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Labor Epidurals and Long Term Back Pain

(Originally posted 20 February 2001 on About Anesthesiology)

INTRODUCTION
The question often arises as to whether epidurals cause long-term back pain in patients. This is an issue that is especially troublesome in labor analgesia, where patients are often young and problems with back pain are unexpected. Anesthesiologists are quick to point out that many other factors contribute to back pain. What is the truth about this topic?

GENERAL COMMENTS
First of all, patients need to realize that an epidural does involve the insertion of a fairly sizable needle into the body. Anytime the body is injured in such a way, whether intentional (as with an epidural) or unintentional (as with an accidental injury), there is a local tissue reaction to that insult. Therefore, it would not be unusual for the area that the epidural is done in to be sore, swollen, etc. for a few days after the surgery.

Another issue to remember is that if a patient already has problems with chronic low back pain, an epidural is not going to make this better or worse. Many times, patients with pre-existing back conditions have a worsening of their symptoms "around" the time of their epidural - however, this may just reflect the normal cycle of symptoms.

THE REAL QUESTION
The real question is not the soreness associated with a needle stick that lasts a few days or in the patient that already has back problems. The real question is whether epidurals increase the risk of long-term back problems. It is important to draw this distinction in order to talk about the issue clearly and precisely.

RECENT STUDY RESULTS
A study released on February 6, 2001 in the British Journal of Obstetrics and Gynaecology found no evidence that the use of epidurals increased the incidence of backache in the first three months or in the first year.

Utilizing two groups of patients, one of which received epidurals for their labor pain and the other which received pain relief in another form, the researchers compared the amount of backache at three months and then at twelve months. Interestingly, while the rate of back pain was high (about 20% at three months and about 35% at twelve months), there was no difference between the two groups.

This study lends more weight to the statement that backache is multifactorial. The high incidence of back pain in these patients suggests that back pain is real - but that it is due to other factors associated with pregnancy. In addition, it suggests that epidurals play no detectable role in the development of back pain.

SUMMARY
These conclusions are important, as many patients wonder if the back pain they experience was somehow caused by a mistake in placing their epidural, or even from a normal epidural. While it is not unheard of to have complications associated with any anesthetic technique, including an epidural, it does not seem that backache is a common problem related to epidural anesthesia.

 

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