When you think about pain relief during labor and delivery, epidurals are the first thing that come to mind. The analgesia is the most commonly used pain relief for laboring women, offering a numbing effect, and is generally a safe and effective option. But some people do report back pain that persists for days, weeks, or even months after the medication wears off. Read on to learn what you need to know about back pain after an epidural, why it happens, and what you can do to ease the symptoms.

What Is an Epidural?

An epidural is a procedure that involves injecting a medication into the space around your spinal nerves, known as the epidural space. Depending on the reason for the procedure, this medicine can be either an anesthetic or a steroid, but in both cases, the goal is to provide pain relief or numbness to a particular region of the body. The use of pain relief during labor focuses on the lower half of the body.

Epidurals are considered a form of local anesthesia because they are administered while the patient is awake and are centered on a certain area of the body. While the most common use of epidurals is for labor-related pain relief, epidural injections using steroids are also often used by back pain specialists to manage pain.

How Do Epidurals Work?

Epidural anesthesia injections work by injecting medication into the epidural space that surrounds the spine, stopping pain signals from traveling to the brain from the spine. This space is filled with fluid and surrounds the spinal cord, acting like a liquid sleeve to protect the critical spinal cord.

The spinal cord is so important because it connects the nerves located all over your body to the brain. For example, if you are injured, the nerve in that area of your body is designed to send a pain signal through your spinal cord to your brain and your back. The epidural anesthetic works by temporarily numbing the spinal nerves, in turn blocking pain signals in certain regions of your body, depending on where along your spine the provider injected the epidural. Depending on the type of drug used, the concentration of that drug, and the dosage, an epidural can provide either temporary pain relief or a temporary complete loss of feeling.

Epidural steroid injections work slightly differently, as they are aimed at managing chronic pain rather than temporary uses. Instead of anesthetic medication, a steroid or corticosteroid is injected into the epidural space around your spine. The steroid then coats the irritated nerve or nerves that are causing pain, working to reduce swelling and giving the nerves time to heal. Epidural steroid injections can result in temporary, long-term, or permanent pain relief.

Side Effects from Epidurals

Epidurals are a low-risk procedure, but they can come with some risks, especially for those with certain existing conditions. Some common risks you should discuss before opting for an epidural include:

  • Low blood pressure and lightheadedness
  • Severe headaches caused by spinal fluid leakage
  • Infections, including an epidural abscess, discitis, osteomyelitis, or meningitis
  • Hot flashes or rashes
  • Damage to a blood vessel, hematomas, or clots
  • Nerve damage at the injection site
  • Temporary loss of control of bladder and bowels

However, one of the most common things people experience after an epidural is short-term back pain. Tenderness and soreness at the injection site usually appears and lasts for a couple of days. It can sometimes be difficult to distinguish this from other back pain that results from the experience of labor and delivery as your body begins to realign after pregnancy. It is rare, but not impossible, for an epidural to cause chronic or long-term back pain.

Back Pain After Childbirth

It can be difficult to understand how much back pain is caused by epidural injections as opposed to how much results from the experience of giving birth in the same time frame. Symptoms that are often cited in relation to both include:

  • Pain at the injection site
  • Lingering numbness in the back
  • Pain throughout the back
  • Issues rotating the body
  • Weakness of the core muscles
  • Sharp pains when sitting or standing for long periods of time
  • Unstable back or hips

During pregnancy, there is extreme pressure placed on the pelvis as it changes shape and grows to accommodate delivery. Immediately after giving birth, the pelvis begins to shrink back to a smaller size and tries to realign, which places additional pressure on the sacroiliac joints. Other strain on muscles and ligaments is also attempting to repair itself during this time. As women move more or exert themselves in the postpartum period, it can cause pain that radiates through the back.

If the pain seems to be linked directly to the injection site, or the pain lasts for more than a few days, you should seek care related to your epidural. In most cases of pain after giving birth, a chiropractic adjustment should help your body as it returns to a new state of normal.

Treating Back Pain at Home After an Epidural

Since it can be difficult to determine what back pain is related to an epidural as opposed to birth, they are often treated the same way. Many at-home remedies help ease this back pain, in addition to treatment by back pain specialists like chiropractors.

Massages

Even a simple massage from a partner can go a long way in terms of easing sore muscles in the back. But a professional massage is also recommended. Not only is it a way to target areas that are causing pain, but it can be a nice break and a way to incorporate self-care into a postpartum routine.

Hot and Cold Therapy

Many people gravitate towards using either heat or ice to relieve pain, but the best thing to do is to alternate between the two to minimize pain and discomfort.

When you notice back pain beginning, even if you are still in the hospital, you can start with cold therapy. Use a cold compress, a bag of ice, or even frozen vegetables onto your lower back. Be sure to wrap this in a towel to prevent it from making direct contact with bare skin. You can do this as often as you’d like, but not for more than 20 minutes at a time.

