title: Intrapartum analgesia and its association with post-partum back pain and headache in nulliparous women.
abstract: BACKGROUND
  The effect of intrapartum analgesia on post-partum maternal back and neck pain, headache and migraine, is uncertain.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  This analysis supports previous research suggesting that epidural analgesia is not a significant risk factor for persisting post-partum back pain, headache or migraine.
authors.affiliation: Staff Specialist Anaesthetist, Royal Hobart Hospital, Perth, Western Australia, Australia.
authors.forename: Christopher E P
authors.initials: CE
authors.lastname: Orlikowski
authors.forename: Jan E
authors.initials: JE
authors.lastname: Dickinson
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Paech
authors.forename: Susan J
authors.initials: SJ
authors.lastname: McDonald
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Nathan
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000009:adverse effects*; D005260:Female; D006801:Humans; D048949:Labor Pain / Q000628:therapy*; D008880:Midwifery / Q000379:methods*; D008881:Migraine Disorders / Q000209:etiology*; D010146:Pain / Q000209:etiology*; D010298:Parity; D011247:Pregnancy; D011644:Puerperal Disorders / Q000209:etiology*; D011795:Surveys and Questionnaires