Does Labour Epidural Cause Chronic Backache?

April 4, 2009, Cheryl Ng, Associate Principal Physiotherapist

After childbirth with an epidural, one may experience short-term back soreness at the catheter site where the medication was injected. As such, most women tend to associate labour epidural analgesia with chronic or long-term back pain. But is there really a connection between labour epidural and chronic backache?

In some retrospective studies conducted, there were suggestions that there is mild association between epidural analgesia during labour and low back pain 6 months post delivery. However, such studies were flawed by recall bias or reporting bias as they relied heavily on the respondent’s memory of past events. If the surveys were performed months and years post delivery, as in the case of such retrospective studies, the results may be inaccurate.

Source: The Martha Jefferson Hospital

A recent study by Howell et al concluded that the use of epidural analgesia was not associated with the development of chronic backache. In fact, the studies found no significant differences in the incidence of long-term back pain between women who received epidural pain relief and women who received other forms of pain relief. Instead, the backache, if any, developed because mothers receiving epidural analgesia were less sensitive to back stressing postures and hence allowed the poor back positions to remain for prolonged periods, resulting in back strains post delivery. Another possible reason for the back pain experienced post delivery could be trauma to the back muscles and ligaments during insertion of the epidural needle at the catheter site. However, this is relatively uncommon and usually the pain is short-term.

In sum, based on studies conducted, there is no connection between back pain and epidural usage, and the epidural pain relief during delivery do not increase the risk of long-term back pain. Back pain post delivery is more likely attributed to the pre-existing prenatal backaches due to mechanical and structural changes in the spine which are a result of normal physiological changes during pregnancy.

So what can I do if I have back pain post delivery?

Seek advice from your Doctor. Mothers should be informed about back care and how best to nurse the newborn baby with appropriate care and attention to posture. This should help resolve the back pain. Oral analgesics may sometimes be required. However, should symptoms persist for more than 6 weeks, your doctor will refer you to a physiotherapist specialized in women’s health. Meanwhile, some back care advice for postnatal mummies:

Make sure your posture is correct in all working and resting positions
Ensure work surfaces are of the correct height to prevent stooping (especially when changing nappies for your baby!)
Tighten your abdominals and pelvic floor muscles before changing positions or performing activities.
Get out of bed by bending knees, rolling over on to side keeping knees together
Avoid exercises such as curl-ups or sit-ups if your back hurts
Avoid heavy lifting if possible but if it is unavoidable, use correct lifting/handling techniques.
Sit in a chair with good back support, with a rolled up towel behind the lower back (if necessary) and feet resting firmly on the floor.
Have frequent rest breaks in between tasks
Avoid wearing high heels

Reference

Alison Macarthur, Colin Macarthur, and Sally Weeks. Epidural anaesthesia and low back pain after delivery: a prospective cohort studyBMJ 1995 311: 1336-1339
Howell CJ, Dean T, Lucking L, et al. Randomised study of long term outcome after epidural versus non-epidural analgesia during labour. BMJ 2002; 325:357. Erratum in: BMJ 2002; 325:580
Loughnan BA, Carli F, Romney M, Dore J, Gordon H. Epidural analgesia and backache: a randomized controlled comparison with intramuscular meperidine for analgesia during labour.Br J Anaesth 2002; 89:466-72
Russell, R., Reynolds, F. Back pain, pregnancy, and childbirth.BMJ 314: 1062-1062
Young G, Jewell D. Interventions for preventing and treating pelvic and back pain in pregnancy.Cochrane Database Syst Rev 2002;(1): CD001139

This work by Musculoskeletal Consumer Review is licensed under a Creative Commons Attribution-Noncommercial-Share Alike 3.0 Singapore License. This article was contributed by Etonia - Pregancy Pains Musculoskeletal Specialist. In the spirit of promoting health education, you may copy, distribute and transmit the work under the conditions specified by the license. For articles re-printed with permission, copyright remains with the original copyright holder (author or publisher). MCR's Creative Commons License does not apply in such cases.