Background & Aims
Pain control of Pregnant woman with severe LBP.
Low Back Pain is a prevalent condition,
impacting an estimated 50% of pregnant women.
Despite its ubiquity, it is often dismissed as a
standard aspect of pregnancy. LBP can escalate to
obstetric complications and an increased rate of
cesarean sections1-3.
The etiology of LBP during pregnancy includes the
mechanical strain exerted by the expanding gravid
uterus, the subsequent adjustment in lumbar
lordosis, augmented weight, and ligamentous laxity3.
A study found that 56% of the participating pregnant
women experienced LBP. However, only 32% of
these women reported their symptoms to their
prenatal care providers. Of these, 75% indicated that
their care providers did not suggest therapeutic
interventions to alleviate their symptoms1.
For LBP that proves resistant to
conservative management, interventional options
may be explored, particularly in instances
presenting with signs of radiculopathy
Methods
We communicate a case treated with an interventional procedure to alleviate the low back pain with a Neuropathic component of pain in a pregnant woman.
Age: 36 years
Gestational Age: Third Trimester
Pregnancy: First
First algologist appointment: 08/28/2023
Trauma history: Six month ago with no apparent
immediate injuries.
Results
Intervention (08/28/2023): Dexamethasone 8mg + NaCl 0.9%
8cc was applied via epidural hiatus with ultrasound, with a remarkable improvement in pain(95%)
In addition, 5cc of 1% lidocaine was applied to the right
facet of L4/L5. The patient leaves with a 99% improvement
Follow-up (08/30/2023): The pain was minimal on the day of the intervention, but the following night
it became severe. At the time of consultation, the pain presented with a VAS of 8
Intervention (09/01/2023): An epidural neuroplasty was performed by hiatus with ultrasonography, applying air that caused discomfort up to the upper lumbar area. 12cc of 5% dextrose was injected, then ozone, and finally 6cc of PRP. PRP was also used to the right facets of L3, L4, and L5, which generated pain radiating to the RPL
Telephone follow-up (12/29/2023): The patient has her
vaginal delivery without complications: “Hello doctor, no, it didn’t hurt anymore, I just had my baby on the 26th and everything is fine.
Conclusions
Low back pain in pregnancy is a highly prevalent condition
that has received little interest from the point of view of
scientific research. Although there are multiple practical
approaches for mild cases, a percentage will not disappear
and will have a neuropathic component. It is essential to look
at ultrasound-guided interventional methods to relieve pain at
such a delicate stage as pregnancy.
References
1.
Telephone follow-up (12/29/2023): The patient has her
vaginal delivery without complications: “Hello doctor, no, it
didn’t hurt anymore, I just had my baby on the 26th, and
everything is fine thanks to God and you because the pain has
not returned.”
CONCLUSION
Low back pain in pregnancy is a highly prevalent condition
that has received little interest from the point of view of
scientific research. Although there are multiple practical
approaches for mild cases, a percentage will not disappear
and will have a neuropathic component. It is essential to look
at ultrasound-guided interventional methods to relieve pain at
such a delicate stage as pregnancy.
Wang SM, Dezinno P, Maranets I, Berman MR, Caldwell-Andrews AA, Kain ZN. Low back pain during pregnancy: Prevalence, risk factors, and outcomes. Obstetrics and Gynecology. 2004;104(1):65-70.
doi:10.1097/01.AOG.0000129403.54061.0e
2.
Sehmbi H, D’Souza R, Bhatia A. Low Back Pain in Pregnancy: Investigations, Management, and Role of Neuraxial Analgesia and Anaesthesia: A Systematic Review. Gynecol Obstet Invest.
2017;82(5):417-436. doi:10.1159/000471764
3. Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain Management in Pregnancy: Multimodal
Approaches. Pain Res Treat. 2015;2015. doi:10.1155/2015/987483
4. ERDO?AN A, KOÇY???T BF, OKYAY RA. An Important but Overlooked Public Health Problem:
Pregnancy-Related Low Back Pain. Sakarya Medical Journal. Published online May 26, 2021.
doi:10.31832/
smj.898585
Presenting Author
Cesar Amescua-Garcia
Poster Authors
Cesar Amescua
Medical Doctor/Pain Specialist
Hospital Angeles
Lead Author
Topics
- Specific Pain Conditions/Pain in Specific Populations: Obstetric and Labor Pain