Acupuncture for pelvic and back pain in pregnancy: a systematic review
Ee, Manheimer, Pirotta and White 2008 (1) published a randomised controlled trial involving 88 women in labour, in the Holistic Nursing Journal.
Summary:
This paper is a systematic review (SR) of clinical trials to date that reported on back/pelvic pain in pregnancy. The review aimed to compare acupuncture plus standard care, to standard care alone in each of the studies, for the reduction of back/pelvic pain.
In this review, there were three randomised controlled trials (RCTs) that met the inclusion criteria for the SR. The study reported on a total of 546 women with pelvic and/or back pain. Two studies were small, investigating pelvic/back pain, and one study was a large high quality trial on pelvic pain.
Standard care was defined as interventions such as physiotherapy/physical therapies, analgesics, stabilising exercises etc. The acupuncture was used as an adjunct therapy to standard care - that is, it was additional to standard care, not an ‘either/or’ scenario.
Acupuncture was found to be clinically and statistically superior to standard care and physiotherapy alone or stabilising exercise, pelvic belt and standard treatment.
Treatment method:
Acupuncture interventions consisted of ear acupuncture (plus body acupuncture if needed) in one study, Chinese acupuncture at ‘ah shi’ (tender) points in another study, and unspecified Chinese acupuncture in the third study.
Results:
In this review, women in the study groups had a significant reduction in pain in all 3 studies, however the way they reported this differed and it was necessary for the authors to report narratively.
Importantly, no serious adverse events were reported in any of the studies.
Authors’ conclusions and practice implications:
The authors conclude that though the evidence is limited, it is promising. The evidence to date suggests that acupuncture in addition to standard treatment has better pain relief outcomes than standard care and stabilising exercises alone. Given that acupuncture is relatively safe, and that hip and pelvic pain is relatively common, painful and can be quite debilitating, health care providers should consider referring women for acupuncture treatment.
Levett et al., (2014). Acupuncture and acupressure for pain management in labour and birth: A critical narrative review of current systematic review evidence.
http://www.sciencedirect.com/science/article/pii/S0965229914000557
https://doi.org/10.1016/j.ctim.2014.03.011
Summary:
Reviews of maternity services highlight the need for a reduction of medical interventions for women with low risk pregnancies and births to prevent the potential cascade of interventions and their associated risks. Complementary medicines (CM) such as acupuncture and acupressure have claimed to be effective in reducing interventions in labour; however, systematic reviews of evidence are conflicting.
Conclusion:
The benefit of acupuncture may lie largely in the capacity to help women manage labour and avoid pharmacological medication in the context of hospital based maternity care. The point specific and point combination effects for analgesia and anaesthesia and the relative benefits of different forms of acupuncture are also important to identify. The effectiveness of acupuncture and acupressure as a viable, safe alternative or adjunct to the conventional analgesia offered to women in maternity care settings would be well addressed by pragmatic trial designs and outcome measures reflecting patient-centred outcomes as well as objective pain measures. Acupuncture efficacy trials addressing the degree of pain relief offered by specific treatment protocols, would be well reflected in appropriate placebo-controlled, single-blinded, clinical trials where patients were tightly regulated and outcomes are specific and focused. Both are required for researchers to understand the effectiveness and safety and to make recommendations based on the overall benefits to women in the birthing environment.
Acupressure for pain relief in labour
Hamlaci & Yazici 2017 (1)
Summary:
The study examined the role of using acupressure on acupoint LI-4 (Hegu) for perceived labour pain in a maternity hospital in Turkey. The study used a randomised controlled trial design, where participants were randomly allocated to receive either acupressure or routine care during labour. There were 44 women allocated to each group, all of whom had gone into spontaneous labour.
Treatment method:
Acupressure was applied at two time points (4 to 5cm dilation, and 7 to 8cm dilation), to the LI-4 point on both hands. Acupressure was applied by the researcher by placing both thumbs on the point at the same time from the beginning to the end of the contraction. Acupressure was applied 8 times at each of the 2 time points at a constant pressure during the contraction.
Results:
The researchers found that there were statistically significant differences between the groups in subjective labour pain scores at both time points (p<0.0001).
The study group had an average pain score of 3.77 out of a maximum of 10 at 5-6cm dilation, compared with the control group who had an average pain score of 6.22/10. At the second application at 7-8cm dilation, the study group had an average pain score of 7.37 out of a maximum score of 10, compared with the control group who had an average score of 8.61/10. The authors also report a significant difference between the groups in terms of total duration of labour (p<0.05).
The authors conclude that applying acupressure to Point LI4 was found to be effective in decreasing the perception of labour pains and shortening the labour (p < .05). Mothers were pleased with this treatment, but they found just one point insufficient to control their pain fully.
Implications for practice:
Authors, Hamlaci & Yazici (1), are promoting a protocol that can be easily taught in clinical practice and applied in the labour and delivery wards of most hospitals. It also provides valuable evidence for low income settings, where pharmacological pain relief is not always available, or where women would like to avoid pharmacological treatments.
The treatment is simple, yet may be insufficient to completely manage labour pain. Many other studies and clinical practice includes points such as Sp6, Bl32, St36, GB21, and Bl60, which may be a good adjunct to treatment.
This may form a valuable part of overall treatment and management of labour for women who would like to avoid pharmacological analgesia.