Long term sequelae of childbirth: backache

Backache affects up to 90% of the population at some time during adult life. It has been estimated that in the UK backache results in two million general practitioner consultations1 and 150 million lost working days each year.2 Although a cause for backache, such as mechanical strain, lumbar spondylosis, prolapsed disc and spinal stenosis may be found, in many cases the aetiology is uncertain and treatment less than effective. These patients, much to their own distress, are commonly thought to be malingering or to have some psychological element to their condition. Should a possible cause of chronic non-specific backache be offered, it is easy to see why sufferers readily accept the explanation in order to validate their condition. Such has been the case with allegations that epidural analgesia in labour may increase the incidence of long term postnatal backache. Evidence to support this relationship is however far from conclusive and has overlooked several essential issues. Backache is not a diagnosis but a symptom, and when reported every effort should be made to establish a cause. Unfortunately investigators often overlook the need for diagnosis and, more importantly, the association between pregnancy and backache. A closer examination of this relationship is vital before examining any possible effect of labour analgesia.