Introduction

Have you or a loved one experienced back pain that started or worsened after spinal anaesthesia—especially following childbirth or surgery? This condition, often referred to as Post-Dural Puncture Backache (PDPB) or Post-Spinal Anaesthesia Back Pain, is a common but frequently misunderstood problem.

In this blog, we explain why this happens, who is more at risk, how long it usually lasts, and what you can do to manage or prevent it.

Is Post-Spinal Back Pain Common?

Yes, back pain after spinal anaesthesia is common. In fact, up to 70–80% of adults will suffer from back pain at some point in their life, and 20–40% of patients undergoing spinal anaesthesia report back discomfort in the days or weeks following the procedure.

Among women undergoing C-section deliveries, up to 24% experience significant backache afterwards. While most cases are mild and resolve on their own, some people experience pain that lasts for several weeks or even months.

Why Does This Happen?

There are several possible causes of back pain after spinal anaesthesia:

• Needle trauma to tissues and ligaments in the back
• Multiple attempts during the spinal injection
• Muscle spasm or inflammation at the injection site
• Prolonged surgical positioning, especially in awkward or strained positions (e.g. lithotomy)
• Pregnancy-related changes like increased weight, posture changes, and ligament laxity

Sometimes, back pain may be coincidental and not directly caused by the spinal anaesthesia at all—especially if the patient had back pain before the procedure.

Who Is More At Risk?

Certain people are more likely to experience this kind of pain, such as:

• Those with pre-existing back pain
• Individuals with a high BMI (Body Mass Index)
• Patients who remained in one position for long surgeries
• Women who have undergone C-sections
• Those who needed multiple spinal puncture attempts

Interestingly, studies show that new cases of persistent back pain after spinal anaesthesia are rare—less than 1%.

How Long Does It Last?

In most cases, this type of back pain:

• Appears within a few days after the procedure
• Begins to improve within 1–2 weeks
• Resolves completely by 3 months

Only a very small number of patients experience pain beyond this period. When this happens, it’s often related to underlying issues that were already present before the spinal injection.

How Can You Prevent It?

While it may not always be preventable, the following steps can reduce the risk:

• Using smaller gauge spinal needles
• Choosing the paramedian approach instead of the midline technique (less tissue trauma)
• Minimising the number of puncture attempts
• Ensuring good positioning during and after surgery
• Staying active after surgery (as per medical advice)

Your anaesthetist can play a key role in adopting these techniques to make your spinal procedure safer and more comfortable.

What Can You Do to Manage the Pain?

Most cases of PDPB are self-limiting and respond well to conservative care. Here are some useful management tips:

• Rest: Allow your back to recover, especially in the early days.
• Heat therapy: Warm compresses or hot baths can relax tense muscles and reduce spasms.
• Gentle exercise: Light stretching, yoga, or walking can aid recovery and prevent stiffness.
• Maintain good posture: Use pillows for support while feeding your baby or sitting for long periods.
• Avoid heavy lifting: Learn to lift using your legs, not your back.
• Pain relief medications: Paracetamol or anti-inflammatory medicines can be helpful if prescribed by your doctor.
• Physiotherapy: Can be very effective in restoring strength and function.
• Massage therapy: Helps to relax the back muscles and improve blood circulation.

If your pain continues or worsens over time, consult a pain specialist to rule out other causes and discuss further treatment options.

Final Thoughts

Back pain after spinal anaesthesia can be a source of discomfort but is usually temporary and treatable. With the right care and guidance, most people make a full recovery within a few weeks.

If you’re experiencing persistent back pain after surgery or childbirth, don’t ignore it. At the International Pain Centre in Delhi, we offer expert evaluation and evidence-based treatments to help you live pain-free.

Need help with persistent back pain?

Contact our experienced Pain Specialists at International Pain Centre, Delhi.

Let’s work together to remove your pain.

