 0.05. Results: Overall, OMT significantly decreased pain and disability compared to SMT on this study. The change in VAS was -2.8 1.4 for OMT and 0 0.9 for SMT. The change in Oswestry Disability Index -8.4 8.5 for OMT and 0.3 7.2 for SMT). There was a significant interaction (group x time) for both visual analog scale (p <0.01) and for Oswestry Disability Index (p <0.01). No adverse events were recorded during the study. Discussion: Similarly to previous investigation in this area (Licciardone et al 2005) OMT appears to provide benefits over and above usual care for the treatment of CLBP. The improvement in the OMT compared to the SMT demonstrated that placebo effects such as interaction with patients and range of motion activities do not justify per se the results of this study. Future studies should aim to use less subjective outcome measures and focus on the mechanism through which OMT is able to reduce pain and disability in CLBP patients.

Intrapartum Analgesia and Its Association with Post-Partum Back Pain and Headache in Nulliparous Women

Intrapartum Analgesia and Its Association with Post-Partum Back Pain and Headache in Nulliparous Women

Effects of a Postpartum Back Pain Relief Program for Korean Women

Despite the high prevalence of back pain and its subsequent effects in post-partum women, intervention programs are scarce. The purpose of this study was to test the effects of a back-pain-reducing program on post-partum women who experienced low-back pain during pregnancy. A non-equivalent control-group pretest-posttest design was used. Pregnant women who attended a hospital for prenatal check-ups and experienced back pain participated in an intervention program (n=27), and the results were compared with women in a control group from another hospital (n=25). At 8 weeks post-partum, the pain intensity, functional limitations were lower in the intervention group than in the control group. However, differences in mean change of the pain intensity and functional limitations between 36 and 39 weeks of gestation and at 8 weeks post-partum were not statistically significant between the groups. Moreover, the flexibility, post-partum functional status, and post-partum depression did not differ significantly between the groups. A back-pain-relief program in this study was not effective to reduce the back-pain intensity in post-partum women and to decrease the associated functional limitations. The implications for nursing practice and directions for future research are discussed.

Intrapartum analgesia and its association with post‐partum back pain and headache in nulliparous women

The effect of intrapartum analgesia on post-partum maternal back and neck pain, headache and migraine, is uncertain. To determine if nulliparous women having epidural analgesia during labour have a similar incidence of the above-mentioned post-partum symptoms compared with women managed using other forms of pain relief. Secondary analysis of cohort data from a randomised trial in which nulliparous women intending to deliver vaginally were randomised to either epidural analgesia (EPI) or continuous midwifery support (CMS) at admission for delivery. Because of high cross-over rates, groups were initially defined by the randomised treatment allocation and the actual treatment received (CMS-CMS n = 185, EPI-CMS n = 117, EPI-EPI n = 376 and CMS-EPI n = 314). Univariate analysis showed no difference between groups, so final analysis was based on the actual treatment received. Six hundred and ninety women received epidural analgesia (EPIDURAL) and 302 received other methods of pain relief including CMS. Back pain was common before, during and after pregnancy, and risk factors for post-partum back pain at six months were back pain prior to pregnancy or at two months post-partum. Epidural analgesia, mode of delivery, spontaneous or induced labour, birthweight and back pain during pregnancy had no significant relationship with post-partum back pain at six months. Headache was significantly more common in the EPIDURAL group during pregnancy and at two months post-partum, but not at six months. Migraine was not associated with intrapartum analgesia. This analysis supports previous research suggesting that epidural analgesia is not a significant risk factor for persisting post-partum back pain, headache or migraine.