back pain after epidural - Mothering Forums

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#1 of 11 Old 02-03-2007, 09:33 AM - Thread Starter
 
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This came from another thread, but didn't want to make a big tangent there...

I hear from many women years later that they swear they have persistant back pain at the site where their epidural was placed. I believe them, but I don't know why it can happen. Scarring? Infection? Muscle damage? Can anyone enlighten me? Sounds like it can happen both when the epi takes and is routine and normal, and when something goes wrong with it.
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#2 of 11 Old 02-03-2007, 11:37 AM
 
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I've heard this too (and I've heard an OB on a call in medical show refute the possibility of this).

My understanding of this that it is related to scarring, otherwise termed adhesions, of the dura mater of the spinal cord, or leaking of cerebrospinal fluid at the site of the epidural into the epidural space if it goes in too deep.

I really began to understand this concept in massage school, when we applied the info to CST of the dural sheath to remove adhesions. Adhesions can be caused by anything that damages the dural sheath in some way, a common one being whiplash. I'll quote from my A&P text "The Principles of Anatomy and Physiology" by Tortora to explain:

"The most superficial of the spinal meninges [connective tissue sheaths] is the dura mater, it forms a sac from the level of the foramen magnum in the occipital bone, where it is continuous with the dura mater of the brain; The spinal cord is also protected by a cushion of fat and connective tissue located in the epidural space, a space between the dura mater and the wall of the vertebral canal [the inner "tube" formed by the bones of the spine]"

Because the dura mater is continous with the sheaths covering the brain, epidurals can also cause headaches, as well as pain at the site.

-Lau
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#3 of 11 Old 02-03-2007, 11:42 AM
 
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I wanted to add one thing I forgot: all connective tissue in the body is connected (naturally!) which means that the fascia surrounding all muscles and nerves all the way out into the more superficial skin layers, is part of a continous whole. this includes the dura mater and other meninges. I've learned that that is one reason that the experience of pain or discomfort may not always appear to make sense in a direct way, but somewhere, there is a root for it, oftentimes along a nerve pathway, but not always.

-Lau
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#4 of 11 Old 02-03-2007, 11:51 AM
 
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Hey, thanks for the explanation! I had back pain after my epidural with #1. Thankfully it only last 9 months. Guess what my doctor said when I was pg with #2 not too keen on getting an epidural again?

"Oh, it's unlikely to happen again."

That may be, but it happened to me once and that's enough!

Switched to a home birth after that.

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#5 of 11 Old 02-03-2007, 12:15 PM - Thread Starter
 
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Thank you, that makes sense to me. I studied cranio-sacral therapy a bit and learned about the dura then... Perhaps that would be an avenue of treatment for those who experience this kind of pain? I have just heard it too many times for it not to be true....
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#6 of 11 Old 02-03-2007, 07:13 PM
 
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There are sound physiological reasons for why punching a hole in someone's spine can be complicated and go onto be painful in later years. I know so many women who've experienced nerve damage and repeated attempts by anaesthetists to get the thing in there. It's not like they don't get a lot of practice, now is it...

I just wanted to add a mention of emotional issues into this too. I've seen many many women with pain in birth scars that erupts from time to time as they deal with the issues or if they think about them in the early stages of grieving. I'm not saying it in a dismissive "Oh it's all in your head" way, I just like to acknowledge that we can and do store these kinds of traumas in the cellular memory of our bodies and so the pain can be a multi-facetted thing indicating the possibilities of more than physical damage as a cause.

ETA: I think for some women who are unsupported in the emotional side of their trauma that physical pain is an acceptable part of the mainstream birth paradigm in which they can express suffering when emotional stuff is dismissed. Again, I say this not to undermine the reality that this stuff HURTS because it does but from working with many women I have seen how it's about the only way many women can initially express the distress of what happened to them. Women often start out describing the physical side of their pain because it's more supported then as time passes and their feelings are validated and they feel safe, they can move into putting the pain where it belongs - their hearts and psyches. Please remember none of this is to dismiss women's physical pain or emotional pain, just to introduce some shades of grey into it and give us a more holistic framework in which to support women more fully after birth trauma has occurred.
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#7 of 11 Old 02-04-2007, 04:16 PM
 
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Glad to help with the explanation. Yes, CST can be utilized to address post epi pain.

I agree with JanetF about the psychoemotional elements that can come with physical pain.

It's also been my experience that CST can access unconsious memories in the reciever.

-Lau
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#8 of 11 Old 02-08-2007, 12:00 AM
 
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All I know is that I experience this pain myself. I received an epidural for #2 and that was 3 years and 3 days ago!!! It was so painful after my birth that when I became pregnant with #3, I refused to get another epi! I guess in a way the pain was beneficial as I'm now pro NCB Oddly enough, after my pregnancy with #3, the pain persisted for a several months and then went away, but when I became pregnant with #4 the pain has come back. I wonder if it's something to do with the relaxin. I don't think it's stress related as I'm having another NCB and am not nervous or anxious about it all, I'm actually excited, can't wait till birth day!
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#9 of 11 Old 02-08-2007, 09:44 AM
 
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Glad to read this, interesting to know! I had pain at site after my epidural, it has subsided a bit. It was worse the first year after birth. I flat out refused to ever get an epidural again.
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#10 of 11 Old 02-08-2007, 01:35 PM
 
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Birthinglau, good explanation.

I wanted to add this story. I am a chiropractor and did on internship with a chiro. who has been in practice for 25 years. He's seen a lot and told me this story about one of his patients. She was (and still is) a wellness patient and had been seeing him monthly for about five years when she got pregnant. She got through her pregnancy with the help of chiropractic care but had a hospital birth with an epidural. After the birth she did not see the chiro for a few months b/c she was so busy but returned b/c of persistent, severe back pain at the site of the epidural. He told her basically what birthinglau just explained to us, but when he did a physical exam, he decided to also take an x-ray based on his findings. You can imagine his surprise when a small, thin, sharp object showed up on the x-ray. B/c he took orthogonal views, he could see this object was between her vertebrae, in her spine! He referred her for surgery...the tip of the epidural needle had broken off and was lodged in her spine! Shocking? YES! And appalling that the anesthesiologist would not have said anything at the time--I think it would be pretty obvious that the tip of the needle was missing when he withdrew it! I do not think that's something you could NOT notice!

Obviously, this is a pretty rare complication, but it can and does happen. The scenario Birthinglau described is much more common.

ETA: I am not telling this story to scare anyone. I found it to be a clinically interesting story and an example of what *might* go wrong with an intervention, however rare. There are plenty of women who have epidurals during labor and have no back pain or headaches later.
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#11 of 11 Old 02-09-2007, 12:57 PM
 
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Wow...interesting thread! I had three epidurals with my first three births and then homebirthed the last two babies and will do the same for any future babes. I had/have tenderness/soreness at the site where I got my epidurals, and this nearly 8 years after my last epidural. I had major lower back pain until I started seeing a chiropractor and got everything back into alignment/massaged out.

I love the information about the dura...that makes perfect sense. And Yikes about the needle tip still being in the spine! Yowsa!

Homebirth Midwifing mama to five blessings in Northeastern PA.
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