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Pain therapy for low back pain in pregnancy is a very topical issue. In fact, it is necessary to balance the patient’s needs to control pain with the need to manage a pregnancy without negative effects on the fetus. We report a case of a 37-year-old woman with low back pain treated with neurostimulation before pregnancy. She described severe chronic low back pain unresponsive to pharmacologic treatments. We first implanted a subcutaneous stimulator into the patient, and then a definitive stimulator resulting in excellent pain control. The improvement in her quality of life allowed the woman to become pregnant. We decided to stop neurostimulation with the patient during pregnancy. The patient completed her pregnancy without complications and the baby was born healthy. During the pregnancy, the woman took only paracetamol when needed. However, this painful symptomatology, completely anecdotal, is not attributable solely to the previous spine problem but probably also to the changes occurring during pregnancy. At the end of pregnancy, the neurostimulator was reactivated without any discomfort for the patient, who is now pain free. This case report provides a first line of evidence of a possible treatment of low back pain in women intending to become pregnant, with risk-free management for both the patient and the child.

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Background Cesarean section (CS) is the most frequently performed obstetric procedure globally, and postoperative pain remains a prominent concern. This study aimed to evaluate the effectiveness of the bilateral transversus abdominis plane (TAP) block in addressing this issue. Methods We performed a randomized trial in women with term pregnancies who underwent elective CS with spinal anesthesia. The women were randomized (1:1) to receive bilateral TAP or postoperative systemic analgesics (control group). The primary outcome was the effect on postoperative pain assessed using the numeric rating score (NRS) at 2, 6, 12, and 24 h in the postoperative period. Results At 2 and 6 h after the surgical procedure, there was a significant reduction in both resting (rNRS p = 0.004) and movement-related pain (dNRS p = 0.0001, p = 0.001 respectively). However, at 12 h, a reduction of dNRS was demonstrated (p = 0.0001), while no benefit was observed at rest. The percentage of women with NRS ≤ 4 was higher after the block at 2 h for both resting and movement-related pain (rNRS p = 0.010; dNRS p = 0.0001); at 6 and 12 h, it was only significant for dNRS (p = 0.002). Rescue doses of analgesics were significantly higher in the control group at 2, 6, and 12 h (p = 0.01, p = 0.0383, p = 0.0003 respectively). No complications with the procedure were recorded. Conclusion Bilateral TAP block has the potential to alleviate postoperative pain and reduce the need for additional analgesics after CS. Trial registration This study is registered with ClinicalTrials.gov, number (NCT02801968), registered 28 May 2016, https://clinicaltrials.gov/ct2/show/NCT02801968?term=NCT02801968&draw=2&rank=1