Lumbopelvic pain during and after pregnancy : aspects of catastrophizing, fear-avoidance beliefs, physical ability and health-related quality of life

Abstract

Background: Every second pregnant woman suffers from lumbopelvic pain, and many report remaining pain postpartum. Lumbopelvic pain affects the woman s life in many ways and it is the main reason for sick leave during pregnancy. Lumbopelvic pain has mainly been studied from a biomedical perspective, but to fully explain the experience and its consequences a biopsychosocial approach is needed.

Aim: To study aspects of pain, catastrophizing, fear-avoidance beliefs, physical ability, and health related quality of life during and after pregnancy, among women with and without lumbopelvic pain.

Methods: Self-report questionnaires were used in two different samples. In Study I women at weeks 34 37 of pregnancy rated pain intensity, physical ability and health-related quality of life. In addition, in studies II-IV the women also rated catastrophizing and fear-avoidance beliefs on three occasions; at weeks 19 21 and weeks 34 37 of pregnancy, and 6 months postpartum. In studies I (n=136) and II (n=324), comparisons were made between women with and women without lumbopelvic pain. In Study III (n=273) determinants for postpartum lumbopelvic pain were investigated. In Study IV (n=242) catastrophizing was followed over time and the associations between catastrophizing and lumbopelvic pain and level of physical ability postpartum were studied. Non-parametric analyses were used in studies I-IV and the Cox proportional hazards model was used in Study III.

Results: Women with lumbopelvic pain (44%) in weeks 19 21 of pregnancy had higher levels of catastrophizing and fear-avoidance beliefs, limited physical ability and lower health-related quality of lifecompared with women without lumbopelvic pain (Study II). Women with lumbopelvic pain (51%) in weeks 34 37 of pregnancy had limited physical ability and lower health-related quality of lifecompared with women without lumbopelvic pain (Study I). High levels of catastrophizing and more limited physical ability, in combination with lumbopelvic pain during pregnancy, doubled the risk for postpartum lumbopelvic pain (Study III). Most women did not report catastrophizing on any of the three measurement occasions, while 10% reported catastrophizing in all three occasions. For 32% catastrophizing varied over time (Study IV). Women who catastrophized on any occasion had limited physical ability postpartum compared with non-catastrophizing women.

Conclusion: Pregnancy adversely affects physical ability and health-related quality of life, and in these studies, pregnant women with lumbopelvic pain reported the most negative consequences. They also had higher levels of catastrophizing and fear-avoidance beliefs compared with pain-free women. Catastrophizing seems important in this context of lumbopelvic pain and pregnancy. One-tenth of the women reported catastrophizing on all of the measurement occasions and, surprisingly, catastrophizing varied over time in one-third of the women. The results imply that a broad perspective is necessary when meeting pregnant women both with and without lumbopelvic pain since, apart from biological factors, also psychosocial factors seem relevant.