Pregnancy - Copyright - Stock Photo / Register Mark

For your health
June 2021 (Volume 15, Issue 06)

Posted by Ronald Feise, DC

The prevalence of pregnancy-related low back pain and disability is significant. According to a literature review, the mean prevalence of pregnancy-related low back pain is about half of all pregnancies.1-2 Most women report that low back pain has returned to pre-pregnancy levels within six months of delivery, but some continue to have chronic back pain. Research reports a postpartum prevalence of 37 percent after one year and 18 percent after six years

There are four types of pregnancy-related low back pain: pelvic posterior pain, lumbar pain, mixed pain, and radiculopathy. Of these, posterior pelvic pain is unique in that it is only associated with pregnancy and accounts for about a third of all pregnancy-related low back pain

There are two main approaches to treating chronic pelvic pain – pharmacological or non-pharmacological. Let’s take a look at the effectiveness and safety of each approach.

The pharmacological approach

Horne et al. conducted a randomized, double-blind, placebo-controlled study to measure the efficacy and safety of gabapentin in women with chronic pelvic pain.5 More than 300 participants were randomized to receive gabapentin or a placebo for 16 weeks.

Gabapentin treatment compared to placebo did not result in lower pain scores in women with chronic pelvic pain and was associated with higher side effects than placebo.

Although acetaminophen and NSAIDs offer modest pain relief, they have a poor safety profile. Maternal use of paracetamol during pregnancy is associated with a higher risk of attention deficit disorder and autism spectrum disorder in children.6 In addition, two meta-analyzes found an association between use of paracetamol during pregnancy and asthma in children.7-8

Increased risks of miscarriages and malformations are associated with the use of NSAIDs in early pregnancy.9 Exposure to NSAIDs after the 30th week of pregnancy is associated with an increased risk of premature occlusion of the fetal duct.10 Li et al conception was associated with a increased risk of miscarriage associated with dose-response relationship.11

The non-pharmacological approach

An effective non-pharmacological approach to pelvic pain involves a customized treatment program consisting of: 1) appropriate patient education and reassurance, 2) individual exercises, and 3) spinal manipulation.

Exercises: An individual exercise program with stabilizing exercises and aerobic exercises is part of an effective treatment strategy for pregnant women with back or pelvic pain. In a randomized, controlled study, the researchers found that stabilizing exercise had a significantly better statistical and clinical effect on pain, functional status and health-related quality of life than controls, as measured after 20 weeks of intervention and one year after birth A Cochrane system review confirmed these results. 13

Aerobic exercise contributes to the overall treatment plan for patients with spinal pain as it is associated with improvements in mood and general wellbeing, strengthening of the supportive spinal muscles, improving neuromotor control and coordination, and increasing disc nutrition. Therefore, current research supports an exercise program made up of strengthening exercises and aerobic exercise.

Spinal manipulation: Researchers have found that spinal manipulation can provide safe and effective relief from back and pelvic pain in pregnant women. A randomized clinical trial evaluated the effects of a multimodal chiropractic approach (including stabilization exercises) versus standard obstetric care.14 The research team consisted of doctors and chiropractors, and the results were published in the American Journal of Obstetrics & Gynecology.

The “effect size” is a measure of the treatment benefit. The larger the effect size, the better the result. The chiropractic approach showed a clinically meaningful reduction in pain compared to standard obstetric care.

In addition, several systematic reviews support the conclusion that chiropractic treatment is a safe and effective intervention for reducing pain intensity and frequency in pregnant women with back and pelvic pain

Science supports conservative care

Chiropractic is the first non-pharmacological choice for patients with chronic pelvic pain. As a patient, you can use this study to help convey the safety and effectiveness of chiropractic to your doctor / gynecologist and health insurance company. And of course, if you’re pregnant and have pelvic or other pain, make an appointment with your chiropractic doctor.


  1. Ansari NN. Low back pain during pregnancy in Iranian women: prevalence and risk factors. Physiother Theory Pract, 2010; 26: 40-8.
  2. Mogren IM, Pohjanen AI. Lower back and pelvic pain during pregnancy: prevalence and risk factors. Spine, 2005; 30: 983-91.
  3. Stapleton DB, et al. The prevalence of remembered low back pain during and after pregnancy: a South Australian population survey. Aust NZJ Obstet Gynaecol, 2002; 42: 482-5.
  4. MacEvilly M, Buggy D. Back Pain and Pregnancy: A Review. Pain, 1996; 64: 405-14.
  5. Horne A. et al. Gabapentin for chronic pelvic pain in women (GaPP2): a multicenter, randomized, double-blind, placebo-controlled study. Lancet, 2020; 396: 909-917.
  6. JiY, et al. Association of umbilical cord plasma biomarkers for paracetamol exposure in utero with the risk of attention deficit / hyperactivity disorder and autism spectrum disorder in childhood. JAMA Psychiatry, 2019 Oct 30: 1-11.
  7. Eyers S. et al. Paracetamol in pregnancy and the risk of wheezing in offspring: a systematic review and meta-analysis. Clin Exp Allergy, 2011; 41: 482-9.
  8. Etminan M. et al. Paracetamol use and the risk of asthma in children and adults: a systematic review and meta-analysis. Breast, 2009; 136: 1316-23.
  9. Edwards DR. Et al. Periconceptional exposure of over-the-counter nonsteroidal anti-inflammatory drugs and risk of spontaneous abortion. Obstet Gynecol, 2012; 120: 113-22.
  10. MusuM, et al. Acute nephrotoxicity of NSAIDs from the fetus to the adult. Eur Rev Med Pharmacol Sci, 2011; 15: 1461-72.
  11. Li DK et al. Use of NSAIDs during pregnancy and the risk of miscarriage. Am J Obstet Gynecol, 2018; 219: 275.e1-275.
  12. Stuge B, et al. The effectiveness of a treatment program that focuses on specific stabilization exercises for pelvic girdle pain after pregnancy. A Randomized Controlled Study. Spine, 2004; 29: 351-359.
  13. Pennick VE, Young G. Interventions for the Prevention and Treatment of Pelvic and Back Pain During Pregnancy. Cochrane Database Syst Rev, 2007; (2): CD001139
  14. George JW et al. A randomized controlled trial comparing multimodal intervention and standard obstetric treatment for lower back and pelvic pain during pregnancy. Am J Obstet Gynecol, 2013; 208: 295.e1-7.
  15. Khorsan R, et al. Manipulation therapy for pregnancy and related diseases: a systematic review. Obstet Gynecol Surv, 2009; 64: 416-27.
  16. Stuber KJ, Smith DL. Chiropractic treatment for pregnancy-related low back pain: a systematic review of the evidence. J Manipulative Physiol Ther, 2008; 31: 447-54.

Dr. Ron Feise attended the University of New Mexico for his pre-employment training and is a graduate of Palmer Chiropractic College. He also earned certification from the National Acupuncture Committee. He was the owner and clinic director of five chiropractic clinics in Arizona and is currently the president of the Institute of Evidence-Based Chiropractic and RJF Consulting.