Topical Patches for Back Pain in Pregnancy
For pregnant patients with back pain, menthol-containing topical patches (such as Bengay or Icy Hot patches) are the safest and most appropriate option, as they provide localized pain relief through counter-irritant effects with minimal systemic absorption and no known pregnancy risks. 1
Recommended Topical Patch Options
First-Line: Menthol-Based Patches
- Over-the-counter patches containing menthol in combination with methyl salicylate (Ultra Strength Bengay Pain Relieving Patch, Icy Hot) are recommended as first-line topical treatments for pregnancy-related back pain 2
- These products work through counter-irritant and mild analgesic properties, providing immediate relief with excellent safety profiles 3
- Apply to the affected back area 3-4 times daily as needed for optimal relief 3
- These agents have minimal systemic absorption, making them particularly suitable for pregnancy 4
Application Guidelines
- Apply patches to intact, non-irritated skin only 1
- Avoid contact with eyes or mucous membranes 1
- Do not bandage tightly over the patch 1
- Discontinue use if excessive skin irritation develops or symptoms persist beyond 7 days 1
Options to AVOID in Pregnancy
Capsaicin Patches - Not Recommended
- Capsaicin patches and creams should be avoided during pregnancy as there is insufficient safety data for use in pregnant patients 2
- While capsaicin 0.025-0.075% cream is FDA-approved for adults 18 years and older 5, pregnancy-specific safety has not been established
- The 2025 guidelines on special populations specifically note avoiding topical agents lacking pregnancy safety evidence 2
Lidocaine Patches - Limited Data
- Lidocaine 4% patches lack robust pregnancy safety data and should be reserved for cases where benefits clearly outweigh risks 4
- While lidocaine patches are effective for localized neuropathic pain 4, back pain in pregnancy is typically musculoskeletal rather than neuropathic 6, 7
NSAIDs (Diclofenac) - Contraindicated
- Topical diclofenac gel should be avoided in pregnancy, particularly in the third trimester, due to risks of premature closure of the ductus arteriosus and other fetal complications 2
Clinical Context and Pitfalls
Understanding Pregnancy-Related Back Pain
- Approximately 50% of pregnant women experience back pain, most commonly after the sixth month of pregnancy 7, 8, 9
- The pain results from biomechanical changes (stretched abdominal muscles, altered posture) and hormonal effects (relaxin-induced joint laxity in the lumbar spine and sacroiliac joints) 7
- The global prevalence increases by trimester: 28.3% in first trimester, 36.8% in second trimester, and 47.8% in third trimester 9
Common Pitfalls to Avoid
- Do not assume all topical treatments are safe in pregnancy - many lack adequate safety data 2
- Avoid ice immersion or prolonged cooling (limit to 10 minutes at a time, maximum 4 times daily) as excessive cooling can be harmful 2
- Do not use topical NSAIDs despite their effectiveness in non-pregnant patients 2
- Recognize that prone positioning is not possible for pregnant patients, limiting certain manual therapy approaches 6
When to Escalate Care
- If menthol-based patches provide inadequate relief after 4 weeks of consistent use, consider referral for pregnancy-safe manual therapy or physical therapy 3, 6
- Evaluate for neurologic deficits or hip pathology, which would warrant further investigation 7
- Consider sacroiliac joint dysfunction versus lumbar discogenic pain through specific physical examination maneuvers 7