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Acupuncture or acupressure for pain management in labour

  • Review
  • Intervention

Authors

  • Caroline A Smith,

    Corresponding author
    1. University of Western Sydney, Centre for Complementary Medicine Research, Penrith South DC, New South Wales, Australia
    • Caroline A Smith, Centre for Complementary Medicine Research, University of Western Sydney, Locked Bag 1797, Penrith South DC, New South Wales, 2751, Australia. caroline.smith@uws.edu.au.

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  • Carmel T Collins,

    1. Women's and Children's Health Research Institute, Flinders Medical Centre and Women's and Children's Hospital; Discipline of Paediatrics, The University of Adelaide, Child Nutrition Research Centre, Bedford Park, South Australia, Australia
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  • Caroline A Crowther,

    1. The University of Adelaide, ARCH: Australian Research Centre for Health of Women and Babies, Discipline of Obstetrics and Gynaecology, Adelaide, South Australia, Australia
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  • Kate M Levett

    1. University of Western Sydney, Sydney, Australia
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Abstract

Background

Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. This review examined evidence supporting the use of acupuncture and acupressure for pain management in labour.

Objectives

To examine the effects of acupuncture and acupressure for pain management in labour.

Search methods

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register and The Cochrane Complementary Medicine Field's Trials Register (October 2010), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2010, Issue 4), MEDLINE (1966 to October 2010), and CINAHL (1980 to October 2010).

Selection criteria

Published and unpublished randomised controlled trials comparing acupuncture and acupressure with placebo, no treatment or other non-pharmacological forms of pain management in labour. We included all women whether primiparous or multiparous, and in spontaneous or induced labour.

Data collection and analysis

We performed meta-analysis using risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. The outcome measures included pain intensity, satisfaction with pain relief, use of pharmacological pain relief, relaxation, caesarean section rate, augmentation with oxytocin, length of labour and anxiety.

Main results

We included 13 trials with data reporting on 1986 women. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention (standardised mean difference (SMD) -1.00, 95% confidence interval (CI) -1.33 to -0.67, one trial, 163 women). One trial increased satisfaction with pain relief compared with placebo control (RR 2.38, 95% CI 1.78 to 3.19, 150 women). Reduced use of pharmacological analgesia was found in one trial of acupuncture compared with placebo (RR 0.72, 95% CI 0.58 to 0.88, 136 women), and compared with standard care, however, there was significant heterogeneity (RR 0.68, 95% CI 0.56 to 0.83, three trials, 704 women). Fewer instrumental deliveries from acupuncture were found compared with standard care (RR 0.67, 95% CI 0.46, 0.98, three trials, 704 women). Pain intensity was reduced in the acupressure group compared with a placebo control (SMD -0.55, 95% CI -0.92 to -0.19, one trial, 120 women), and a combined control (SMD -0.42, 95% CI -0.65 to -0.18, two trials, 322 women). No trial was assessed as being at a low risk of bias for all of the quality domains.

Authors' conclusions

Acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management. However, there is a need for further research.

Resumen

Antecedentes

Acupuntura o acupresión para el tratamiento del dolor durante el trabajo de parto

A muchas mujeres les gustaría evitar los métodos farmacológicos o invasivos para el manejo del dolor durante el trabajo de parto y esto puede contribuir a la popularidad de los métodos complementarios para el manejo del dolor. Esta revisión examinó las pruebas que apoyan el uso de la acupuntura y la acupresión para el tratamiento del dolor durante el trabajo de parto.

Objetivos

Examinar los efectos de la acupuntura y la acupresión para el tratamiento del dolor durante el trabajo de parto.

Estrategia de búsqueda

Se realizaron búsquedas en el Registro de Ensayos del Grupo Cochrane de Embarazo y Parto (Cochrane Pregnancy and Childbirth Group) y en el Cochrane Complementary Medicine Field's Trials Register (octubre 2010), en el Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (The Cochrane Library 2010, número 4), MEDLINE (1966 hasta octubre 2010) y en CINAHL (1980 hasta octubre 2010).

Criterios de selección

Ensayos controlados aleatorios publicados y no publicados que compararon acupuntura y acupresión con placebo, ningún tratamiento u otras formas no farmacológicas para el tratamiento del dolor durante el trabajo de parto. Se incluyeron todas las mujeres primíparas o multíparas en trabajo de parto espontáneo o inducido.

Obtención y análisis de los datos

Para realizar el metanálisis se utilizaron los cocientes de riesgos (CR) para los resultados dicotómicos y las diferencias de medias (DM) para los resultados continuos. Las medidas de resultado incluyeron la intensidad del dolor, la satisfacción con el alivio del dolor, el uso de analgesia farmacológica, la relajación, la tasa de cesárea, la estimulación con oxitocina, la duración del trabajo de parto y la ansiedad.

