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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Piriformis muscle is located deep in the buttock and helps to rotate the leg outwards. It extends from the side of sacrum and tailbone to the upper part of thigh bone. One of the main nerves of the leg (sciatic nerve) runs in close relation to this muscle. Problems of the piriformis muscle such as spasms or swelling, can cause irritation of the sciatic nerve leading to sciatica like symptoms. This condition is addressed as piriformis syndrome (PS). Other names for this condition include extra-spinal sciatica, deep gluteal syndrome or wallet neuritis.

What are the symptoms of piriformis syndrome?

Most patients present with buttock and leg pain which is worse on sitting and with hip movements. Pain is described as a dull ache, shooting or burning sensation associated with buttock tenderness. Most patients sit with the affected side tilted upwards. Some patients complain of a swelling, sausage shaped lump sensation in the buttock. Pain commonly radiates towards hip or down the back of the thigh, leg. Walking upstairs or on inclines can increase pain, with relief on lying down. Sometimes when pain is severe it may cause individuals to limp while walking. In females there may be pain during sexual intercourse (dyspareunia).

What causes piriformis syndrome?

PS is six times more common in women and middle ages. Individuals sitting for prolonged periods (long-distance bikers, office workers) and occupations such as truck & taxi drivers, tennis players are at a higher risk. Variations in the anatomy of piriformis muscle, sciatic nerve or its path can predispose to the irritation of the nerve. In majority of individuals the nerve travels below the muscle, it may however travel through or over the muscle or may be split into two. Other causes of piriformis syndrome include

• Trauma or Injury to the muscle such as after a fall onto the buttock, surgery or lumbar and sacroiliac joint pathologies.
• Overuse and microtrauma such as during intense downhill or long-distance running/walking. This can cause muscle spasm and shortening.
• Direct compression as during sitting on hard surfaces may cause repetitive trauma
• Compression due to direct pressure from a tumour invasion, or abnormal dilatation of a nearby blood vessel (inferior gluteal artery aneurysm)
• Post-radiotherapy fatty atrophy of the piriformis muscle
• Altered leg, back or pelvis biomechanics

How is piriformis syndrome diagnosed?

The commonest cause of sciatica is the irritation of the nerves in or near the spine. PS represents an extra spinal cause where the site of nerve irritation lies outside the spine although the symptoms are similar. Correct diagnosis helps to offer targeted treatment and increases the probability of a successful outcome. Another nearby muscle (obturator internus) can cause similar symptoms and this needs to be differentiated from the PS.

Diagnosis begins with a comprehensive history and physical examination. An MRI is useful for detailed evaluation of the lumbar spine & pelvis and ruling out other conditions with similar presentation. X-rays can be used for the evaluation of neighbouring bony structures such as the hip and sacroiliac joints. Electromyography (EMG) may help in differentiating PS from pain originating from the spine.

A local injection into the piriformis muscle is often used to confirm the diagnosis. This is discussed in the treatments section.

What are the treatment options for piriformis syndrome?

Treatment involves a combination of the following;

• Short term rest and activity modification
• Lifestyle modification
• Physical therapy including stretching exercises of the piriformis, hamstring muscle and strengthening of the abductor and adductor muscles
• Medications including anti-inflammatories, muscle relaxants, neuropathic medications (ones used for nerve pain).

If these measures fail to resolve symptoms, then the next step is injections.

Ultrasound Guided Injections

Steroid injections are the most commonly used injection option. As stated previously injections can not only provide relief, but also help in confirming the diagnosis. Using ultrasound helps to improve accuracy and reduce chances of complications. X-rays guidance is an alternative, although ultrasound is preferred as it can be performed in outpatient settings and offers other advantages such as visualisation the piriformis muscle, blood vessels and the sciatic nerve. Local anaesthetic and steroid mixture is used for the injection. Local anaesthetics help to relax the muscle and steroids aid in reducing inflammation thus prolonging the effect of the injection.

Botox injections work by paralysing and relaxing the piriformis muscle, thereby taking the pressure off the sciatic nerve. The effect of these injections can last for a few months proving an opportunity to address the root cause and engage in physical therapy.

Surgery may be considered for severe cases not responding to other measures. It involves either cutting the piriformis tendon from its hip attachment or cutting through the piriformis muscle to take pressure off the sciatic nerve.

Return to sports and activities varies between individuals and depend on the time taken in reduction of the symptoms. Too early a return has the potential to cause worsening of injury and reoccurrence of the symptoms.

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If you do not believe this statement then let me remind you of some common scenes from your daily life. You may have stopped noticing these believing that nothing can be done or accepted them as a part of aging. BUT IS THAT SO?

…remember the grandma who grunts in pain every time she tries to get up

…. the husband who complains of a backache every morning, taking his time to overcome the stiffness before he can start his day

….aunt who finds it difficult to get out of the car because of pain

….your colleague who has to randomly take time off work because of severe headaches

…your work colleague who keeps pressing his neck complaining of neck pain

….your friend who gave up badminton because of shoulder pain

….diabetic uncle who cannot sleep as he feels his feet are on fire

….your close friend who underwent breast surgery a few years back and still complains of pain

#lifewithoutpain#justadream#

Do these sound familiar… and I have not even talked about the numerous patients with sciatica, tennis elbow, heel pain, abdominal pain, cancer pain, pelvic pain, testicular pain, chest-wall pain, post-traumatic pain, nerve injury pain etc. The list is endless. The financial burden of these problems on individuals, families, society, and government is enormous.

Yes, these are all examples of chronic pain

Yes, these are challenging to treat because pain is a very personal experience and one therapy does not work for all.

BUT YES…. there are options that can improve your quality of life significantly. After all, quality of life is important for everyone. For someone, it may all be about being able to play a few rounds of golf and for someone to attend an important meeting at work without being distracted by pain. Your goals are your goals and they are important.

Chronic pain is a frequent condition affecting an estimated 20% of people worldwide. Globally 1 in 10 adults is diagnosed with chronic pain each year. Despite this, not many are aware of the available pain management options. The general perception is that pain management is for cancer pain. Even for the majority of well-informed people it stops at a few nerve blocks for relieving pain in cancer or trigeminal neuralgia.

In India, there is a huge variability in the services offered by the existing pain clinics. Lack of recognized comprehensive training curriculum in pain medicine with government approved minimal training standards may be one of the contributing factors. The focus of most specialists is on interventions rather than holistic management. This is contrary to most western countries where Pain Medicine is a separate specialty with well-defined curriculum and minimal standards that must be fulfilled for one to proclaim himself as a pain specialist. The focus there is on long term solutions using multi disciplinary approach and teamwork. Nevertheless, the awareness for chronic pain options is increasing with an important role being played by the media. I hope that the benefits do not get restricted to a privileged few and all fellow brothers and sisters are able to benefit.

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