Treatment of severe low back pain with opioids during pregnancy in a patient with incomplete tetraplegia

We report a case of severe low back pain during pregnancy in a woman with i ncomplete tetraplegia due to viral myelitis. The pain was interpreted as a radiculopathy in the presence of multiple herniated discs. Surgical interve ntion was not indicated and physiotherapy failed; therefore, a symptomatic drug treatment with oral analgesics was initiated. To minimise the total da ily opioid dosage and the potential risk of a neonatal withdrawal syndrome due to opioids, the route of administration was changed from oral to epidur al. Adequate pain relief was maintained with this regimen until caesarean s ection was necessary. The neonatal withdrawal symptoms after delivery were mild. Residual pain slowly diminished after delivery and the patient was ab le to discontinue opioid therapy. The aetiology of low back pain remains un clear and may be multifactorial.