Backaches related to pregnancy: the risk factors, etiologies, treatments and controversial issues.
OBJECTIVE
There is no clear documentation in either the anesthetic/pain or obstetric literatures regarding the management of backache related to pregnancy. Backache can occur during pregnancy, in labor, and postpartum; different stages should be managed differently. The purpose of this review is to discuss the different types of backache, to provide an overview of diagnosis and treatment options, and to address several controversial issues related to pregnancy-related backaches.


RESULTS
Gestational backache is a substantial problem and can have a significant impact on a pregnant woman's daily activities. Non-pharmacological/complementary treatments such as posture adjustment, acupuncture, physical therapy, physiotherapy, yoga, and chiropractic may become the first line of treatment options. In labor backache the posture of the parturient can have an effect in decreasing the intensity of pain. Allopathic medicine, regional techniques (epidural), and complementary interventions are routinely given to parturients. However, there is a major perception of differences among midwives, obstetricians and anesthesiologists in terms of the risks and benefits of labor epidural analgesia. Postpartum backache is usually self-limited, but for some mothers the pain can last from a few months to several years. Early literature suggested that this problem was associated with the use of epidurals, but recent data in the literature deny such an association.


CONCLUSIONS
Overall, backache related to pregnancy is a significant problem. Education is still the first line of intervention for preventing backaches related to pregnancy. Both allopathic and complementary medicines are frequently used as treatments for backache related to pregnancy.
Wang
Shu-Ming
SM
Department of Anesthesiology, Yale University School of Medicine, New Haven, Connecticut 06520, USA. shu-ming.wang@yale.edu