Multimodal approach relieves obstetric back and pelvic pain

By Lucy Piper, Senior medwireNews Reporter

Pregnant women with low-back pain (LBP) and pelvic pain (PP) could benefit from a multimodal approach of musculoskeletal and obstetric management, say researchers.

They found that this multimodal intervention, which included manual therapy, exercise, and education was superior to standard obstetric care for reducing pain, impairment, and disability in the antepartum period.

"We cannot state which of the 3 components of the multimodal approach was most influential in the outcome that was observed because there is support for each component," James George, from Logan University in Chesterfield, Missouri, USA, and team acknowledge.

The team randomly assigned 169 women, aged 15-45 years, with LBP or PP to receive the multimodal intervention or standard obstetric care at 24-28 weeks of gestation. Chiropractic specialists provided the manual therapy, stabilization exercises, and patient education elements of the extended musculoskeletal management.

The women's progress was then monitored and re-assessed at 33 weeks' gestation.

The results, published in the American Journal of Obstetrics and Gynecology, showed that women receiving the multimodal intervention had a significant reduction in pain scores on the Numerical Rating Scale, from an average 5.8 to 2.9.

They also experienced a significant reduction in scores on the Quebec Disability Questionnaire, from an average 4.9 to 3.9.

By contrast, women receiving standard obstetric care experienced no significant improvement in these measures.

The multimodal intervention also resulted in significant reductions in pain during left straight leg raises, active straight leg raises, the long dorsal ligament test, and for personal pain history for the leg and shoulders.

However, only one pain measurement - personal pain history for the leg - improved in the women receiving standard obstetric care.

With differences between the two groups significant in favor of the multimodal intervention for the majority of pain measures, the researchers conclude that such an approach to musculoskeletal LBP/PP that is "instituted in the late second and early third trimesters of pregnancy benefits patients above and beyond standard obstetrics provider care."

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