An updated systematic review of interventions for preventing and treating pelvic and back pain in pregnancy

SD Liddle, VE Pennick

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Introduction: Over two-thirds of pregnant women experience low-back pain (LBP); approximately one-fifth experience pelvic pain. For many, the pain is severe enough to interfere with work, daily activities and sleep.
Purpose / Aim: To update the 2007 Cochrane Review assessing the effects of interventions for preventing and treating pelvic and back pain in pregnancy.
Materials and Methods: The Cochrane Pregnancy and Childbirth and Back Review Groups’ Trials Registers were searched to July 2012; reference lists from relevant articles were screened. Randomised controlled trials (RCTs) of interventions to prevent or reduce the severity of LBP, pelvic pain or both in pregnancy were independently selected and assessed for risk of bias. The main outcomes of interest were pain and function.
Results: Twenty-six RCTs examining 4103 pregnant women were included. Eleven trials examined LBP (N=1322), four investigated pelvic pain (N=661) and 11 trials included women with combined lumbo-pelvic pain (N=2120). There was moderate quality evidence that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain significantly more than usual care; acupuncture was significantly more effective at reducing evening pelvic pain than stabilising exercises. There was low quality evidence that the reduction in evening pelvic pain was not significantly different after receiving either superficial or deep acupuncture. Low quality evidence suggested that LBP and physical function were similar when wearing pelvic support belts or receiving osteopathic manipulation (OMT). For lumbo-pelvic pain there was low quality evidence suggesting that OMT significantly improved pain and function; acupuncture improved these outcomes more than usual care or physiotherapy, particularly if started at 26- rather than 20-weeks’ gestation. There were conflicting results for prevention of pelvic or back pain. Adverse events, when reported, were minor and transient.
Relevance: Many women appeared to experience some pain relief when they received more than usual prenatal care, and would consider some of the interventions in subsequent pregnancies.
Conclusions: Acupuncture or exercise, appropriately tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain more than usual care alone; acupuncture reduced evening pelvic pain significantly more than stabilising exercises. There was no significant difference in pain or function for different acupuncture techniques or other interventions studied. No recommendation can be made for the prevention of these conditions.
Discussion: The quality of evidence for the prevention and treatment of pelvic and back pain in pregnancy has not improved appreciably since the last review in 2007, despite the addition of 19 new trials; no outcomes were supported by high quality and very few by moderate quality evidence. Clinical heterogeneity of population, interventions, comparisons and outcome measures precluded meta-analyses. Implications: Future research would benefit from an agreed classification system for pelvic and back pain in pregnancy along with the use of standardised clinical outcome measures. This is likely to have an important impact on our confidence in the estimates of effect and to change the estimates.
LanguageEnglish
Title of host publicationUnknown Host Publication
Number of pages1
Publication statusPublished - 28 Oct 2013
Event8th Interdisciplinary World Congress on Low Back and Pelvic Pain - Dubai, United Arab Emirates
Duration: 28 Oct 2013 → …

Conference

Conference8th Interdisciplinary World Congress on Low Back and Pelvic Pain
Period28/10/13 → …

Fingerprint

Pelvic Pain
Back Pain
Pregnancy
Acupuncture
Low Back Pain
Pain
Osteopathic Manipulation
Exercise
Pregnant Women
Randomized Controlled Trials
Outcome Assessment (Health Care)
Prenatal Care
Population Characteristics
Meta-Analysis

Keywords

  • Low-back pain
  • pelvic pain
  • pregnancy
  • exercise and therapeutic interventions