For more information watch the video below

References

• Schwabe K, Hopf H-B. Persistent back pain after spinal anaesthesia in the non-obstetric setting: incidence and predisposing factors. British Journal of Anaesthesia. 2001;86(4):535–539. https://doi.org/10.1093/bja/86.4.535
• Aryasa T, Pradhana AP, Ryalino C, Hartawan IGAGU. Post-Spinal Backache after Cesarean Section: A Systematic Review. Bali Journal of Anesthesiology. 2021;5(4):234–238. https://doi.org/10.4103/bjoa.BJOA_72_21
• Rafique MK, Taqi A. The causes, prevention and management of post spinal backache: An overview. Anaesthesia, Pain & Intensive Care. 2011;15(1):65–69.
• Munnur U, de Boisblanc MR, Suresh MS. Backache, headache, and neurologic deficit after regional anesthesia. Anesthesiology Clinics of North America. 2003;21(1):71–86.
• Mishra NK, Singh R, Prakash R, et al. Post-Spinal Anesthesia Low Back Pain in Obese Female Patients: Comparison of the Median Versus Paramedian Approach. Cureus. 2024;16(3):e56784. https://doi.org/10.7759/cureus.56784
• Lee JH, Yoon DH, Heo BH. Incidence of newly developed postoperative low back pain with median versus paramedian approach for spinal anesthesia. Korean Journal of Anesthesiology. 2020;73(6):518–524. https://doi.org/10.4097/kja.19409
• Shanthi M, Gayathiri N, Paul EJ. Prevalence of back-pain following caesarean section under spinal anesthesia. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2023;12(9):2876–2880. https://doi.org/10.18203/2320-1770.ijrcog20232758
• Akdemir M, Kaydu A, Yanlı Y, et al. The Postdural Puncture Headache and Back Pain: The Comparison of 26-gauge Atraucan and 26-gauge Quincke Spinal Needles in Obstetric Patients. Anesthesia: Essays and Researches. 2017;11(2):458–462.

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• Persistent or worsening back pain. Back pain often goes away in a few days or weeks but if it is persisting or progressively increasing then its reason to seek medical attention. 
• Back pain associated with progressive numbness, tingling, or weakness. This could be a symptom of pinched nerve, slipper disc or narrowing of the space in the spine (slipped disc) and requires medical attention
• Inability to control your bowels or urination (incontinence) Spinal nerve compression can have an impact on one’s ability to control bladder and bowel function, leaving to incontinence. This is a severe symptom and requires immediate medical attention. 
• Back pain starting after an accident. If your back pain began after a fall, accident or an injury
• Back pain that is worse at night
• Back pain associated with unexplained weight loss. .
• Back pain with Fever. This could be a sign of infection or ongoing inflammation
• Back pain in extremes of ages (too young or too old patients) or in high risk individuals such as those with severe osteoporosis or prolonged use of steroids or drug abuse history

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• Narrows blood vessels, reducing the blood flow to the muscles, bones and other body parts
• Impact on brain circuitry
• Impact on immunity and slow healing
• Increased fatigue
• Increase blood pressure

The incidence of chronic low back pain among smokers compared to non-smokers is higher, and smokers experience more severe pain. This is true irrespective of the sex and nature of work (manual laborers Vs white-collar). Some studies have reported former smokers having a higher prevalence of back pain than never smokers and other studies have reported that those who smoked more cigarettes per day had higher prevalence of back pain.

For those with back pain, it is important to know about the link between smoking and back pain as smoking is known to

Impact on Discs

One of the most important factors responsible for increased back pain is the impact of smoking on the discs. The disc is dependent on the surrounding tissues for its nutrition and when we smoke, the pores through which the nutrition goes, start getting blocked, negatively affecting the healing and regenerating capacity of the discs. Nicotine can alter the size of the blood vessels and the ability for the body to adapt, increasing the chances of damage. The flexibility of discs suffers and they can degenerate quickly, leading to early disc problems.

Impact on Bones

Your bones also become weak due to smoking because smoking increases osteoporosis.

Impact on Pain Sensitivity

Another factor due to which the pain can increase is pain sensitivity. When you smoke your pain sensitivity increases which means that the pain which was less troublesome before increases in severity.

