Table 4 - uploaded by Anuj Bhatia
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Background:
Low back pain (LBP) is commonly experienced during pregnancy and is often poorly managed. There is much ambiguity in diagnostic work-up, appropriate management and decision-making regarding the use of neuraxial analgesia and anaesthesia during labour and delivery in these patients. This systematic review summarises the evidence regardi...
Context in source publication
Context 1
... spite this, we found a low rate of use for electrodiagnostic studies, which may be due to patient preference (electro- diagnostic studies can be painful), urgency of the presen- tation or lack of awareness among health care providers. Table 4 summarized the common pain generators in the lower back and pelvis, their common presentations, imaging or investigations of choice and their common findings. It must be borne in mind that the correlation between the causes of back pain and the radiological find- ings is poor [125,126] and that findings on imaging do not always imply aetiology [127] . ...
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Purpose
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Objective:
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Citations
... Low back pain (LBP) it's a very common condition and frequently affects women during pregnancy and has a great impact on their daily lives 1,2 , in terms of quality of life, public health costs and productivity 2,3 . According to several studies, the development of LBP during pregnancy is related to low physical activity (PA) levels of pregnant women [4][5][6] . PA and exercise provide physiological benefits for pregnant women, without compromising fetal growth or adversely impacting pregnancy, labor and delivery [7][8][9] . ...
Background: Low back pain (LBP) is an increasingly reported condition, and physical activity (PA) may play an important role. The aim of the present study was to evaluate the proportion of pregnancy-related LBP and its association with type and intensity level of PA during pregnancy. Methods: A longitudinal prospective study was carried out with a cohort of 118 pregnant women. Participants were evaluated in all trimesters. LBP was assessed with a self-reported questionnaire and participants were categorized according to its occurrence. The type and intensity of PA were evaluated using the Pregnancy Physical Activity Questionnaire and categorized into tertiles. Binary logistic regression models were constructed to verify the relationship between LBP and type, the intensity of PA in all trimesters, and LPB pre-pregnancy. Results: LBP was reported by 40.7%, 52.2% and 66.7% of the subjects in the first, second, and third trimesters, respectively. No significant associations were found between LBP and type and intensity of PA. However ,women who had LBP before pregnancy, compared to those who did not, had higher odds of expressing LBP during pregnancy (OR= 3.85, 95% CI: 1.344-11.025). Conclusions: LBP is a common condition and increased during pregnancy. Results of this study suggest that type and intensity of PA are not associated with emerging of LBP during pregnancy.
... In addition, there are several physiological factors that cause back pain in pregnancy, namely an increase in hormones (relaxin, progesterone, and estrogen) which results in increased joint weakness, structural imbalances caused by a weakening of the abdominal muscles due to an enlarged uterus, compensatory hyperlordosis (rotation of the uterus) sagittal pelvis and a shift in the anterior center of gravity. Other rare pathologies such as spinal tumors and osteomyelitis (Sehmbi, D'Souza, & Bhatia, 2017) The effects of back pain in pregnancy are not lifethreatening, but this condition can affect the daily life activities of pregnant women, such as work, and sleep, and also affect the mother's mood, resulting in a decrease in quality of life. Therefore, the problem of back pain during pregnancy needs to get good therapy so that the health condition of pregnant women is maintained and the activities of the daily life of pregnant women are not disturbed (Shijagurumayum Acharya et al., 2019). ...
... The causes of back pain during pregnancy can be influenced by various factors, including a heavy workload, flexion of body position, a history of previous back pain, a history of previous trauma in the pelvic area, body mass index, parity, and depression. Sehmbi, D'Souza, & Bhatia, (2017) state that there are several factors that cause low back and pelvic pain in pregnancy, namely an increase in hormones (relaxin, progesterone, and estrogen) which results in increased joint weakness, structural imbalances caused by muscle weakness. abdomen due to the uterus, compensatory hyperlordosis (sagittal rotation of the pelvis), and a shift in the anterior center of gravity. ...
... abdomen due to the uterus, compensatory hyperlordosis (sagittal rotation of the pelvis), and a shift in the anterior center of gravity. Other less common pathologies such as osteomyelitis and spinal tumors (Sehmbi et al., 2017). ...
