Lfficacy of back care progran in chronic back pain during pregnancy

Ebrahim Ghaiem Hasankhani

[Abstract¸ Objective 1o cvaluaic ihc cfficacy of hack carc pro,ram in prcvcniin, or rcducin, hack pain durin,
prc,nancy in womcn wiih chronic hack pain.Methods 56 paiicni- wiih chronic hack pain wcrc includcd in ihi-
-iudy¸of whom 16 wcrc -ccn hcforc¸14 in carly pcriod(fir-i monih}¸and 26 in laic pcriod(aficr 4ih monih}of prc,-
nancy.1hc -iudy wa- donc hciwccn Ichruary 1999 and Harch 2006.ihc mcan a,c wa- 22 ycar-(18 ~32 ycar-}.all
of ihc paiicni- wcrc in-irucicd ihc ,cncral hack carc pro,ram ai ihc fir-i vi-ii.Results 1hc paiholo,y of hack pain
in ihc-c paiicni- wa- a- follow-¸-pondyloli-ihc-i-¸dcformiiy of ihc -pinc¸di-c hcrnia¸malformaiion of ihc -pinc¸and
unknown paiholo,y.1hc paiicni- who wcrc -ccn hcforc or in carly pcriod(fir-i monih}of prc,nancy(30 paiicni-}
(,roup A}and cncoura,cd io hc,in a hack carc pro,ram had cxccllcni-,ood rc-uli-(13 ~20 poini PBULU -calc}.
1hc paiicni- who wcrc -ccn in laic pcriod(aficr 4ih monih}of prc,nancy(26 paiicni-}(,roup B}had fair-poor rc-
-uli-(4 ~12 poini PBULU -calc}¸hui aficr hc,innin, of hack carc pro,ram¸ihcy had ahoui 4 ~8 poini- rccovcry.
Conclusion A hack carc pro,ram i- a -oluiion in prcvcniin, or rcducin, chronic hack pain wiih variou- paiholo,y
in prc,nancy.
[Key words¸ chronic hack pain,prc,nancy,hack carc pro,ram
INTRODUCTION
1hc majoriiy of -iudic- havc rcporicd a hi,h incidcncc
of hack pain durin, prc,nancy
[1¸2¸
.Ahoui 50% of
womcn will cxpcricncc hack pain durin, a prc,nancy
and for ahoui 30% of ihcm¸ihc pain will hc -cvcrc
cnou,h io impcdc ihcir daily livc-
[3 ~5¸
.
Back pain may hc,in carly¸hui for mo-i womcn ii
will hc,in hciwccn ihc fifih and -cvcnih monih of prc,-
nancy
[3 ~7¸
.Iuraiion of hack pain i- variahlc¸ wiih
-omc womcn havin, only hricf pcriod of pain and oihcr-
havin, many monih- of -cvcrc pain
[4¸5¸
.
Alihou,h ihcrc arc -omc acccpicd ri-k facior- for
hack pain durin, prc,nancy¸hui hi-iory of hack pain
(pariicularly chronic hack pain }¸ i- a con-i-icnily
found ri-k facior
[8¸
}.Vhilc prcvcniion of all prc,nan-
cy-rclaicd hack pain i- unlikcly io hc po--ihlc¸advicc
on hack carc pro,ram -hould hc availahlc io all prc,-
nani womcn and ihcir aciivc pariicipaiion in daily ac-
iiviiic- -hould hc cncoura,cd
[9¸10¸
.
1hc purpo-c of ihi- -iudy i- io dcicrminc ihc rcla-
iion-hip of prc,nancy and hack pain¸and io cvaluaic
ihc cfficacy of hack carc pro,ram in prcvcniin, or rc-
ducin, hack pain durin, prc,nancy.
MATERIALS AND METHODS
56 paiicni- wiih chronic hack pain wcrc includcd in ihc
-iudy¸of whom 16 wcrc -ccn hcforc¸14 in carly pcriod
(fir-i monih}¸and 26 in laic pcriod(aficr 4ih monih}
of prc,nancy Vc u-cd a quc-iionnairc io ohiain ihc
paiicni-`ha-ic daia and ihc PBULU -calc wa- donc ai
ihc fir-i and ncxi vi-ii-¸coniainin, 4 iicm- includin,¸
pain¸funciion¸cconomic¸and mcdicaiion(1ahlc 1}.
