Chiropractic treatment of pregnancy-related low back pain: A pilot randomized controlled trial

Pregnancy-related low back pain (PRLBP) begins during pregnancy and is lumbar or pelvic pain of insidious onset. In the United States it is considered to be a natural part of pregnancy caused by the size of the belly, and is assumed to resolve after birth. PRLBP is an important public health concern because it affects up to 80% of all pregnant women, results in lost work days and income, and if untreated 1/3 of all cases persist one year after birth and are associated with additional co-morbidities. This pilot RCT compares specific exercises (control), spinal manipulation, and a mind-body therapy called neuro-emotional technique for the treatment of PRLBP. The primary outcome measure was Roland Morris disability index. Secondary outcome measures were pain intensity, heart rate variability, and intra-uterine attachment. Heart rate variability and attachment style are influenced by pain. 90 women were recruited within 18 months at an average cost of $25/person. The randomization by preferred intervention strategy worked well. Each woman received an average of seven treatments and all improved in terms of pain and disability. Attrition was rampant (25%) in the exercise group and decreased with the addition of an optional group yoga class and the promise of post-partum spinal manipulation if a woman remained in the study until 37 weeks gestation. The spinal manipulation and neuro-emtional technique attrition was <10% before week 37. Roland Morris was an inadequate means to evaluate disability since women had difficulty differentiating between disability secondary to pain and that secondary to pregnancy.