(Kiosk 5) Resurgence of Lower Back Pain Post-partum Not Amenable to Conservative Management: A Case Report

Case Diagnosis: A 38-year-old female with a post-partum resurgence of previously resolved chronic lower back pain.

Case Description or Program Description: A 38-year-old female with a past medical history of lumbar radiculopathy after a motor vehicle accident four years ago which resolved with epidural steroid injection now presents with new onset lower back pain (LBP) after delivering her child via cesarean section. The pain radiates to both legs and is associated with numbness. It is worse with bending, lifting, and ovulation. It has not been relieved with physical therapy, oral pain medications, or corticosteroid injections.

Setting: Outpatient pain management clinic.

Assessment/Results: Physical examination revealed pain with range of motion but no tenderness to palpation. Slump’s test was positive on the right. MRI without contrast of the lumbar spine was unremarkable. The patient was referred to obstetrics and gynecology for evaluation of possible components of pelvic pain syndrome.

Discussion (relevance): Back pain after pregnancy is well documented and can be due to weight gain, posture changes, muscle strain, and hormonal changes causing relaxed ligaments. Most pregnancy-related back pain is treated with exercise. However, little data is available regarding patients with a prior history of back pain with new or resurgent pregnancy-related back pain not amenable to conservative management such as in our patient. In the current literature, cases of pregnancy-related radiculopathy with the return of previously resolved lower back pain have been sparsely reported.

Conclusions: This case highlights a peculiar finding of chronic back pain resurgence after pregnancy. Pregnancy-related lower back pain is commonly treated with conservative management including physical therapy. However, further research and awareness are needed to determine effective treatment in those with a prior history of LBP with new-onset lumbar radiculopathy not amenable to conservative care. Proper management will help improve the quality of life in mothers and, in turn, allow them to focus on nurturing their newborns.