Resultados principales

Se incluyeron 13 ensayos que informaban datos sobre 1986 mujeres. Nueve ensayos informaron sobre acupuntura y cuatro ensayos informaron sobre acupresión. Se encontró dolor menos intenso con la acupuntura comparada con ninguna intervención (diferencia de medias estandarizada [DME] −1,00; intervalo de confianza [IC] del 95%: −1,33 a −0,67; un ensayo, 163 mujeres). En un ensayo aumentó la satisfacción con el alivio del dolor en comparación con el control placebo (CR 2,38; IC del 95%: 1,78 a 3,19; 150 mujeres). Se encontró una reducción del uso de analgesia farmacológica en un ensayo de acupuntura comparada con placebo (CR 0,72; IC del 95%: 0,58 a 0,88; 136 mujeres); sin embargo, en comparación con la atención estándar hubo heterogeneidad significativa (CR 0,68; IC del 95%: 0,56 a 0,83; tres ensayos, 704 mujeres). Se encontraron menos partos instrumentados con la acupuntura en comparación con la atención estándar (CR 0,67; IC del 95%: 0,46 a 0,98; tres ensayos, 704 mujeres), aunque hubo heterogeneidad significativa. La intensidad del dolor se redujo en el grupo de acupresión en comparación con un control placebo (DME −0,55; IC del 95%: −0,92 a −0,19; un ensayo, 120 mujeres) y un control combinado (DME −0,42; IC del 95%: −0,65 a −0,18; dos ensayos, 322 mujeres). Ningún ensayo se clasificó como de bajo riesgo de sesgo para todos los dominios de calidad.

Conclusiones de los autores

La acupuntura y la acupresión pueden tener una función en el alivio del dolor, el aumento de la satisfacción con el tratamiento del dolor y la reducción del uso del tratamiento farmacológico. Sin embargo, es necesario realizar más investigación.

Traducción

Traducción realizada por el Centro Cochrane Iberoamericano

Plain language summary

Acupunture or acupressure for relieving pain in labour

Acupuncture or acupressure may help relieve pain during labour, but more research is needed.

The pain of labour can be intense, and may be worsened because of a woman's tension, anxiety and fear affecting their labour and birth experience . Many women would like to labour without using drugs or invasive methods of pain management, and turn to alternatives to manage the pain. The review of 13 trials, with data reporting on 1986 women, found that acupuncture or acupressure may help relieve labour pain. Single or limited numbers of trials reported less intense pain, increased satisfaction with pain relief and reduced use of analgesic drugs with acupuncture compared with placebo or usual care. Acupressure also reduced pain intensity. Acupuncture involves the insertion of fine needles into different parts of the body to correct the imbalance of energy in the body. The intervention was administered at term as individualised treatment (six trials) or at standardised acupuncture points in the majority of trials but with wide variation in the mode of stimulation, duration of needling, number of points used, depth of needling and duration of the trial.

쉬운 말 요약

분만 시 통증을 줄이기 위한 침 치료 및 경혈 지압

침 치료 또는 경혈 지압은 분만 과정의 통증을 줄이는 데 도움이 될 수도 있지만, 이에 대해 더 많은 연구가 필요하다.

분만 통증은 매우 심할 수 있으며 산모의 긴장, 불안, 두려움이 분만 시 영향을 주어 더 심하게 느껴질 수도 있다. 많은 여성들은 통증 조절을 위한 약물이나 침습적 치료법을 사용하지 않고 출산하고 싶어하며, 통증 조절을 위한 대안적 방법을 찾는다. 13건의 임상시험 (1986명의 산모) 을 분석한 결과, 침 치료 또는 경혈 지압은 분만 통증을 줄이는 데 도움이 될 수도 있음을 발견했다. 하나 또는 몇 안 되는 수의 임상시험에서는 침 치료를 플라세보 또는 일상적 통증 관리법과 비교했을 때, 통증의 심한 정도가 줄어들었으며 통증 경감으로 인한 만족도가 증가했고 진통 약물의 사용도 줄어들었음을 보고했다. 경혈 지압 역시 통증의 강도를 줄였다. 침 치료는 몸의 각 부위에 가는 바늘 형태의 호침을 자입하여 기운의 불균형을 조정하고자 한다. 침 치료는 분만 시 개별 맞춤형 치료 (임상시험 6건) 또는 표준화된 경혈을 사용한 치료 (대부분의 임상시험) 형태로 이루어졌다. 표준화된 치료라 하더라도 자극 방법, 유침 시간, 사용한 경혈 수, 자침 깊이, 임상시험 기간 측면에서 다양한 편차가 있었다.

역주

이 번역은 김건형 (부산대학교 한의학전문대학원; pdchrist@gmail.com) 이 작성하였습니다. 번역과 관련한 문의사항은 위 메일로 주시기 바랍니다.

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