... O ne of the most common problems in pregnant women is back pain; accordingly, some studies reported that this issue might be contributed to 30% to 70% of their problems [1][2][3]. For this reason, about 30% of women may stop at least one of their daily activities during pregnancy [4,5]. ...
Background:
Low back pain is one of the most common problems for pregnant women during pregnancy. Most belts are designed for supporting the surface of the symphysis pubis or upper anterior iliac spine without any support in the lumbar region.
Objective:
This study aimed to compare the related effects between the new design and the current belt on the pain and function of pregnant women.
Material and methods:
In this randomized control trial study, 48 pregnant women with pelvic and lumbar pain participated. The participants were randomly divided into three groups: current belt, modified belt, and control. Pain intensity assessment, pelvic girdle (PG), and Oswestry disability index (ODI) questionnaires were utilized at the beginning of the study and three weeks later.
Results:
The pain intensity decreased more in the modified belt group than in the current belt group. ODI and PG scores decreased in two belt groups after three weeks of follow-up. However, this decrease was greater in the modified belt group, there was no statistically significant difference.
Conclusion:
The disability decreased in both groups using the belts, and their function was improved. Accordingly, the use of a modified belt with lumbar and PG support can significantly reduce back and pelvic pain in pregnant women compared to the current pelvic belt.
... The most frequently observed symptoms are: low back pain, headache, pelvic girdle pain (PGP), leg cramps, breast tenderness, abdominal pain, and ligament pain (Davis, 1996;Jarrell, 2017;Lutterodt et al., 2019). Some symptoms, such as PGP and low back pain, could be physiological consequences of the musculoskeletal adaptations of the maternal body, due to an increasing uterine volume (Davis, 1996;Vermani et al., 2010;Casagrande et al., 2015;Sehmbi et al., 2017;Lutterodt et al., 2019). This could be a potential causing factor of the time-dependent onset of pain symptoms during the pregnancy. ...
Il sistema nervoso autonomico (SNA) gioca un ruolo di rilievo nella regolazione della salute dell'organismo e dei suoi processi di adattamento agli stressor. Tuttavia, spesso viene data poca attenzione ai suoi legami con i sistemi immunitario ed endocrino. Ancor di più, poca attenzione viene data a come l'SNA si sviluppa durante la gestazione e a quali fattori possono interferire con la sua maturazione, nonostante oggi, tramite l'analisi della variabilità della frequenza cardiaca (HRV), è possibile monitorare lo sviluppo dell'SNA persino a livello fetale e prevenire complicazioni potenzialmente letali. Scopo di questo articolo è, pertanto, fornire un quadro della complessità dello sviluppo dell'SNA, con specifici accenni al nervo vago, con particolare attenzione ai fattori ambientali che possono interferire durante lo sviluppo fetale e neonatale, fornendo in conclusione rilevanti spunti per la pratica clinica.
... The results ranged from 0, no disability, to 24, high disability. The patients were divided into four groups depending on the number of points obtained: no disability-0-3 points, low level of disability-4-10 points, medium-11-17 points, high-18-24 points [19,21,[23][24][25]. All questionnaires used in this study had already been translated into Polish, and their reliability and validity had been tested and approved [22,25]. ...
... Many scientific reports have examined the occurrence and treatment of back pain during pregnancy [7,9,18,23,24,[27][28][29][30], but the authors did not find any reports comparing the occurrence of LBP in women who were pregnant with women who were not pregnant. ...
(1) Background: Low Back Pain is a major health concern. Pregnancy-related lower back pain is a common complaint among women. The aim of this study was to determine the influence of pregnancy history on the occurrence and profile of pain in the lower spine. (2) Methods: The diagnosis of Lower Back Pain during pregnancy was based on the authors’ questionnaire, Visual Analogue Scale (VAS), Oswestry Disability Index and Roland Morris Disability Questionnaire. The research group consisted of 1112 women who were students or came for various reasons to the Gynecology and Obstetrics Clinical Hospital of Poznan University of Medical Sciences and completed the questionnaires. Patients were divided into two groups. The first group consisted of women who had never been pregnant (never-pregnant, n = 872 (78.4%), and the second group consisted of women who had been pregnant at least once in their lives (ever-pregnant, n = 240 (21.6%)). (3) Results: In the never-pregnant and the ever-pregnant women, respectively, the intensity of pain was 4.6 ± 1.6 and 5.0 ± 2.0 on the VAS scale, the degree of disability on the Oswestry Disability Index Questionnaire was 5.0 ± 3.9 and 5.5 ± 4.4, while the impact of pain on functioning on the Roland Morris Disability Questionnaire was 3.9 ± 3.1 and 3.9 ± 3.3. There were no significant differences (Mann-Whitney U test) between the studied groups in the parameters tested. (4) Conclusions: Pregnancy is a risk factor for back pain during pregnancy, but one year or more after pregnancy the occurrence of back pain is similar to that in women who have never been pregnant.
