Low Back Pain in Pregnancy: A Practical Guide With Focus on Differential Diagnoses

Pregnancy-related low back pain (PRLBP) is a common multifactorial condition that can affect the mental, physical and social well-being of pregnant women. The aim of this review was to propose a practical guide to the practitioners based on the current knowledge about low back pain (LBP) during pregnancy. Diagnosis of PRLBP can be challenging as several pregnancy complications and visceral abdominal conditions can be revealed by LBP. Besides, it can also be a referred pain from other loco-regional musculoskeletal conditions such as hip complex regional pain syndrome type 1 and osteonecrosis of femoral head. Low back pain can also be a symptom of serious conditions such as infectious spondylitis, spinal tumours or pregnancy-related osteoporotic vertebral compression fractures. After ruling out these differential diagnoses, PRLBP can be considered. Although its natural course is usually favourable, an adequate therapeutic management of PRLBP is crucial and this complaint should not be considered as a normal part of the pregnancy. Management of PRLBP should be based on the fundamental approach of minimizing medication usage when possible, considering the potential risks to the developing foetus throughout the pregnancy. Therefore, pharmacological treatment can be prescribed after a shared medical decision, for the shortest possible period and in association with non-pharmacological options. Promoting the active participation of the pregnant woman and maintaining the minimal tolerable physical activity are the main measures to provide an optimal medical care.