Interventions effective for preventing and treating pelvic and back pain in pregnancy

Clinical question: 
How effective are interventions for preventing and treating pelvic and back pain in pregnancy?
Bottom line: 
Moderate quality evidence suggests acupuncture or exercise, tailored to the stage of pregnancy, significantly reduces evening pelvic pain or lumbo-pelvic pain more than usual care alone. Acupuncture was significantly more effective than exercise for reducing evening pelvic pain. A 16- to 20-week training programme was no more successful than usual prenatal care at preventing pelvic or low back pain (LBP). Low-quality evidence suggests exercise significantly reduces pain and disability from LBP. Physiotherapy, osteopathic manipulation, acupuncture, a multimodal intervention, or the addition of a rigid pelvic belt to exercise, relieved pelvic or back pain more than usual care alone. There was no significant difference in LBP and function for different support belts, exercise, neuroemotional techniques or spinal manipulation, or in evening pelvic pain between deep and superficial acupuncture.
Caveat: 
No outcomes were supported by high-quality evidence and only 3 by moderate-quality evidence (acupuncture for pelvic pain, exercise for lumbo-pelvic pain and lumbo-pelvic work absenteeism). Overall, there was low-quality evidence for outcomes because of high risks of bias and sparse data. Trials were generally small (range 30 to 855 women; with only three trials including over 300 women).
Context: 
More than two-thirds of pregnant women experience LBP and almost one-fifth pelvic pain. Pain increases with advancing pregnancy and interferes with work, daily activities and sleep.
Review CD#: 
CD001139
PEARLS No: 
419
Date: 
January, 2014
Authored by: 
Brian R McAvoy