Ha-hhad Inivr-iiy of Hcdical -cicn-c-¸Imam Bcza Ho-piial
Correspondence to Lhrahim Chaicm Ha-ankhani¸profc--or of orihopacdic and -pinc -ur,cry¸Ha-hhad Inivr-iiy of Hcdical -cicn-c-¸Imam Bcza Ho-piial
E-mail¸c,ha-ankhaniCyahoo.com
7 8 |UIB^AL of CHI^L-L CLI^ICAL HLIICI^L \ULIHL 4 |^IHBLB 2 |Ichruary 2009
Table 1 PROLO scale
Pain Iunciion Lconomic Hcdicaiion
P1¸ Lxcruciaiin, or unhcara-
hlc
I1¸1oial incapaciiy
L1¸ Inahlc io ia-k- around
ihc homc
H1¸ >10 hydrocodonc iahlc- or
cquivalcni
P2¸-cvcrc
I1¸ Ahlc io do aciiviiic- in
ihc homc
L2¸Ahlc io do ia-k- around
ihc homc¸hui unahlc io work
H2¸6 ~9 hydrocodonc iahlci- or
cquivalcni
P3¸Hodcraic
I3¸Ahlc io do aciiviiic- oui-
-idc ihc homc wiih limiiaiion
modcraic dcmand aciiviiic-
L3¸Ahlc io work ai li,hi or
-cdcniary capaciiy
H3¸3 ~5 hydrocodonc iahlci- or
cquivalcni
P4¸Hild
I4¸ Limiiaiion of -ircnuou-
aciivc- or -pori
L4¸Ahlc io work ai modcraic
capaciiy
H4¸ Bc,ular ^-AII- or occa-
-ional hydrocodonc iahlci-
P5¸^onc I5¸Ahlc io do all aciiviiic-
L5¸Ahlc io work ai hcavy ca-
paciiy or prcviou- occupaiion
H5¸^onc or occa-ional ^-AII-
or cquivalcni
Ahhrcviaiion¸^-AII- =non-iroidal anii-inflammaiory dru,.Pain +funciion +cconomic +mcdicaiion -corc- arc addcd io crcaic a
4 ~20-poini raiin, of clinical -iaiu- in which poor =4 ~8 poini-¸fair =9 ~12 poini-¸,ood =13 ~16 poini- and cxccllcni =17 ~20
poini-.
Lach iicm ha- 5 poini-.Pain¸funciion¸cconomic and
mcdicaiion -corc- arc addcd io crcaic a 4 ~20 poini-¸
raiin, of clinical -iaiu- in which 4 ~8 poini- i- poor¸9
~12 poini- i- fair¸13 ~16 poini- i- ,ood and 17 ~20
poini- i- cxccllcni.^cxi vi-ii- wcrc donc cvcry 2 ~4
wcck-¸and PBULU -calc wa- donc cvcry 4 wcck-.1hc
-iudy wa- donc hciwccn Ichruary 1999 and Harch
2006.1hc mcan a,c wa- 22 ycar-(18 ~32 ycar-}.All
of ihc paiicni- wcrc in-irucicd ihc ,cncral hack carc
pro,ram ai ihc fir-i vi-ii.Ic-cripiivc -iaii-iical indicc-
wcrc u-cd for dc-cripiion of ihc daia and ic-i and ¡
2
ic-i wcrc u-cd io comparc ihc variahlc- of ihc iwo
,roup-.
RESULTS
1hc paiholo,y of hack pain in ihc-c paiicni- wa- a- fol-
low-¸ -pondyloly-ihc-i- ( 6 paiicni- }¸ 3 paiicni- had
,radc ¸¸1 paiicni ,radc }¸1 paiicni ,radc ±¸and 1
paiicni ,radc | -pondyloly-ihc-i-.Icformiiy of ihc
-pinc(10 paiicni-}¸4 paiicni- had idiopaihic -colio-i-
(dor-olumhar and lumhar curvc}¸2 paiicni- con,cniial
-colio-i-(lumhar curvc}¸2 paiicni- con,cniial kypho-
-i-¸2 paiicni- -chcucrmann`- kypho-i-.Ii-c hcrnia(8
paiicni-}¸5 paiicni- had L
4 ~5
and 3 paiicni- had L
5
~
-
1
di-c hcrnia.All of ihcm had po-iiivc clinical and
HBI findin,-.Halformaiion of ihc -pinc(16 paiicni-}¸
8 paiicni- had -pina hifida occulia¸5 paiicni- -acraliza-
iion and 3 paiicni- lumhali-aiion.Inknown paiholo,y
(16 paiicni-}(1ahlc 2}.