After a few days of ice therapy, switch to using heat to soothe your back. You can use a heating pad, a warm compress, or a warm bath to do so. Even a sock filled with uncooked rice and microwaved can be a great way to do this.

Rest

This can be difficult if you have a new baby at home, but the more you can rest your back, the better luck you will have eliminating back pain. In this case, rest can mean avoiding strenuous activities as well as actually lying in bed. It can help to have a supportive pillow placed under your knees when you’re lying down to avoid additional strain on your back.

Exercise

While rest is important, you may also need to implement some movement as a way to reduce pain. Low-impact exercises are best and are usually what you will be cleared for in the early postpartum period. Core exercises that strengthen your pelvic area and abdomen are good options, as well as yoga, according to the National Center for Complementary and Integrative Health.

Over-the-Counter Medications

If you feel your back pain is hard to deal with, you can use an over-the-counter medication like ibuprofen. You may have even been sent home with some from your obstetrician. If you are breastfeeding or have any prescribed medications, always check with your doctor before taking over-the-counter medications.

When to Seek Professional Help for Back Pain

Back pain that is not easily remedied with these methods or lasts for a prolonged period of time may require professional help. Data from a 2019 study showed that general postpartum back pain is usually resolved within 6 months of delivery, but you can seek care well before that.

So when does back pain require a trip to the spine doctor? Any troubling symptoms, like numbness or weakness in the legs, worsening of existing pain, or headaches, should be reported to a doctor or back pain specialist.

Depending on the symptoms you describe and any problems that appear on diagnostic scans, your provider will create a plan for treatment that fits your needs and lifestyle.

Physical Therapy

One of the first treatments you may seek out is physical therapy. A physical therapist will seek to help relieve your pain, in addition to improving mobility and posture and teaching you techniques to prevent pain in the future.

Some techniques you may learn from a physical therapist include:

  • Maintaining proper posture and avoid hunching, especially when feeding or cuddling your baby
  • Being conscious of how you bend and lift, using your legs and not your back
  • Doing gentle exercises like pelvis floor muscle strengthening movements
  • Elevating your feet when sitting
  • Avoiding standing for long periods of time, or when standing, keeping one foot on a low stool to remove pressure from the lower back

In addition to these tips for home, a physical therapist will create a personalized plan that combines in-office exercises and other treatments to help you relieve pain and return to better movement.

Chiropractic Care

In the time when your pelvis and spine are shifting and shrinking, a chiropractor will be able to help guide them to do so properly, avoiding misalignments once they settle. This can also help the process along. Many chiropractors that specialize in working with pregnant women also work with postpartum women often and are able to perform adjustments that are designed to relieve or manage this pain.

Nerve Damage from Epidurals

In rare cases, the back pain you experience will be directly related to the process of receiving an epidural.

The most common example is nerve damage that results from the injection itself. This will usually impact a single nerve and cause numbness on the skin or limited weakness in the muscles, along with back pain. There may also be sensory issues or loss of motor control associated with nerve damage. In most cases, these symptoms will be temporary and resolve within a few weeks. Even rarer is permanent nerve damage that results in the loss of use of a limb or loss of control of the bladder or bowels.

When nerve damage does occur, it can be a result of an injury caused by the needle or catheter, a blood clot, infections, or inadequate blood supply.

If you are concerned about nerve damage, a neurologist will be able to evaluate you to understand the cause of your symptoms and the extent. You may undergo an MRI or CT scan in addition to nerve conduction studies. This will help guide a treatment plan to attempt to reverse the nerve damage or prevent further complications.

What About Epidural Steroid Injections?

For those who use epidurals to manage existing back pain, there may be additional hesitation at the idea of back pain as a side effect. Because most back pain is believed to be related to pregnancy and birth, the risk is much lower in these cases.

However, these injections are not without risk. Many people experience nausea, headaches, dizziness, flushing, or anxiety as a result of the procedure. These are short-term and usually do not require more treatment than an ice pack.

Any potential back pain related to these injections would be related to the injection site itself. For this reason, it is important to be sure you go to a trusted provider when seeking epidural steroid injections. They will be able to administer the treatment in the most careful way possible to lower the risk of any injection site problems that could cause nerve complications.

Whether you recently gave birth or you are seeking experts in epidural steroid injections, AICA Orthopedics has a staff that is ready to help you. Our physical therapists and chiropractors work with pregnant and postpartum women every day and will design plans specific to your needs.

Sources

https://my.clevelandclinic.org/health/diseases/9639-headaches

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681359/

https://www.nhs.uk/conditions/epidural/side-effects/

https://www.nccih.nih.gov/health/yoga-what-you-need-to-know