Joint pain related to post partum

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

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There are multiple causes of aches and pains in the postpartum period. These include the physical stress related to carrying a child plus the effects of the pregnancy hormone relaxin (oxytocin), which relaxes the ligaments attached to the pubic bone. There is the trauma related to delivery, which can sprain the coccyx (tailbone). In addition, epidural anesthesia which (as my wife said, "I NEED IT!" ) during delivery also blocks pain signals that ordinarily would warn the patient to switch body position.

Many new mothers can get neck, back, hip and even carpal tunnel (wrist) pain as a result of the tasks of caring for a baby and all the unfamiliar work that involves.

Another common cause of joint aches and pains that sometimes gets worse in the post partum period is fibromyalgia.

Fibromyalgia syndrome (FMS) presents with symptoms of muscle aches, pains and fatigue.

Criteria have been developed for the diagnosis of fibromyalgia (American College of Rheumatology) and although the criteria are mainly based on specific muscle or tendon points of pain, the syndrome also includes generalized aches and pains, poor sleep, stiffness upon waking, fatigue, headaches, memory and concentration problems, dizziness, numbness and tingling, itching, fluid retention, crampy abdominal or pelvic pain, constipation, and diarrhea. With fibromyalgia, the fatigue and tiredness factor is based primarily on sleep deprivation.

Rheumatoid arthritis often improves during pregnancy, then flares up again after pregnancy. It is not uncommon for rheumatoid arthritis to first appear after pregnancy. Possible causes for flare-up during the postpartum period include the following:

• A decrease in circulating anti-inflammatory steroid levels
• Elevated levels of prolactin (ie, proinflammatory hormone effect)
• Change in the neuroendocrine axis (the link between the brain and the rest of the body)
• Change from a TH2 to a helper T cell 1 cytokine profile. (A bit technical... but trust me... not a good thing!)

Postpartum thyroid difficulties are common – as many as 10 percent of women may suffer thyroid problems after childbirth. Thyroid disease can often be associated with joint pains.

Systemic lupus erythematosus (SLE) often flares during pregnancy and in the postpartum period, causing severe jointpains as well as other systemic symptoms.

Two interesting articles discussing pain syndromes after pregnancy follow...

Hip, knee, and foot pain during pregnancy and the postpartum period

Journal of Family Practice, July, 1996 by Valerie J. Vullo, James K. Richardson, Edward A. Hurvitz

This study suggests that musculoskeletal pain in the lower extremity is common in all women, but pregnancy is a significant risk factor, especially for hip and foot pain. Biomechanical factors appear to play a larger role than hormonal influences in contributing to lower extremity pain in pregnant women. Exercise, amount of stair climbing, and amount of weight gain do not appear to increase or decrease the prevalence of lower extremity pain in pregnant women, but there was a trend toward more pain among older patients in both groups. This pain, however, tends to be self-limited and generally resolves within 4 months.

Acta Obstet Gynecol Scand. 2001 Jun;80(6):505-10.

Prognosis in four syndromes of pregnancy-related pelvic pain.

Albert H, Godskesen M, Westergaard J.

Departments of Physiotherapy and Gynecology and Obstetrics, Odense University Hospital, Odense, Denmark.

BACKGROUND: The aim of the present study was to describe, on the basis of specific classification criteria and for a period of two years after delivery, the prognosis for women suffering from pregnancy-related pelvic joint pain, and to describe the characteristics influencing the prognosis. METHODS: One thousand seven hundred and eighty-nine pregnant women who were booked for delivery at Odense University Hospital formed a cohort to investigate the prognosis. Women whose reported daily pain from pelvic joints could be objectively confirmed were divided, according to symptoms, into five subgroups (n=405) - four classification groups (pelvic girdle syndrome, symphysiolysis, one-sided sacroiliac syndrome and double-sided sacroiliac syndrome) and one miscellaneous. The women in the five subgroups were re-examined at regular intervals for two years after delivery or until disappearance of symptoms (whichever was less). Thre hundred and forty-one women from the 5 subgroups participated in the postpartum follow-up. RESULTS: The majority (62.5%) of women in the four classification groups experienced disappearance of pain within a month after delivery. Two years after parturition 8.6% were still suffering from pelvic joint pain (determined subjectively and objectively). Persistence of pain was found to vary significantly from one classification group to another. None of those initially classified as suffering from symphysiolysis had pain 6 months after delivery in comparison to the 21 percent of those with pelvic girdle syndrome who continued to have pain at the two-year mark. CONCLUSIONS: This study shows that pregnancy-related pelvic joint pain had an excellent postpartum prognosis (in general) in three out of four classification groups. The women with pelvic girdle syndrome (pain in all 3 pelvic joints) had a markedly worse prognosis than the women in the other three classification groups. High number of positive test and a low mobility index were identified as giving the highest relative risk for long term pain.

PMID: 11380285 [PubMed - indexed for MEDLINE]

Get more information about joint pain related to post partum and related conditions as well as...

• Insider arthritis tips that help you erase the pain and fatigue of rheumatoid arthritis almost overnight!

• Devastating ammunition against low back pain... discover 9 secrets!

• Ignored remedies that eliminate fibromyalgia symptoms quickly!

• Obsolete treatments for knee osteoarthritis that still are used... and may still work for you!

• The stiff penalties you face if you ignore this type of hip pain...

• 7 easy-to-implement neck pain remedies that work like a charm!

• And much more...

Click here Second Opinion Arthritis Treatment Kit

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