1hc paiicni- who wcrc -ccn hcforc(16 paiicni-}or
in carly pcriod of prc,nancy (14 paiicni-}¸wcrc cn-
coura,cd io hc,in a ,cncral hack carc pro,ram.18 pa-
iicni- of ihcm (40%} had cxccllcni rc-uli (17 ~20
poini PBULU -calc}¸and 12 paiicni-(40%}had ,ood
rc-uli(13 ~16 poini PBULU -calc}.
4 paiicni- who wcrc -ccn hcforc prc,nancy and
had hccn prohihiicd from prc,nancy hy ihcir phy-ician-
hccau-c of ,radc I\ -pondyloly-ihc-i- (1 paiicni} and
di-c hcrnia (3 paiicni- } wcrc in-irucicd ihc ,cncral
hack carc pro,ram and had a prciiy prc,nancy wiih
mild pain and limiiaiion of aciiviiic-.
8 8 |UIB^AL of CHI^L-L CLI^ICAL HLIICI^L \ULIHL 4 |^IHBLB 2 |Ichruary 2009
Table 2 Clinical data of patients with back pain in preg-
nancy
Iaia ^umhcr of paiicni-
1imc of fir-i vi-ii
Bcforc prc,nancy 16 _
Larly pcriod of prc,nancy 14 _
Laic pcriod of prc,nancy 26 _
Liiolo,y of hack pain
-podyloly-ihc-i- 6 o
Icformiiy of -pinc 10 _
Ii-c hcrnia 8 o
Halformaiion of -pinc 16 _
Inknown 16 _
^umhcr of prc,nancy
Iir-i iimc 39 _
-ccond iimc 15 _
1hird iimc 2 o
1hc paiicni- who wcrc -ccn in laic pcriod of prc,-
nancy¸6 paiicni-(23%}had ,ood rc-uli(13 ~16 poini
PBULU -calc}¸10 paiicni-(38%}had fair rc-uli(9 ~
12 poini PBULU -calc}¸and 10 paiicni- (38%} had
poor rc-uli(4 ~8 poini PBULU -calc}(1ahlc 3}.
Table 3 Clinical evaluation of pregnant women with chro-
nic back pain based on the 20 point PROLO scale
PBULU -calc
Bcforc and carly
pcriod of prc,-
nancy
^umhcr Pcrccni
Laic pcriod of
prc,nancy
^umhcr Pcrccni
Lxccllcni
(17 ~20 poini}
18 4 60 . 0 4 0 E
Cood
(13 ~16 poini}
12 4 40 . 6 4 23 \
Iair
(9 ~12 poini}
0 _ 0 10 4 38 \
Poor
(4 ~8 poini}
0 _ 0 10 4 38 \
1oial 30 4 26 4
1hcy wcrc in-irucicd ihc ,cncral hack carc pro-
,ram ai fir-i vi-ii¸in ihc ncxi vi-ii rccovcry wa- -ccn in
ihcir rc-uli- ahoui 4 poini PBULU -calc.1hcrc wa- a
-i,nificani diffcrcncc hciwccn ihc iwo ,roup- ( ¡
2
=
399¸ =0 000}.
DISCUSSION
Back pain i- common durin, prc,nancy¸ihi- i- pariicu-
larly iruc for womcn wiih hi-iory of chronic hack
pain
[11¸
.Back pain may cau-c con-idcrahlc di-ahiliiy
and di-irc-- durin, prc,nancy¸and may impcdc ihcir
daily aciiviiic-.
