Background: To compare the efficiency of transcutaneous electrical nerve stimulation (TENS) with those of exercise and acetaminophen for the treatment of pregnancy-related low back pain (LBP) during the third trimester of pregnancy. Methods: This prospective study included 79 subjects (≥32 gestational weeks) with visual analog scale (VAS) pain scores ≥5. Participants were divided randomly into a control group (n = 21) and three treatment groups [exercise (n = 19); acetaminophen (n = 19); TENS (n = 20)]. The VAS and the Roland-Morris disability questionnaire (RMDQ) were completed before and 3 weeks after treatment to assess the impact of pain on daily activities. Results: During the study period, pain intensity increased in 57% of participants in the control group, whereas pain decreased in 95% of participants in the exercise group and in all participants in the acetaminophen and TENS groups. Post-treatment VAS and RMDQ values were significantly lower in the treatment groups (p < 0.001). VAS and RMDQ scores indicated a significantly greater degree of pain relief in the TENS group than in the exercise and acetaminophen groups (p < 0.001). No adverse effect of TENS application on pregnant women was observed during the study. Conclusion: TENS is an effective and safe treatment modality for LBP during pregnancy. TENS improved LBP more effectively than did exercise and acetaminophen.

1.
Sabino J, Grauer JN: Pregnancy and low back pain. Curr Rev Musculoskelet Med 2008;1:137–141.
2.
Mogren IM, Pohjanen AI: Low back pain and pelvic pain during pregnancy: prevalence and risk factors. Spine 2005;30:983–991.
3.
Ostgaard HC, Andersson GB, Karlsson K: Prevalence of back pain in pregnancy. Spine 1991;16:549–552.
4.
Wang SM, Dezinno P, Maranets I, Berman MR, Caldwell-Andrews AA, Kain ZN: Low back pain during pregnancy: prevalence, risk factors, and outcomes. Obstet Gynecol 2004;104:65–70.
5.
To WW, Wong MW: Back pain symptoms and bone mineral density changes in pregnancy as measured by quantitative ultrasound. Gynecol Obstet Invest 2009;67:36–41.
6.
Wu WH, Meijer OG, Uegaki K, Mens JM, van Dieën JH, Wuisman PI, Ostgaard HC: Pregnancy-related pelvic girdle pain (PPP). I. Terminology, clinical presentation, and prevalence. Eur Spine J 2004;13:575–589.
7.
Stapleton DB, MacLennan AH, Kristiansson P: The prevalence of recalled low back pain during and after pregnancy: a South Australian population survey. Aust N Z J Obstet Gynaecol 2002;42:482–485.
8.
Pennick VE, Young G: Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Syst Rev 2007;CD001139.
9.
Berg G, Hammar M, Moller-Nielsen J, Linden U, Thorbald J: Low back pain during pregnancy. Obstet Gynecol 1988;71:71–75.
10.
Stuge B, Hilde G, Vollestad N: Physical therapy for pregnancy-related low back and pelvic pain: a systematic review. Acta Obstet Gynecol Scand 2003;82:983–990.
11.
Mens JM, Damen L, Snijders CJ, Stam HJ: The mechanical effect of a pelvic belt in patients with pregnancy-related pelvic pain. Clin Biomech 2006;21:122–127.
12.
Sabatowski R, Radbruch L, Grond S, Göhring UJ: Treatment of severe low back pain with opioids during pregnancy in a patient with incomplete tetraplegia. Acta Anaesthesiol Scand 2000;44:348–350.
13.
Kvorning N, Holmberg C, Grennert L, Aberg A, Akeson J: Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand 2004;83:246–250.
14.
Wang SM, DeZinno P, Fermo L, William K, Caldwell-Andrews AA, Bravemen F, Kain ZN: Complementary and alternative medicine for low-back pain in pregnancy: a cross-sectional survey. J Altern Complement Med 2005;11:459–464.
15.
Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965;150:971–979.
16.
Augustinsson LE, Bohlin P, Bundsen P, Carlsson CA, Forssman L, Sjöberg P, Tyreman NO: Pain relief during delivery by transcutaneous electrical nerve stimulation. Pain 1977;4:59–65.
17.
Lechner W, Jarosch E, Sölder E, Waitz-Penz A, Mitterschiffthaler G: Beta endorphins during childbirth under transcutaneous electric nerve stimulation (in German). Zentralbl Gynakol 1991;113:439–442.
18.
Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC, Hao JX, Terenius L: Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain 1991;47:295–298.
19.
Holdcroft A, Power I: Recent developments: management of pain. BMJ 2003;326:635–639.
20.
Dowswell T, Bedwell C, Lavender T, Neilson JP: Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev 2009;CD007214.
21.
Kaplan B, Rabinerson D, Lurie S, Bar J, Krieser UR, Neri A: Transcutaneous electrical nerve stimulation (TENS) for adjuvant pain-relief during labor and delivery. Int J Gynaecol Obstet 1998;60:251–255.
22.
Labrecque M, Nouwen A, Bergeron M, Rancourt JF: A randomized controlled trial of nonpharmacologic approaches for relief of low back pain during labor. J Fam Pract 1999;48:259–263.
23.
Thakur R, Patidar R: Comparative study of transcutaneous electrical nerve stimulation (TENS) and tramadol hydrochloride for pain relief in labor. J Obstet Gynecol Ind 2004;54:346–350.
24.
Chao AS, Chao A, Wang TH, Chang YC, Peng HH, Chang SD, Chao A, Chang CJ, Lai CH, Wong AM: Pain relief by applying transcutaneous electrical nerve stimulation (TENS) on acupuncture points during the first stage of labor: a randomized double-blind placebo-controlled trial. Pain 2007;127:214–220.
25.
Tsen LC, Thomas J, Segal S, Datta S, Bader AM: Transcutaneous electrical nerve stimulation does not augment combined spinal epidural labour analgesia. Can J Anaesth 2000;47:38–42.
26.
Roland M, Morris R: A study of the natural history of back pain. I. Development of a reliable and sensitive measure of disability in low-back pain. Spine 1983;8:141–144.
27.
Albert H, Godskesen M, Westergaard J: Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J 2000;9:161–166.
28.
Ostgaard HC, Zetherström G, Roos-Hansson E, Svanberg B: Reduction of back and posterior pelvic pain in pregnancy. Spine 1994;19:894–900.
29.
Mogren IM: Previous physical activity decreases the risk of low back pain and pelvic pain during pregnancy. Scand J Public Health 2005;33:300–306.
30.
Garshasbi A, Faghih Zadeh S: The effect of exercise on the intensity of low back pain in pregnant women. Int J Gynaecol Obstet 2005;88:271–275.
31.
Suputtitada A, Wacharapreechanont T, Chaisayan P: Effect of the ‘sitting pelvic tilt exercise’ during the third trimester in primigravidas on back pain. J Med Assoc Thai 2002;85(suppl 1):S170–S179.
32.
Dumas GA, Reid JG, Wolfe LA, Griffin MP, McGrath MJ: Exercise, posture, and back pain during pregnancy. Clin Biomech 1995;10:104–109.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.