Brazilian Journal of Pain
Brazilian Journal of Pain
Review Article

Pregnancy-related lumbosacral pain

Dor lombossacral relacionada à gestação

Fábio Farias de Aragão

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BACKGROUND AND OBJECTIVES: Pregnancy causes physiological and anatomical changes in the woman's body, affecting several systems such as the musculoskeletal. During pregnancy or in the postpartum period, these changes may cause low back pain or low pelvic pain, preventing the normal movement of these structures and causing suffering. The objective of this study was to discuss the diagnosis and treatment of pregnancy-related lumbosacral pain, focusing on terminology, epidemiology, risk factors, pathophysiology, prognosis, diagnosis, and treatment.

CONTENTS: We searched the literature in Pubmed, Cochrane Library, Ovid and Google using the terms "low back pain", "pelvic girdle pain", "lumbopelvic pain", "posterior pelvic pain", "pregnancy-related low back pain", "pregnancy-related pelvic girdle pain" and "pregnancy-related lumbopelvic pain", for articles in English, Portuguese and Spanish in the last 20 years or older, where relevant.

CONCLUSION: Pregnancy is one of the main causes of lumbosacral pain, and one of the most frequent diseases during gestation. The correct management of this pathology reduces negative impacts on the life of pregnant women.


Low back pain, Pelvic pain, Pregnancy


JUSTIFICATIVA E OBJETIVOS: A gestação causa alterações fisiológicas e anatômicas no corpo da mulher, podendo afetar diversos sistemas como o musculoesquelético. Durante a gestação ou no período pós-parto, essas alterações podem causar dor lombar ou dor pélvica baixa, impedindo a movimentação normal dessas estruturas e causando sofrimento. O objetivo deste estudo foi discutir o diagnóstico e o tratamento da dor lombossacral relacionada à gestação, com foco na terminologia, epidemiologia, fatores de risco, fisiopatologia, prognóstico, diagnóstico e tratamento.

CONTEÚDO: Foi realizada busca na literatura no Pubmed, Cochrane Library, Ovid e Google, utilizando-se os termos “low back pain”, “pelvic girdle pain”, “lumbopelvic pain”, “posterior pelvic pain”, “pregnancy-related low back pain”, “pregnancy-related pelvic girdle pain” e “pregnancy -related lumbopelvic pain”, por artigos em inglês, português e espanhol nos últimos 20 anos, ou mais antigos, quando relevantes.

CONCLUSÃO: A gestação é uma das principais causas de dor lombossacral e esta é uma das doenças mais frequentes durante a gestação. O correto manuseio desta doença reduz os impactos negativos na vida da gestante.


Dor pélvica, Gestaçao, Lombalgia


Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol. 2013;27(6):791-802.

Gallo-Padilla D, Gallo-Padilla C, Gallo-Vallejo FJ, Gallo-Vallejo JL. Low back pain during pregnancy. Multidisciplinary approach. Semergen. 2016;42(6):e59-64.

Gutke A, Olsson CB, Völlestad N, Öberg B, Wikmar LN, Robinson HS. Association between lumbopelvic pain, disability and sick leave during pregnancy - a comparison of three Scandinavian cohorts. J Rehabil Med. 2014;46(5):468-74.

Robinson HS, Eskild A, Heiberg E, Eberhard-Gran M. Pelvic girdle pain in pregnancy: the impact on function. Acta Obstet Gynecol Scand. 2006;85(2):160-4.

Hansen A, Jensen DV, Wormslev M, Minck H, Johansen S, Larsen EC. Symptom-giving pelvic girdle relaxation in pregnancy. II: symptoms and clinical signs. Acta Obstet Gynecol Scand. 1999;78(2):111-5.

Talbot L, Maclennan K. Physiology of pregnancy. Anaesth Intens Care Med. 2016;17(7):341-5.

Casagrande D, Gugala Z, Clark SM, Lindsey RW. Low back pain and pelvic girdle pain in pregnancy. J Am Acad Orthop Surg. 2015;23(9):539-49.

Ireland ML, Ott SM. The effects of pregnancy on the musculoskeletal system. Clin Orthop Relat Res. 2000:169-79.

Borg-Stein J, Dugan SA, Gruber J. Musculoskeletal aspects of pregnancy. Am J Phys Med Rehabil. 2005;84(3):180-92.

Madeira HG, Garcia JB, Lima MV, Serra HO. Disability and factors associated with gestational low back pain. Rev Bras Ginecol Obstet. 2013;35(12):541-8.

Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI. Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J. 2004;13(7):575-89.

Liddle SD, Pennick V. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev. 2015.

Gomes MR, Araújo RC, Lima AS, Pitangui AC. Gestational low back pain: prevalence and clinical presentations in a group of pregnant women. Rev Dor. 2013;14(2):114-7.

