Impact of Low Back Pain on Musculoskeletal Health in Prime Gravida Women With or Without Spinal Anesthesia

Layba Khalid Janjua; Moeen Ahmad Khan; Harum Fatima; Ayesha Zaheer; Armeen Shahid; Anam Abbas

doi:10.61919/fwrw3133

Authors

Layba Khalid Janjua Physiotherapist, Rehmatul lil Alameen Free Medical Centre, Lahore, Pakistan Author
Moeen Ahmad Khan Lecturer, University of Management and Technology, Lahore, Pakistan Author
Harum Fatima Physiotherapist, Mian Hospital, Lahore, Pakistan Author
Ayesha Zaheer University of Management and Technology, Lahore, Pakistan Author
Armeen Shahid Physiotherapist, Rehmat Bibi Hospital, Walton Lahore, Lahore, Pakistan Author
Anam Abbas Lecturer, University of Management and Technology, Lahore, Pakistan Author

DOI:

https://doi.org/10.61919/fwrw3133

Keywords:

Spinal anesthesia, primigravida, postpartum, musculoskeletal health, low back pain, stiffness, MSK-HQ.

Abstract

Background: Postpartum musculoskeletal symptoms may affect maternal mobility, self-care, physical activity, and return to daily routine, particularly among primigravida women recovering after delivery. Spinal anesthesia is commonly used in obstetric practice, yet its association with postpartum musculoskeletal health remains clinically relevant and insufficiently defined. Objective: To determine the association between spinal anesthesia exposure and postpartum musculoskeletal health among primigravida women. Methods: A cross-sectional observational study was conducted among 266 primigravida women assessed eight weeks after delivery. Participants were divided equally into women who received spinal anesthesia before delivery (n = 133) and women who did not (n = 133). Data were collected using a structured form and the Musculoskeletal Health Questionnaire, assessing pain intensity, joint or muscle stiffness, walking interference, washing or dressing difficulty, physical activity limitation, disruption of daily routine, and overall musculoskeletal health score. Descriptive statistics and Pearson correlation analysis were performed using SPSS version 25. Results: Pain intensity was comparable between groups, with moderate-to-severe pain reported by 16.5% of women in the spinal anesthesia group and 15.0% in the non-spinal anesthesia group. However, severe functional interference was more frequent among women exposed to spinal anesthesia, particularly daily routine disruption (27.8% vs 12.8%), daytime pain or stiffness (24.1% vs 11.3%), and walking interference (24.1% vs 11.3%). Spinal anesthesia status showed a significant weak-to-modest negative correlation with Musculoskeletal Health Questionnaire score (r = −0.231, p < 0.001). Conclusion: Spinal anesthesia exposure was associated with poorer postpartum musculoskeletal health among primigravida women, mainly through greater stiffness and functional interference rather than pain intensity alone. These findings support routine postpartum musculoskeletal screening and early rehabilitative guidance.

References

1. Tariq M, Ahmed U, Afzal W, Hanif K, Shafiq H. Prevalence of pregnancy-related low back pain among pregnant women at selected hospitals of Lahore city, Pakistan. Asian J Allied Health Sci. 2020;31:14-8.

2. Parveen U, Zeb B, Sadaf A. Frequency of backache and its management in pregnant women attending IUH OPD. Parity.

3. Cooper DW, Jeyaraj L, Hynd R, Thompson R, Meek T, Ryall DM, et al. Evidence that intravenous vasopressors can affect rostral spread of spinal anesthesia in pregnancy. Anesthesiology. 2004;101(1):28-33.

4. Lee JH, YD, Heo BH. Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia. Korean J Anesthesiol. 2020;73(6):518-24.

5. Dunkin MA. WebMD. 2022.

6. Cheema ZR, Akhtar MW, Mahmood M, Alam MM, Saeed AS, Burhan M, et al. Prevalence of low back pain in pregnant females. J Health Rehabil Res. 2024;4(2):291-5.

7. Saghafian S, Niksolat M, Mirfakhraee H, Rahimi M, Asadi S, Mahdavynia S, et al. Comparison of the outcomes of normal vaginal delivery with and without spinal anesthesia in mothers admitted to the maternity ward of Firoozabadi Hospital. J Family Med Prim Care. 2022;11(9):5633-7.

8. Abbasi S, Hamid M, Ahmed Z, Nawaz FH. Prevalence of low back pain experienced after delivery with and without epidural analgesia: a non-randomised prospective direct and telephonic survey. Indian J Anaesth. 2014;58(2):143-8.

9. Shafi P, Khan R, Ahmad T, Zeb SA, Sajjad A. Prevalence of lower back pain in pregnant women with pre-eclampsia. Age. 2021;33(7.41):32-47.

10. Zeleke TG, Mersha AT, Endalew NS, Ferede YA. Prevalence and factors associated with back pain among patients undergoing spinal anesthesia at the University of Gondar Comprehensive and Specialized Hospital, North West Ethiopia: an institutional-based cross-sectional study. Adv Med. 2021;2021:1-8.

11. Chen YC, Liang FW, Ho CH, Chang YJ, Hung KC, Chu CC, et al. Anesthesia for cesarean delivery and subsequent depression: a nationwide retrospective cohort study. J Affect Disord. 2024;364:108-15.

12. Guglielminotti J, Monk C, Russell MT, Li G. Association of general anesthesia for cesarean delivery with postpartum depression and suicidality. Anesth Analg. 2025;141(3):618-28.

13. Yurashevich M, Devinney M, Foster MW, Myers R, O'Grady N, Ji RR, et al. Cerebrospinal fluid proteome of patients with persistent pain and/or postpartum depression after elective cesarean delivery: an exploratory prospective cohort study. J Clin Anesth. 2025;104:111855.

14. Kalvehalli Kashinath S, Kouides PA. The diagnosis, natural history, and management of von Willebrand disease in women in the age of guidelines. Expert Rev Hematol. 2023;16(6):435-50.

15. Li J, Zhou YH, Yang YJ, Wang Q, Lei W, Li SX, et al. Effect of dexmedetomidine for epidural supplementation on postpartum sleep disturbance after cesarean delivery: a double-blind, randomized clinical trial. Int J Surg. 2025;111(7):4495-507.

16. Cohen N, Li A, Nejem R, Lavie O, Zilberlicht A, Reuveni A, et al. Neuraxial morphine anesthesia given during cesarean delivery and risk of urinary retention: a retrospective study. Isr Med Assoc J. 2024;26(7):415-20.

17. Sharpe EE, Sviggum HP, Carvalho B, Guo N, Arendt KW, Stoltenberg AD, et al. Profiling postpartum recovery after scheduled cesarean delivery with neuraxial anesthesia: a longitudinal cohort study. Anesth Analg. 2025;141(5):1089-96.

18. Hadavi SMR, Panah A, Shamohammadi S, Kanaani Nejad F, Sahmeddini MA, Asmarian N. The prophylactic effect of acetaminophen and caffeine on post dural puncture headache after spinal anesthesia for cesarean section: a randomized double-blind clinical trial. Iran J Med Sci. 2024;49(9):573-9.

19. Khusid E, Lui B, Ibarra A, Villegas K, White RS. Review of racial/ethnic disparities in obstetrics-related anesthesia administration and pain management. Pain Manag. 2023;13(7):415-22.