Pregnancy tissue hypersensitivity independent of lumbopelvic pain intensity

Lumbo-pelvic pain is common in pregnancy however sensitisation factors underlying the condition are largely unknown. Skuli Palsson et al. (2015) investigated the somatosensory profile of pregnant women and the relationship between pain, hypersensitivity, and commonly used manual clinical tests.

 

39 pregnant and 22 non-pregnant women were included in the study, with pregnant women divided into low-pain and high-pain groups. Sensitivity to light brush, pin-prick, and pressure pain was assessed bilaterally at three lumbo-pelvic regions, the shoulders and the lower legs. Responses to the active straight leg raise test and pain provocation tests of the sacroiliac joint were recorded. Participants completed questionnaires addressing emotional and physical well-being and rated disability.

 

Compared with non-pregnant women, the high-pain group rated an active straight leg raise test more difficult, and reported worse emotional health and poorer sleep quality. Pregnant women with pain (low and high groups) had significantly more positive pain provocation tests and significantly lower pressure pain thresholds at most assessment sites. Self-reported disability and pain were not correlated with pressure pain thresholds within pregnant participants.

 

Results indicate that musculoskeletal pain during pregnancy is multifactorial due to altered biomechanics, a reduced pain threshold and altered emotional state. There is increased mechanical stress to the lumbosacral spine from the relaxation of ligaments and increased bodyweight, hyperlordosis and forward flexion of the pelvis. Generalised reduction of the pain threshold is due to increased nociceptor sensitivity by significant hormonal changes during pregnancy. Emotional changes also occur from hormone changes and stressors.

 

Pain sensitivity increases during pregnancy not only due to the physical changes the body undergoes during pregnancy but also due to changes in emotional health. Because the somatosensory profile in pregnancy is likely affected by several, parallel factors, it therefore should be accounted for in clinical management of pregnant women with lumbo-pelvic pain.

 

While the study did not look at the influence of pre-existing spinal conditions and injuries with pregnancy, the findings would indicate that pre-existing conditions may potentially be further exacerbated by pregnancy.

 

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Thorvaldur Skuli Palsson, Darren Beales, Helen Slater, Peter O’Sullivan, Thomas Graven-Nielsen. Pregnancy Is Characterized by Widespread Deep-Tissue Hypersensitivity Independent of Lumbopelvic Pain Intensity, a Facilitated Response to Manual Orthopedic Tests, and Poorer Self-Reported Health.
The Journal of Pain. March 2015 Volume 16, Issue 3, Pages 270–282

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