Anecdotal reports and small studies have linked the use of epidural analgesia during childbirth to long-term backache with restriction of movement and disability. Howell and colleagues conducted a large study in an English region to investigate the alleged link.
The authors used data from a randomized controlled trial of epidural analgesia during labor involving 369 primigravidas with cephalic presentation at term. These women were randomly assigned to epidural or other methods of pain relief during delivery. From this original study, 151 women treated with epidural and 155 women from the control group agreed to take part in the follow-up study. On average, the women were contacted 26 months after giving birth and questioned about back pain using a validated questionnaire. The study participants also were assessed by a physical therapist for objective signs of limitation of movement and functional disability.
The two groups of women were comparable in all important respects. Back pain was quite common in both groups one year after childbirth, but the vast majority of women reporting back pain had experienced the same pain before delivery. Women in the epidural group were more likely to report severe pain, but persistent and recent pain were more common among women in the control group. None of the differences between the groups was statistically significant. Similarly, no significant differences could be detected in measures of mobility or functional disability.
The authors conclude that back pain is quite common after childbirth and even two years later, but epidural analgesia does not appear to influence the incidence of pain or functional disability.
editor's note: The astonishing statistic buried in this study is that two thirds of young mothers report back pain and that, for about 50 percent of these mothers, the pain is reported to be moderate or very severe. In one half of these women, back pain began before pregnancy. As physicians, we are conditioned by the “acute back strain” to conceptualize back pain as an acute event, and the general approach is to rule out a sinister cause of pain and then control symptoms while awaiting spontaneous resolution. Perhaps this expectant approach is flawed or only appropriate to the subset of patients with acute pain who consult physicians. Should we ask all young adults about back pain? What interventions would we suggest for those who reveal significant, chronic back pain of several years' duration?—a.d.w.