Impact on Muscles

So when you smoke, your muscles become weak. Muscle mass, flexibility, and strength decreases and this can become a reason for the pain arising from the muscles

Impact on Tendons & Ligaments

The stability and the strength of ligaments and tendons reduces due to which the instability of the spine can increase.

Other Effects

Besides the above effects, smoking has many other adverse effects such as causing inflammation and impairing immune function affecting the healing capacity of the body.

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Myth #1: Discs slip out of place

The name slipped disc is a misnomer as the disc does not slip out of place. It is firmly supported in its place surrounded by strong ligaments on both sides. The discs have a tough outer layer that surrounds a jelly-like material in the centre. Slipped disc is used to refer to a condition where the disc looses its shape and/or consistency and either the central jelly-like material of the disc leaks or bulges out. In medical terminology other terms such as degeneration, bulging, protrusion, extrusion and sequestration are used to refer to varying magnitudes of the problem.

Myth #2: Slipped discs are always caused by injury

Slipped disc results from a magnitude of factors causing weakening of the disc such as genetic factors, age related wear and tear, lifestyle including physical activity, body weight, smoking etc. They may however come to light after a sudden movement/ injury but the predisposition is already present and sometimes even trivial activities can trigger the symptoms.

Myth #3: Slipped discs always cause excruciating pain

Whilst slipped discs can be quite painful, this is not the case always as the severity of pain can vary. It is possible for a person to have a slipped disc and feel no pain or show no symptoms. For most people, a slipped disc will cause some pain and discomfort, and this generally reduces with time.

The pain from a slipped disc may be felt in the back and/ or the arms/legs. This may be accompanied by other symptoms such as numbness, tingling and muscle weakness.

Myth #4: My x-ray is fine so I cannot have a slipped disc

X-rays of the spine are not good at looking at discs. Although they may show problems such as reduced disc height, they are not good for evaluating slipped discs. MRI scans are better at looking at the spine anatomy in detail. X-rays are used more for evaluation of bones.

Myth #5 : MRI imaging will show the cause of my back pain

Technological advancements have enabled us to identify minute changes in disc structure using investigations such as the MRI. A significant number of normal individuals with no symptoms, when scanned will show disc abnormalities on the MRI. This emphasises the point that not every slipped disc causes pain and the findings need to be interpreted in relation to your history and examination findings. Discs normally wear down as we age, so just because the MRI showed a disc problem doesn’t mean that it is the cause of your pain.

Myth #6: Slipped discs require Surgery Sooner Or Later

In an overwhelming majority of cases the problem will NOT require surgery and can be managed conservatively. Disc bulges are NOT forever. A recent study revealed that spontaneous regression of disc injury can occur with conservative care.

Understandably the idea of being under the knife can be terrifying for most people and this option is required only for severe/ non resolving cases. Experienced, knowledgeable medical professionals always try less invasive treatments first. Non surgical interventions, such as medications, physical therapy and injections, can help in reducing the symptoms. Spinal injections such as nerve root block can sometimes play a key role in controlling symptoms and speeding up recovery. Such injections are administered under x -ray guidance to ensure accuracy.

Myth #7: Movement will make my disc problem worse

Whilst extreme pain episodes may require rest, continued activity is generally advised. Simple activities (such as walking, mild stretches) as recommended by your specialist, can reduce the loss of muscle strength and endurance. It can reduce deconditioning of muscles which in itself can be a source of pain. It may be sensible to avoid certain types of activities such as heavy lifting, impact sports etc whilst the body attempts to repair itself. Movement can plan an essential role in the healing process.

Myth #8: Slipped disc is a permanently disabling condition

Many believe that once they get a slipped disc it’s a lifetime problem and they will never be able to return to normal activity. I have seen patients with normal spine who have not bent forwards for years as they were advised not to do that during a back pain episode. Such strongly embedded negative beliefs are disabling and dealing with them can be challenging. With patience, correct knowledge and timely treatment most individuals can return to 100% prior level of function without pain.

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