Physical Therapists Reluctant to Recommend Acupuncture for Low Back Pain in Pregnant Patients

Low back pain is notoriously difficult to treat in common patients. For pregnant patients, who experience low back pain at significantly higher rates, pain management specialists can face some additional and unique challenges.

For one, will the chosen therapy be safe and well-tolerated not just for the patient, but for the fetus as well? Another concern is the dosage to recommend: It is well known that pregnant women metabolize differently than non-pregnant patients. Also, pain medications that might be safe and effective in the first two trimesters of pregnancy, including NSAIDs like ibuprofen and naproxen, show some evidence of human fetal risk if taken in the third trimester.

Beyond that, is there a chance that a pain remedy could inadvertently lead to a premature delivery?

There are few randomized, controlled clinical trials demonstrating safety and efficacy for medications in pregnant women, though there are many animal studies in the clinical research. But even for non-drug treatments such as acupuncture, the concerns outlined above persist. Often, pregnant patients are told that low back pain is a normal part of pregnancy, and many are advised to self-manage pain.

A recent study in Physical Therapyaimed to “explore the perceptions and experiences of physical therapists involved in treating women who are pregnant and have low back pain.” Though there is some available research on the safety and efficacy of acupuncture for pregnant patients, it has yet to be rigorously investigated. What evidence there is shows a low rate of adverse events, and those that were seen, such as needling pain, were mild in severity.

ThePhysical Therapy study employed three focus groups and three individual interviews with patients of twenty-one participating physical therapists. Initial questioning of the participating PTs indicated a lack of experience in treating pregnancy-related complaints, mistrust of the current evidence about the safety and effectiveness of acupuncture for these patients, and personal and professional fear of causing the patients harm. Among the major concerns cited was the possibility of triggering a premature birth, despite the fact that not one documented study has pointed to any increased risk of miscarriage, congenital anomalies, or premature birth resulting from acupuncture treatment during pregnancy.

The researchers hope to use the study to jump-start a larger pilot randomized trial to help develop a standard of low back pain care for pregnant women.