... This causes an increase in SIJ load compounded on the overall laxity of other joints and ligaments, which can further promote the risk of pain and injury [11,12]. Axial spine loading can also compress the intervertebral discs resulting in protrusion and associated back pain [13]. To summarize, pelvic instability, ligament relaxation, asymmetry of the SIJ, and weakness in the pelvic floor, abdominal, and hip extensor muscles are all known contributing factors to continued lower back pain in postpartum women [14]. ...
Pregnancy-related pain in the sacroiliac joint (SIJ), lumbosacral region, pubic symphysis, or in any combination of these joints has been coined as pelvic girdle pain (PGP) and has been estimated to affect almost half of all pregnant women. SIJ dysfunction in pregnancy is due to multiple biomechanical mechanisms, such as increased weight, change in posture, increased abdominal and intrauterine pressure, and laxity of the spine and pelvic structures. Moreover, when compared to men, women have increased SIJ mobility due to increased pubic angle and decreased SIJ curvature. These differences may assist in parturition where hormones, such as relaxin and estrogen, cause symphysiolysis. A retrospective review of the literature was conducted in the PubMed database using the search term "pregnancy-related sacroiliac joint pain." All peer-reviewed studies were included. Around 8%-10% of women with PGP continue to have pain for one to two years postpartum. Patients that were treated with SIJ fusion show statistically significant improvement in pain scores when compared to patients that had non-operative treatment. Although we have a number of studies following patients after sacroiliac (SI) joint fusion for pelvic pain with SI joint dysfunction, further research is needed to study sacroiliac fusion for SI joint dysfunction in postpartum women to better tailor and optimize surgical outcomes for this patient population.
... The most frequently observed symptoms are: low back pain, headache, pelvic girdle pain (PGP), leg cramps, breast tenderness, abdominal pain, and ligament pain (Davis, 1996;Jarrell, 2017;Lutterodt et al., 2019). Some symptoms, such as PGP and low back pain, could be physiological consequences of the musculoskeletal adaptations of the maternal body, due to an increasing uterine volume (Davis, 1996;Vermani et al., 2010;Casagrande et al., 2015;Sehmbi et al., 2017;Lutterodt et al., 2019). This could be a potential causing factor of the time-dependent onset of pain symptoms during the pregnancy. ...
The autonomic nervous system (ANS) is one of the main biological systems that regulates the body's physiology. Autonomic nervous system regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. In particular, several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal, and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible “critical windows” that could impact its maturation. These “critical windows” could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors—i.e., fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure—may have an impact on the development of the vagus during the above-mentioned “critical window” and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses. In fact, fHRV is a non-invasive marker whose changes have been associated with ANS development, vagal modulation, systemic and neurological inflammatory reactions, and even fetal distress during labor.
... The most frequently observed symptoms are: low back pain, headache, pelvic girdle pain (PGP), leg cramps, breast tenderness, abdominal pain, and ligament pain (Davis, 1996;Jarrell, 2017;Lutterodt et al., 2019). Some symptoms, such as PGP and low back pain, could be physiological consequences of the musculoskeletal adaptations of the maternal body, due to an increasing uterine volume (Davis, 1996;Vermani et al., 2010;Casagrande et al., 2015;Sehmbi et al., 2017;Lutterodt et al., 2019). This could be a potential causing factor of the timedependent onset of pain symptoms during the pregnancy. ...