Cite this

@inproceedings{94dc40a49abd4addb4206fa2aa093b61,
title = "An updated systematic review of interventions for preventing and treating pelvic and back pain in pregnancy",
abstract = "Introduction: Over two-thirds of pregnant women experience low-back pain (LBP); approximately one-fifth experience pelvic pain. For many, the pain is severe enough to interfere with work, daily activities and sleep. Purpose / Aim: To update the 2007 Cochrane Review assessing the effects of interventions for preventing and treating pelvic and back pain in pregnancy.Materials and Methods: The Cochrane Pregnancy and Childbirth and Back Review Groups’ Trials Registers were searched to July 2012; reference lists from relevant articles were screened. Randomised controlled trials (RCTs) of interventions to prevent or reduce the severity of LBP, pelvic pain or both in pregnancy were independently selected and assessed for risk of bias. The main outcomes of interest were pain and function. Results: Twenty-six RCTs examining 4103 pregnant women were included. Eleven trials examined LBP (N=1322), four investigated pelvic pain (N=661) and 11 trials included women with combined lumbo-pelvic pain (N=2120). There was moderate quality evidence that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain significantly more than usual care; acupuncture was significantly more effective at reducing evening pelvic pain than stabilising exercises. There was low quality evidence that the reduction in evening pelvic pain was not significantly different after receiving either superficial or deep acupuncture. Low quality evidence suggested that LBP and physical function were similar when wearing pelvic support belts or receiving osteopathic manipulation (OMT). For lumbo-pelvic pain there was low quality evidence suggesting that OMT significantly improved pain and function; acupuncture improved these outcomes more than usual care or physiotherapy, particularly if started at 26- rather than 20-weeks’ gestation. There were conflicting results for prevention of pelvic or back pain. Adverse events, when reported, were minor and transient.Relevance: Many women appeared to experience some pain relief when they received more than usual prenatal care, and would consider some of the interventions in subsequent pregnancies.Conclusions: Acupuncture or exercise, appropriately tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain more than usual care alone; acupuncture reduced evening pelvic pain significantly more than stabilising exercises. There was no significant difference in pain or function for different acupuncture techniques or other interventions studied. No recommendation can be made for the prevention of these conditions. Discussion: The quality of evidence for the prevention and treatment of pelvic and back pain in pregnancy has not improved appreciably since the last review in 2007, despite the addition of 19 new trials; no outcomes were supported by high quality and very few by moderate quality evidence. Clinical heterogeneity of population, interventions, comparisons and outcome measures precluded meta-analyses. Implications: Future research would benefit from an agreed classification system for pelvic and back pain in pregnancy along with the use of standardised clinical outcome measures. This is likely to have an important impact on our confidence in the estimates of effect and to change the estimates.",
keywords = "Low-back pain, pelvic pain, pregnancy, exercise and therapeutic interventions",
author = "SD Liddle and VE Pennick",
year = "2013",
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booktitle = "Unknown Host Publication",

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Liddle, SD & Pennick, VE 2013, An updated systematic review of interventions for preventing and treating pelvic and back pain in pregnancy. in Unknown Host Publication. 8th Interdisciplinary World Congress on Low Back and Pelvic Pain, 28/10/13.

An updated systematic review of interventions for preventing and treating pelvic and back pain in pregnancy. / Liddle, SD; Pennick, VE.

Unknown Host Publication. 2013.

Research output: Chapter in Book/Report/Conference proceedingConference contribution

TY - GEN

T1 - An updated systematic review of interventions for preventing and treating pelvic and back pain in pregnancy