Kovacs FM, Garcia E, Royuela A, González L, Abraira V. Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish National Health Service. Spine. 2012;37(17):1516-33.

Mogren IM, Pohjanen AI. Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine. 2005;30(8):983-91.

Sabino J, Grauer JN. Pregnancy and low back pain. Curr Rev Musculoskelet Med. 2008;1(2):137-41.

Kanakaris NK, Roberts CS, Giannoudis PV. Pregnancy-related pelvic girdle pain: an update. BMC Med. 2011;9:15.

Fairbrother N, Young AH, Janssen P, Antony MM, Tucker E. Depression and anxiety during the perinatal period. BMC Psychiatry. 2015;15:206.

Gutke A, Josefsson A, Oberg B. Pelvic girdle pain and lumbar pain in relation to postpartum depressive symptoms. Spine. 2007;32(13):1430-6.

Vermani E, Mittal R, Weeks A. Pelvic girdle pain and low back pain in pregnancy: a review. Pain Pract. 2010;10(1):60-71.

Vleeming A, Albert HB, Ostgaard HC, Sturesson B, Stuge B. European guidelines for the diagnosis and treatment of pelvic girdle pain. Eur Spine J. 2008;17(6):794-819.

Norén L, Ostgaard S, Johansson G, Ostgaard HC. Lumbar back and posterior pelvic pain during pregnancy: a 3-year follow-up. Eur Spine J. 2002;11(3):267-71.

Smith MW, Marcus PS, Wurtz LD. Orthopedic issues in pregnancy. Obstet Gynecol Surv. 2008;63(2):103-11.

Katonis P, Kampouroglou A, Aggelopoulos A, Kakavelakis K, Lykoudis S, Makrigiannakis A. Pregnancy-related low back pain. Hippokratia. 2011;15(3):205-10.

van Tulder M, Becker A, Bekkering T, Breen A, del Real MT, Hutchinson A. Chapter 3. European guidelines on the management of acute nonspecific low back pain in primary care. Eur Spine J. 2006;15(^sSuppl 2):S169-91.

Barros RR, Simões L, Moretti E, Lemos A. Repercussão da dor da cintura pélvica na funcionalidade de gestantes avaliadas através da versão brasileira do Pelvic Girdle Questionnaire (PGQ-Brasil): estudo transversal. Fisioter Pesq. 2015;22(4):404-10.

Albert HB, Godskesen M, Westergaard JG. Incidence of four syndromes of pregnancy-related pelvic joint pain. Spine. 2002;27(24):2831-4.

Olsson C, Nilsson-Wikmar L. Health-related quality of life and physical ability among pregnant women with and without back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004;83(4):351-7.

van de Pol G, de Leeuw JR, van Brummen HJ, Bruinse HW, Heintz AP, van der Vaart CH. The pregnancy mobility index: a mobility scale during and after pregnancy. Acta Obstet Gynecol Scand. 2006;85(7):786-91.

Stuge B, Garratt A, Krogstad Jenssen H, Grotle M. The pelvic girdle questionnaire: a condition-specific instrument for assessing activity limitations and symptoms in people with pelvic girdle pain. Phys Ther. 2011;91(7):1096-108.

Simões L. Estudo de validação do "Pelvic Girdle Questionnaire" (PGQ) para a população brasileira e análise das propriedades de medida. 2014.

Baysinger CL. Imaging during pregnancy. Anesth Analg. 2010;110(3):863-7.

Kanal E, Barkovich AJ, Bell C, Borgstede JP, Bradley Jr WG, Froelich JW. Expert Panel on MR Safety: ACR guidance document on MR safe practices. J Magn Reson Imaging. 2013;37(3):501-30.

Tirada N, Dreizin D, Khati NJ, Akin EA, Zeman RK. Imaging pregnant and lactating patients. Radiographics. 2015;35(6):1751-65.

Gutke A, Lundberg M, Östgaard HC, Öberg B. Impact of postpartum lumbopelvic pain on disability, pain intensity, health-related quality of life, activity level, kinesiophobia, and depressive symptoms. Eur Spine J. 2011;20(3):440-8.

Mogren IM. BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. Eur Spine J. 2006;15(7):1093-102.

Bergström C, Persson M, Mogren I. Sick leave and healthcare utilisation in women reporting pregnancy related low back pain and/or pelvic girdle pain at 14 months postpartum. Chiropr Man Therap. 2016;24:7.

Elden H, Gutke A, Kjellby-Wendt G, Fagevik-Olsen M, Ostgaard HC. Predictors and consequences of long-term pregnancy-related pelvic girdle pain: a longitudinal follow-up study. BMC Musculoskeletal Disord. 2016;17:276.

Gutke A, Ostgaard HC, Oberg B. Pelvic girdle pain and lumbar pain in pregnancy: a cohort study of the consequences in terms of health and functioning. Spine. 2006;31(5):E149-55.