The autonomic nervous system (ANS) regulatory capacity begins before birth as the sympathetic and parasympathetic activity contributes significantly to the fetus' development. Several studies have shown how vagus nerve is involved in many vital processes during fetal, perinatal and postnatal life: from the regulation of inflammation through the anti-inflammatory cholinergic pathway, which may affect the functioning of each organ, to the production of hormones involved in bioenergetic metabolism. In addition, the vagus nerve has been recognized as the primary afferent pathway capable of transmitting information to the brain from every organ of the body. Therefore, this hypothesis paper aims to review the development of ANS during fetal and perinatal life, focusing particularly on the vagus nerve, to identify possible "critical windows" that could impact its maturation. These "critical windows" could help clinicians know when to monitor fetuses to effectively assess the developmental status of both ANS and specifically the vagus nerve. In addition, this paper will focus on which factors (i.e. fetal characteristics and behaviors, maternal lifestyle and pathologies, placental health and dysfunction, labor, incubator conditions, and drug exposure) may have an impact on the development of the vagus during the above-mentioned "critical window" and how. This analysis could help clinicians and stakeholders define precise guidelines for improving the management of fetuses and newborns, particularly to reduce the potential adverse environmental impacts on ANS development that may lead to persistent long-term consequences. Since the development of ANS and the vagus influence have been shown to be reflected in cardiac variability, this paper will rely in particular on studies using fetal heart rate variability (fHRV) to monitor the continued growth and health of both animal and human fetuses.
... Localized pain in pregnant women is often and easily confused with postpartum lower back pain, and it is not easy to accurately observe it. 9 Thus, a large prospective study was performed in a single, large tertiary teaching facility; the aim was to determine the incidence of localized pain at the epidural insertion site after the administration of epidural anesthesia and to identify the factors that may predispose patients to it. ...
... In fact, localized pain at the epidural insertion site was the most common postoperative complaint and was noted as a major complication in our study, in accordance with previous data. 9 Severe epidural complications are described in detail in our previous report. 5 Localized pain at the epidural insertion site is often underestimated because it does not cause severe sequelae. ...
Background:
This prospective research aimed to determine the incidence of and risk factors for localized pain at the epidural insertion site following nonobstetric surgery performed with epidural anesthesia.
Methods:
A total of 5083 surgical inpatients at the teaching hospital undergoing epidural anesthesia were included in the study. The characteristics of the patients, preoperative basic diseases, details of the epidural techniques, surgical procedures and complications were recorded pre-anesthesia until the complications resolved. Multivariate logistic regression analysis was performed to identify predictors of localized pain at the epidural insertion site.
Results:
In our analysis, target complications were reported in 532 (10.5%) patients; localized pain at the epidural insertion site occurred in 460 (9.05%) patients, while other major complications occurred in 72 (1.45%) patients. A total of 334 patients had mild pain, and 126 patients had moderate pain. The incidence of localized pain at the epidural insertion site was highest among all complications, and the identified risk factors in the multivariate analysis were as follows: lumbar insertion (odds ratio, 1.77; 95% CI 1.33-2.35), age less than 50 years old (odds ratio, 1.56; 95% CI 1.29-1.89), multiple block attempts (odds ratio, 3.39; 95% CI 2.68-4.31), and postoperative patient-controlled epidural analgesia (odds ratio, 0.46; 95% CI 0.33-0.63).
Conclusion:
Localized pain at the epidural insertion site is the most common complaint after epidural anesthesia and requires adequate clinical attention. Improving the proficiency of anesthesiologists to avoid repeated punctures is the best way to reduce injuries.
... Sehmbi et al. [89] reviewed 56 studies investigating management strategies for LBP in pregnancy. According to this review, three case reports involved ESI to alleviate symptoms of LBP, but all pregnant patients eventually required operative intervention due to recurrence or progression of neurological symptoms. ...
Spine disease is one of the most common musculoskeletal diseases, especially in an aging society. An epidural steroid injection (ESI) is a highly effective treatment that can be used to bridge the gap between physical therapy and surgery. Recently, it has been increasingly used clinically. The purpose of this article is to review the complications of corticosteroids administered epidurally. Common complications include: hypothalamic-pituitary-adrenal (HPA) axis suppression, adrenal insufficiency, iatrogenic Cushing's syndrome, hyperglycemia, osteoporosis, and immunological or infectious diseases. Other less common complications include psychiatric problems and ocular ailments. However, the incidence of complications related to epidural steroids is not high, and most of them are not serious. The use of nonparticulate steroids is recommended to minimize the complications associated with epidural steroids. The appropriate interval and dosage of ESI are disputed. We recommend that the selection of appropriate ESI protocol should be based on the suppression of HPA axis, which reflects the systemic absorption of the corticosteroid.