AU - Liddle, SD

AU - Pennick, VE

PY - 2013/10/28

Y1 - 2013/10/28

N2 - Introduction: Over two-thirds of pregnant women experience low-back pain (LBP); approximately one-fifth experience pelvic pain. For many, the pain is severe enough to interfere with work, daily activities and sleep. Purpose / Aim: To update the 2007 Cochrane Review assessing the effects of interventions for preventing and treating pelvic and back pain in pregnancy.Materials and Methods: The Cochrane Pregnancy and Childbirth and Back Review Groups’ Trials Registers were searched to July 2012; reference lists from relevant articles were screened. Randomised controlled trials (RCTs) of interventions to prevent or reduce the severity of LBP, pelvic pain or both in pregnancy were independently selected and assessed for risk of bias. The main outcomes of interest were pain and function. Results: Twenty-six RCTs examining 4103 pregnant women were included. Eleven trials examined LBP (N=1322), four investigated pelvic pain (N=661) and 11 trials included women with combined lumbo-pelvic pain (N=2120). There was moderate quality evidence that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain significantly more than usual care; acupuncture was significantly more effective at reducing evening pelvic pain than stabilising exercises. There was low quality evidence that the reduction in evening pelvic pain was not significantly different after receiving either superficial or deep acupuncture. Low quality evidence suggested that LBP and physical function were similar when wearing pelvic support belts or receiving osteopathic manipulation (OMT). For lumbo-pelvic pain there was low quality evidence suggesting that OMT significantly improved pain and function; acupuncture improved these outcomes more than usual care or physiotherapy, particularly if started at 26- rather than 20-weeks’ gestation. There were conflicting results for prevention of pelvic or back pain. Adverse events, when reported, were minor and transient.Relevance: Many women appeared to experience some pain relief when they received more than usual prenatal care, and would consider some of the interventions in subsequent pregnancies.Conclusions: Acupuncture or exercise, appropriately tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain more than usual care alone; acupuncture reduced evening pelvic pain significantly more than stabilising exercises. There was no significant difference in pain or function for different acupuncture techniques or other interventions studied. No recommendation can be made for the prevention of these conditions. Discussion: The quality of evidence for the prevention and treatment of pelvic and back pain in pregnancy has not improved appreciably since the last review in 2007, despite the addition of 19 new trials; no outcomes were supported by high quality and very few by moderate quality evidence. Clinical heterogeneity of population, interventions, comparisons and outcome measures precluded meta-analyses. Implications: Future research would benefit from an agreed classification system for pelvic and back pain in pregnancy along with the use of standardised clinical outcome measures. This is likely to have an important impact on our confidence in the estimates of effect and to change the estimates.

AB - Introduction: Over two-thirds of pregnant women experience low-back pain (LBP); approximately one-fifth experience pelvic pain. For many, the pain is severe enough to interfere with work, daily activities and sleep. Purpose / Aim: To update the 2007 Cochrane Review assessing the effects of interventions for preventing and treating pelvic and back pain in pregnancy.Materials and Methods: The Cochrane Pregnancy and Childbirth and Back Review Groups’ Trials Registers were searched to July 2012; reference lists from relevant articles were screened. Randomised controlled trials (RCTs) of interventions to prevent or reduce the severity of LBP, pelvic pain or both in pregnancy were independently selected and assessed for risk of bias. The main outcomes of interest were pain and function. Results: Twenty-six RCTs examining 4103 pregnant women were included. Eleven trials examined LBP (N=1322), four investigated pelvic pain (N=661) and 11 trials included women with combined lumbo-pelvic pain (N=2120). There was moderate quality evidence that acupuncture or exercise, tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain significantly more than usual care; acupuncture was significantly more effective at reducing evening pelvic pain than stabilising exercises. There was low quality evidence that the reduction in evening pelvic pain was not significantly different after receiving either superficial or deep acupuncture. Low quality evidence suggested that LBP and physical function were similar when wearing pelvic support belts or receiving osteopathic manipulation (OMT). For lumbo-pelvic pain there was low quality evidence suggesting that OMT significantly improved pain and function; acupuncture improved these outcomes more than usual care or physiotherapy, particularly if started at 26- rather than 20-weeks’ gestation. There were conflicting results for prevention of pelvic or back pain. Adverse events, when reported, were minor and transient.Relevance: Many women appeared to experience some pain relief when they received more than usual prenatal care, and would consider some of the interventions in subsequent pregnancies.Conclusions: Acupuncture or exercise, appropriately tailored to the stage of pregnancy, significantly reduced lumbo-pelvic, back or evening pelvic pain more than usual care alone; acupuncture reduced evening pelvic pain significantly more than stabilising exercises. There was no significant difference in pain or function for different acupuncture techniques or other interventions studied. No recommendation can be made for the prevention of these conditions. Discussion: The quality of evidence for the prevention and treatment of pelvic and back pain in pregnancy has not improved appreciably since the last review in 2007, despite the addition of 19 new trials; no outcomes were supported by high quality and very few by moderate quality evidence. Clinical heterogeneity of population, interventions, comparisons and outcome measures precluded meta-analyses. Implications: Future research would benefit from an agreed classification system for pelvic and back pain in pregnancy along with the use of standardised clinical outcome measures. This is likely to have an important impact on our confidence in the estimates of effect and to change the estimates.

KW - Low-back pain

KW - pelvic pain

KW - pregnancy

KW - exercise and therapeutic interventions

M3 - Conference contribution

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