1hc ri-k facior- in ihc dcvclopmcni of hack pain
durin, prc,nancy includc hormonc-¸ hiomcchanical
-irc--¸and hi-iory of chronic hack pain¸in oihcr word-
hack pain durin, prc,nancy i- likcly io hc muliifaciori-
al
[11¸12¸
.1hc chronic hack pain i- a common and con-
-i-icni facior.Hormonc-¸pariicularly rclaxin¸incrca-c-
li,amcniou- laxiiy ihcrchy dccrca-in, joini- -up-
pori
[13¸14¸
.Biomcchanical -irc-- con-i-i- of incrca-c in
hody wci,hi¸chan,c- in hody -hapc and po-iiion¸and
mu-clc faii,uc
[15¸16¸
.
Back pain i- noi a irivial maicr for many prc,nani
woman¸-o prcvcniion and mana,cmcni of ii -hould hc-
,in a- -oon a- po--ihlc and carcfully
[11¸
.Vhcn a
woman complaini- of hack pain hcforc or in carly pcri-
od of prc,nancy¸a carcful cvaluaiion and hi-iory can
hclp ,uidc iniiial mana,cmcni -u,,c-iion
[8 ~17¸
.1hc
mana,cmcni of ihc hack pain in prc,nancy includc- 3
approachc-¸ cxcrci-c- and phy-ioihcrapy¸ mcdicaiion
and -ur,cry
[18 ~22¸
.1hc majoriiy of ariiclc- havc con-
firmcd ihc imporiancc of hack carc pro,ram in ircai-
mcni of hack pain in prc,nancy
[23 ~25¸
.Larly hc,innin,
of prcvcniion and mana,cmcni providc ihc hc-i oppor-
iuniiy for ,ood rc-uli-
[9¸23 ~25¸
¸a- ha- hccn -hown in
ihi- -iudy.
1hc majoriiy of -iudic-¸amon, ihcm our- dcfincd
ihc imporiancc of hack carc pro,ram¸hoih for prcvcn-
iion and rclicvin, hack pain in prc,nani womcn.-o¸ad-
vicc on hack carc pro,ram -hould hc availahlc io all
prc,nani woman
[17¸26¸27¸
.1hi- -iudy found ihai alihou,h
hack carc pro,ram could noi climinaic ihc hack pain
complcicly¸ii could rcducc pain prohlcm- and dccrca-c
-hori-iimc -ick lcavc.
9 8 |UIB^AL of CHI^L-L CLI^ICAL HLIICI^L \ULIHL 4 |^IHBLB 2 |Ichruary 2009
1hi- -iudy dcfincd ihai in paiicni- who wcrc -ccn
hcforc or in carly pcriod of prc,nancy¸-cvcriiy of pain
and limiiaiion of aciiviiy wa- mild¸hui in paiicni- who
wcrc -ccn in laic pcriod of prc,nancy -cvcriiy of pain
and limiiaiion aciiviiy wa- modcraic or -cvcrc.
1hc -ummary of hack carc pro,ram u-cd in ihi-
-iudy i- a- follow-¸
A =I-c of -uppori¸
- I-c of hack -uppori in -iiiin,¸ -uch a- a
-mall pillow or rollcd iowclin,.
- I-c of a -acral hcli for walkin, and aciivi-
iic-.
B =Corrcciion of po-iiion and po-iurc¸
- Avoidancc of prolon,cd -iandin,¸inicrrupiin,
ihi- wiih walkin, or -ircichin,¸and u-c of a -mall fooi-
-iool for onc fooi¸alicrnaic fcci.
- Po-iural corrcciion hy -iandin, iall¸for cor-
rcciion of flaiicncd or hypcrlordoiic lumhar -pinc.
- Hinimizc -in,lc lc, -iandin, and -iair climh-
in,.
C =Limiiaiion of aciiviiic-¸
- 1akin, -hori hrcak- in daily aciiviiic-(-pc-
cially ai midday}and io rc-i in a po-iiion of comfori io
rclicvc iircd mu-clc-.
- Plannin, cxcrci-c- -uch a- walkin,¸ -wim-
min, and oihcr low-impaci cxcrci-c-
[1¸10¸17¸26¸27¸
.
CONCLUSION
Chronic hack pain wiih cvcry ciiolo,y¸i- noi a difficuliy
or coniraindicaiion in prc,nancy and alihou,h ihi- i-
common durin, prc,nancy and cau-c con-idcrahlc di-a-
hiliiy and di-irc--¸hui prcvcniin, and rcducin, i- po--
-ihlc wiih in-iruciion of hack carc pro,ram.
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