Pain Management

Discuss options for pain relief with your doctor and  ask for a referral to a physiotherapist with an interest in treating pelvic girdle pain.  They will perform a thorough assessment of your spine. pelvis and hips and devise an individual plan of treatment for you.

Advice will also be given  on things you can do  in your everyday life to help reduce pain and make things easier for you. This in itself can make a big difference to the amount of pain  you are experiencing. If you are having difficulties with activities of daily living such as bathing, cooking etc an Occupational Therapy Assessment can also be very helpful. 

The next generally recommended step in managing pain is to try non drug methods such as Trans Electrical Nerve Stimulation (TENS) and Acupuncture.

Acupuncture can be helpful  in managing pelvic girdle pain and is more effective if combined with physiotherapy rather than being used on its own.  In some areas acupuncture is available through the NHS, usually from your physiotherapist, but some GPs are also trained in acupuncture.  

TENS has been used by women during pregnancy for many years and no side effects have been reported for mother or baby.

The ACPWH have recently produced guidelines for the use of TENS  during pregnancy which can be accessed by clicking the link below.

Guidelines:

 ACPWH Guidelines on the safe use of Transcutaneous Electrical Nerve Stimulation for musculoskeletal pain during pregnancy(2007)

These guidelines cover the various things  to consider in using TENS safely in pregnancy and recommend that the use of TENS or  acupuncture is preferable to strong medication for pain.

Reviews:

The British Pain Society produced three reviews in the spring of 2008. The third review (starting on page 10 of the document ) is on the Management of Non Obstetric Pain in Pregnancy. Click here to access the document.

Medications

Discuss your options with your doctor. Paracetamol is often the first thing to try  with  the next step up from this  usually  a combination of Paracetamol and codeine. Both these drugs are generally considered safe to use in pregnancy but like all medicines in pregnancy the potential risks/benefits should be considered carefully. Your GP will know your full medical history and will be able to advise you on the best options available to you.  All anti inflammatory medicines,  including aspirin and ibuprofen which are available to buy over the counter should be avoided in pregnancy.

If  you are continuing to have problems with pain control your GP may refer you to a pain clinic or ask your consultant obstetrician for advice.

Other therapies

Other therapies such as cognitive behavioural therapy can be useful in managing pain. Your GP or pain clinic can advise you.

Massage

Massage can be extremely beneficial in reducing pain from pelvic girdle pain/Symphysis Pubis Dysfunction(SPD). It is also helpful as a means of   relieving muscle tension and reducing muscle and joint pain  and has other  potential benefits including reducing fatigue and promoting feelings of well being.

Massage during pregnancy can help support the physical changes of pregnancy by improving muscular and hormonal imbalances and some therapists have undergone specific  training in the use of pregnancy massage.  It is important that before you embark on any massage therapy that you check that your therapist is suitably qualified and also discuss which oils/wax would be suitable to use. Massage to certain areas including deep massage to the stomach should be avoided in pregnancy and some practioners are reluctant to use massage in the first 12 weeks of pregnancy.

Massage can  be very effective in conjunction with treatment from a physiotherapist, osteopath or chiropractor with experience in managing Pelvic Girdle Pain/Symphysis Pubis Dysfunction(SPD)

Below is an  account of the role of pre and perinatal massage in relation to Pelvic Girdle Pain/Symphysis Pubis Dysfunction(SPD) written by Ronnie Allan, Massage Specialist who has a special interest in pregnancy massage and   who practices in Ayrshire.

"Massage can play a very  important role in the relief, stabilisation and repair of this debilitating problem. It is a problem, which from my point of view appears to be on the increase.

First and foremost it is important to determine that the problem is actually pelvic girdle pain/symphysis pubis dysfunction(SPD), as a number of clients referred to me , have actually been suffering from other problems.  Examples of mistaken pelvic girdle pain which I have seen are round ligament pain and inflammation at the attachment (anterior of the body of the pubis) of the origin of the adductor longus - both of which were easily resolved.

During massage I will use various techniques, from sports and remedial massage, body sculpting, muscle energy techniques and trigger point work, none of which require contact with the actual painful area of the pubic bone. The only contact with the pubic bone is during palpation of the pubic symphysis from a superior position to help confirm firstly that it is a Symphysis Pubis Dysfunction(SPD) problem and secondly to confirm whether there is separation or shear.

During the massage, work is also done on the sacroiliac joint, which may be the main cause of the problem. Massage and mobilisation in this area can help realign the pelvic girdle, giving relief and stabilisation. Without exception, all of the clients I have seen with this problem have benefited from pre and peri- natal massage.

Advice and massage early on the pregnancy are also very important and as yet any client I have worked with on a regular basis from early in the pregnancy has avoided this and many of the other problems that occur during pregnancy.

Simple things can help make a difference or prevent pelvic girdle pain/Symphysis pubis dysfunction (SPD) when getting in and out of a car, keep the knees together, shuffling the feet round and then lifting both legs together. Look at the best way of getting in and out of bed, sitting down or standing up from a chair and general posture. 

Post partum work is also very important with the client returning for massage at their earliest convenience. Early massage again will help in the realignment of the pelvis and correct posture.

Pre and peri -natal massage has great benefits during pregnancy, labour and post partum, due to the many soft tissue problems that occur and without question regular massage can help prevent a problematic pregnancy and improve the quality of life."

 

Other Complimentary Therapies

Such as soft tissue therapy and the Bowen Technique.

Information on this will be added in shortly. In the meantime if you have any experiences you would like to share please contact us at info@pelvicinstability.org.uk

Other factors

Depression and anxiety can also affect the way your body responds to pain. Seek advise from your GP if you feel this may apply to you.

Remember you are not alone with this problem. Talking to others who are experiencing similar problems can be very therapeutic.

There are forums for pelvic girdle pain, where experiences can be shared along with hints and tips for coping on many of the pregnancy websites such as bounty, babyworld and babycentre.These forums are under the previous name "symphysis pubis dysfunction" or "spd".

 You may also wish to become a member of  Pelvic Instability Network Scotland (PINS)  and help us raise awareness of Pelvic Girdle Pain. We can put you in touch, if you wish, with other members  who are affected by pelvic girdle pain.

A Personal Account

Click Here to view Avril's Story of Managing Chronic Pain.

 Other sources of support/information:

Pain Association Scotland - www.chronicpaininfo.org

Pain Concern  - www.painconcern.org.uk

British Pain Society  www.britishpainsociety.org

Information about Cognitive Behavioural Therapy    www.livinglifetothefull.com

Have a look at our useful links page for further information.

Free Membership of PINS - click here

References:

Acupuncture

Nina Kvorning, Catharina Holmberg, Lars Grennert, Anders Aberg, Jonas Akeson.  Acupuncture relieves pelvic and low-back pain in late pregnancy Acta Obstet Gynaecol Scand 2004: 83: 246-250

Elden H, Ladfors L,Olsen MF, Ostgaard HC, Hagberg H. Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain randomised single blind controlled trial. BMJ 2005: 330: 761