Management options General management

Back care advice early in pregnancy has been reported to reduce the incidence and severity of low back pain during pregnancy. This may be particularly important for women with a history of prepregnancy back pain, who may be at increased risk of worsening pain during pregnancy. Simple physiotherapy, exercise programmes and the use of lumbosacral corsets have all been reported to provide symptomatic pain relief during pregnancy.

Use of simple analgesics such as paracetamol and codeine-based preparations is acceptable during pregnancy but non-steroidal anti-inflammatory drugs should be avoided whenever possible. If their use is considered essential, treatment should be agreed with the obstetrician and fetal cardiac ultrasound monitoring arranged because of the risk of premature closure of the ductus arteriosus. Amitriptyline may be prescribed as a co-analgesic, especially if pain is disrupting normal sleep patterns. In cases of severe back pain, strong opioid analgesia may be required.

Transcutaneous electrical nerve stimulation for back pain during the second half of pregnancy is not recommended by the manufacturers of the machines but is used in clinical practice, frequently with good effect. Injection of local anaesthetic and steroid into the epidural space, the sacroiliac joints or the symphysis pubis may be considered necessary if symptomatic control of pain cannot be achieved by other methods. The safety of such procedures during pregnancy is unknown, and a risk-benefit analysis must be undertaken for each woman.

Delivery before term may be considered when pain control is difficult to achieve.

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