Bishop A, Holden MA, Ogollah RO, Foster NE. Current management of pregnancy-related low back pain: a national cross-sectional survey of UK physiotherapists. Physiotherapy. 2016;102(1):78-85.

Thomas IL, Nicklin J, Pollock H, Faulkner K. Evaluation of a maternity cushion (Ozzlo pillow) for backache and insomnia in late pregnancy. Aust N Z J Obstet Gynaecol. 1989;29(2):133-8.

Guerreiro da Silva JB, Nakamura MU, Cordeiro JA, Kulay Jr L. Acupuncture for low back pain in pregnancy - a prospective, quasi-randomised, controlled study. Acupunct Med. 2004;22(2):60-7.

Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand. 2004;83(3):246-50.

Elden H, Ladfors L, Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial. BMJ. 2005;330(7494):761.

Elden H, Fagevik-Olsen M, Ostgaard HC, Stener-Victorin E, Hagberg H. Acupuncture as an adjunct to standard treatment for pelvic girdle pain in pregnant women: randomised double-blinded controlled trial comparing acupuncture with non-penetrating sham acupuncture. BJOG. 2008;115(13):1655-68.

Jóźwiak-Bebenista M, Nowak JZ. Paracetamol: mechanism of action, applications and safety concern. Acta Pol Pharm. 2014;71(1):11-23.

Nakhai-Pour HR, Broy P, Sheehy O, Bérard A. Use of nonaspirin nonsteroidal anti-inflammatory drugs during pregnancy and the risk of spontaneous abortion. CMAJ. 2011;183(15):1713-20.

Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015.

Furu K, Kieler H, Haglund B, Engeland A, Selmer R, Stephansson O. Selective serotonin reuptake inhibitors and venlafaxine in early pregnancy and risk of birth defects: population-based cohort study and sibling design. BMJ. 2015;17:350:h1798.

Ornoy A, Weinstein-Fudim L, Ergaz Z. Antidepressants, antipsychotics, and mood stabilizers in pregnancy: what do we know and how should we treat pregnant women with depression. Birth Defects Res. 2017;109(12):933-56.

Casassus B. France bans sodium valproate use in case of pregnancy. Lancet. 2017;390(10091):217.

Weston Z, Bromley R, Jackson CF, Adab N, Clayton-Smith J, Greenhalgh J. Monotherapy treatment of epilepsy in pregnancy: congenital malformation outcomes in the child. Cochrane Database Syst Rev. 2016.

Andrade C. Adverse pregnancy outcomes associated with gestational exposure to antiepileptic drugs. J Clin Psychiatry. 2018;79(4).

Patorno E, Bateman BT, Huybrechts KF, MacDonald SC, Cohen JM, Desai RJ. Pregabalin use early in pregnancy and the risk of major congenital malformations. Neurology. 2017;88(21):2020-5.

Moreira A, Barbin C, Martinez H, Aly A, Fonseca R. Maternal use of cyclobenzaprine (Flexeril) may induce ductal closure and persistent pulmonary hypertension in neonates. J Matern Fetal Neonatal Med. 2014;27(11):1177-9.

Nezvalová-Henriksen K, Spigset O, Nordeng H. Effects of codeine on pregnancy outcome: results from a large population-based cohort study. Eur J Clin Pharmacol. 2011;67(12):1253-61.

Källén B, Reis M. Use of tramadol in early pregnancy and congenital malformation risk. Reprod Toxicol. 2015;58:246-51.

Bloor M, Paech MJ, Kaye R. Tramadol in pregnancy and lactation. Int J Obstet Anesth. 2012;21(2):163-7.

Kraychete DC, Siqueira JT, Zakka TR, Garcia JB. Recomendações para uso de opioides no Brasil: Parte III. Uso em situações especiais (dor pós-operatória, dor musculoesquelética, dor neuropática, gestação e lactação). Rev Dor. 2014;15(2):126-32.

Shah S, Banh ET, Koury K, Bhatia G, Nandi R, Gulur P. Pain management in pregnancy: multimodal approaches. Pain Res Treat. 2015;2015.

Cohen RS. Fentanyl transdermal analgesia during pregnancy and lactation. J Hum Lact. 2009;25(3):359-61.

Price HR, Collier AC. Analgesics in pregnancy: an update on use, safety and pharmacokinetic changes in drug disposition. Curr Pharm Des. 2017;23(40):6098-114.

Sehmbi H, D'Souza R, Bhatia A. Low back pain in pregnancy: investigations, management, and role of neuraxial analgesia and anaesthesia: a systematic review. Ginecol Obstet Invest. 2017;82(5):417-36.

Han IH, Kuh SU, Kim JH, Chin DK, Kim KS, Yoon YS. Clinical approach and surgical strategy for spinal diseases in pregnant women: a report of ten cases. Spine. 2008;33(17):E614-9.

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