(Research Hub Theater) Low Back Pain During Pregnancy: Documentation and Referral Patterns at a Tertiary Care Center

Friday, November 17, 2023

8:00 AM – 9:15 AM CT

Primary Author(s)

Christian Nicolosi, MD

Resident
University of Colorado PM&R Program
Littleton, Colorado

Co-Author(s)

JF

Joshay Ford, Other

Medical Student
n/a
Aurora, Colorado
RH

Ryan Hagens, MD

Pain Fellow
UCLA/West LA VA
Los Angeles, California
Eduardo Carrera, MD

Pain Medicine Fellow
University of Colorado
Denver, Colorado
JF

Jeri Forster, PhD

Associate Professor
University of Colorado Anschutz Medical Campus
Aurora, Colorado
Adele Meron, MD

Assistant Professor
University of Colorado Denver School of Medicine PM&R Program
Aurora, Colorado

Background and/or Objectives: Many women experience low back pain (LBP) at some point in their pregnancy. There are physiologic changes of pregnancy that contribute to LBP. It is often viewed as a normal part of pregnancy resulting in under-treatment. We assessed the association between demographic characteristics and likelihood of documented LBP diagnosis/referral for specialty treatment.

Design: We performed a retrospective cohort study using Health Data Compass data of subjects over a 5-year period (2015-2019).

Setting: A tertiary care center.

Participants: Subjects were 23,043 pregnant women aged 12-55 who established care at least 90 days prior to delivery.

Interventions: not applicable

Main Outcome Measures: LBP diagnosis, back pain type, specialty referral , referral department.

Results: 14.6% of subjects had LBP diagnosis (95% confidence interval [CI]: 14.1%, 15.1%). While women were 11% less likely (95% CI: -13%, -8%) to have a documented LBP diagnosis for each 5-year increase in age, they were 21% more likely (95% CI: 12%, 30%) to be referred for specialty treatment for each 5-year increase in age. Hispanic women were 15% more likely to be diagnosed (95% CI: 7%, 24%) than women of all other ethnicities, but were 20% less likely to be referred (95% CI: -37%, 0%). Compared to White women, Black women were 48% more likely to be diagnosed (95% CI: 35%, 64%), while Asian women were 25% less likely to be diagnosed (95% CI: -39%, -7%). Axial and neurogenic LBP were more likely to be referred to rehabilitation services including physical therapy and integrative medicine modalities. Sacrococcygeal and cervical/thoracic back pain were more likely to be referred to rehabilitation medicine (physical medicine & rehabilitation, spine, and pain medicine).

Conclusions: A small percent of women with diagnosed LBP during pregnancy were referred. There were discrepancies amongst referral and diagnosis in demographic domains. Sacrococcygeal and cervical/thoracic back pain were referred to different services than axial and neurogenic LBP.