Research Review: Chiropractic for pregnancy-related back pain

Study title: Outcomes of pregnant patients with low back pain undergoing chiropractic treatment

Low back and pelvic pain are so common during pregnancy they are often considered normal. However, the high prevalence, effects on quality of life and common link to general back pain post-pregnancy, make these conditions a concern.  

The current study aimed to further knowledge in this area by: reporting outcomes for pregnant patients receiving chiropractic treatment for low back and pelvic pain at various time points up to one year after baseline; comparing outcomes by subgroup; and investigating demographic factors as predictors of outcomes.

Pertinent results
Baseline and one year data were available on 115 patients, treated by 15 chiropractors. The average patient age was 33 and the average gestation week was 26.2 at baseline, with a slight majority of patients in their third trimester. Fifty-three patients had at least one previous pregnancy, and 58 per cent of those reported back pain during a previous pregnancy.

At one week, more than half of the patients reported clinically relevant improvement. At all other data collection points, the vast majority of patients were improved, with statistically significant reductions seen in the NRS (numeric rating scale) and Oswestry scores. Patients reporting LBP in previous pregnancies showed significantly lower NRS scores at baseline, but no significant differences were revealed between this subgroup and all other patients’ NRS scores at any follow-up point. No significant link was found between the category of location of LBP (LBP only, PPP only or both) and improvement at any of the follow-up points. Patients who had more previous episodes of LBP showed less improvement, with significantly higher NRS scores at one year. More specifically, patients who reported a high number (5+) previous episodes of LBP were less likely to report clinically significant improvements, particularly at the one week and one year points, but not at the one, three and six month points. Patients with LBP during a previous pregnancy did not show worse outcomes than those without LBP in previous pregnancies.    

At one year, 85.2 per cent of patients were “happy” or “very happy” with their chiropractic care and only six per cent were “unhappy.” A final important note is that no serious adverse events were reported.

Methods
A prospective, cohort, outcomes study was performed on pregnant patients over the age of 18, suffering from low back pain, pelvic pain or both of any duration who have had no chiropractic or manual therapy in the three months prior to the baseline data collection.

Patients with Paget’s disease, osteoporosis or specific pathologies of the lumbar spine that made chiropractic care contraindicated were excluded. Chiropractic care delivery was not standardized, with the techniques utilized and frequency of care left to the discretion of the treating clinician.     

Trained research assistants who were unknown to both the patients and clinicians conducted the telephone interviews to help avoid bias or unintentional influence over patient answers. Patients selecting the option “slightly better” on the patient’s global impression of change (PGIC) scale were classified as unchanged for the purposes of the study.   

Due to the use of a cohort study rather than a randomized control trial (RCT) the outcomes cannot be attributed to chiropractic treatment. However, strong similarities between these results and those from a recently published RCT support the validity of the results.

Patients in this study were treated at multiple practice sites by a variety of chiropractors and no details were provided with regards to the type of treatments and the treatment dosage provided.

Conclusions, applications
This study suggests a large proportion of pregnant patients with LBP or pelvic pain will report clinically relevant improvement in symptoms with chiropractic care at all time points up to one year (after delivery). This, combined with the lack of serious adverse effects from treatment, suggests that chiropractic care is an effective and safe treatment for pregnant patients with LBP and pelvic pain. It is important to note that a history of multiple episodes of LBP may lead to less significant changes at the one year time point. This frequency of episodes may reflect a more persistent form of LBP for an individual patient (a return to their episodic LBP, rather than pregnancy-related LBP).

Dr. SHAWN THISTLE owns and operates Research Review Service Inc., helping clinicians integrate scientific evidence into practice through subscription-based service (researchreviewservice.com), online courses (onlinecourses.researchreviewservice.com) and seminars (epicureanscholar.com).