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      Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience

      research-article
      Author(s): , ,
      Publication date (Electronic):
      Journal: BMC Complementary and Alternative Medicine
      Publisher: BioMed Central

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          Abstract

          Background

          In a previous randomised controlled trial we showed that acupuncture with a combination of manual- and electrical stimulation (EA) did not affect the level of pain, as compared with acupuncture with manual stimulation (MA) and standard care (SC), but reduced the need for other forms of pain relief, including epidural analgesia. To dismiss an under-treatment of pain in the trial, we did a long-term follow up on the recollection of labour pain and the birth experience comparing acupuncture with manual stimulation, acupuncture with combined electrical and manual stimulation with standard care. Our hypothesis was that despite the lower frequency of use of other pain relief, women who had received EA would make similar retrospective assessments of labour pain and the birth experience 2 months after birth as women who received standard care (SC) or acupuncture with manual stimulation (MA).

          Methods

          Secondary analyses of data collected for a randomised controlled trial conducted at two delivery wards in Sweden. A total of 303 nulliparous women with normal pregnancies were randomised to: 40 min of MA or EA, or SC without acupuncture. Questionnaires were administered the day after partus and 2 months later.

          Results

          Two months postpartum, the mean recalled pain on the visual analogue scale (SC: 70.1, MA: 69.3 and EA: 68.7) did not differ between the groups (SC vs MA: adjusted mean difference 0.8, 95 % confidence interval [CI] −6.3 to 7.9 and SC vs EA: mean difference 1.3 CI 95 % −5.5 to 8.1). Positive birth experience (SC: 54.3 %, MA: 64.6 % and EA: 61.0 %) did not differ between the groups (SC vs MA: adjusted Odds Ratio [OR] 1.8, CI 95 % 0.9 to 3.7 and SC vs EA: OR 1.4 CI 95 % 0.7 to 2.6).

          Conclusions

          Despite the lower use of other pain relief, women who received acupuncture with the combination of manual and electrical stimulation during labour made the same retrospective assessments of labour pain and birth experience 2 months postpartum as those who received acupuncture with manual stimulation or standard care.

          Trial registration

          ClinicalTrials.gov: NCT01197950

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          Most cited references35

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          Neural mechanism underlying acupuncture analgesia.

          Zhi-Qi Zhao (2008)
          Acupuncture has been accepted to effectively treat chronic pain by inserting needles into the specific "acupuncture points" (acupoints) on the patient's body. During the last decades, our understanding of how the brain processes acupuncture analgesia has undergone considerable development. Acupuncture analgesia is manifested only when the intricate feeling (soreness, numbness, heaviness and distension) of acupuncture in patients occurs following acupuncture manipulation. Manual acupuncture (MA) is the insertion of an acupuncture needle into acupoint followed by the twisting of the needle up and down by hand. In MA, all types of afferent fibers (Abeta, Adelta and C) are activated. In electrical acupuncture (EA), a stimulating current via the inserted needle is delivered to acupoints. Electrical current intense enough to excite Abeta- and part of Adelta-fibers can induce an analgesic effect. Acupuncture signals ascend mainly through the spinal ventrolateral funiculus to the brain. Many brain nuclei composing a complicated network are involved in processing acupuncture analgesia, including the nucleus raphe magnus (NRM), periaqueductal grey (PAG), locus coeruleus, arcuate nucleus (Arc), preoptic area, nucleus submedius, habenular nucleus, accumbens nucleus, caudate nucleus, septal area, amygdale, etc. Acupuncture analgesia is essentially a manifestation of integrative processes at different levels in the CNS between afferent impulses from pain regions and impulses from acupoints. In the last decade, profound studies on neural mechanisms underlying acupuncture analgesia predominately focus on cellular and molecular substrate and functional brain imaging and have developed rapidly. Diverse signal molecules contribute to mediating acupuncture analgesia, such as opioid peptides (mu-, delta- and kappa-receptors), glutamate (NMDA and AMPA/KA receptors), 5-hydroxytryptamine, and cholecystokinin octapeptide. Among these, the opioid peptides and their receptors in Arc-PAG-NRM-spinal dorsal horn pathway play a pivotal role in mediating acupuncture analgesia. The release of opioid peptides evoked by electroacupuncture is frequency-dependent. EA at 2 and 100Hz produces release of enkephalin and dynorphin in the spinal cord, respectively. CCK-8 antagonizes acupuncture analgesia. The individual differences of acupuncture analgesia are associated with inherited genetic factors and the density of CCK receptors. The brain regions associated with acupuncture analgesia identified in animal experiments were confirmed and further explored in the human brain by means of functional imaging. EA analgesia is likely associated with its counter-regulation to spinal glial activation. PTX-sesntive Gi/o protein- and MAP kinase-mediated signal pathways as well as the downstream events NF-kappaB, c-fos and c-jun play important roles in EA analgesia.
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            Validation of the Edinburgh Postnatal Depression Scale (EPDS) in non-postnatal women.

            J. Cox (1996)
            This paper reports the validation of the EPDS against a Research Diagnostic Criteria diagnosis of Major and Minor depression. The EPDS was administered to non-postnatal women with older children (mean age of youngest child 3 years 9 months) and to postnatal women (baby aged 6 months). All who scored 9 or above and one third of low scorers were interviewed, using Goldberg's Clinical Interview Schedule. The study confirmed good user acceptability of the EPDS when administered as a postal questionnaire (92% response rate). The EPDS was found to have satisfactory sensitivity (79%) and specificity (85%). Our findings suggest that the EPDS take a place alongside other screening scales for depression in Community samples. It is proposed that when used in these settings it is referred to as the Edinburgh Depression Scale.
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              Pain and women's satisfaction with the experience of childbirth: a systematic review.

              Ellen Hodnett (2002)
              To summarize what is known about satisfaction with childbirth, with particular attention to the roles of pain and pain relief. A systematic review of 137 reports of factors influencing women's evaluations of their childbirth experiences. The reports included descriptive studies, randomized controlled trials, and systematic reviews of intrapartum interventions. Results were summarized qualitatively. Four factors-personal expectations, the amount of support from caregivers, the quality of the caregiver-patient relationship, and involvement in decision making-appear to be so important that they override the influences of age, socioeconomic status, ethnicity, childbirth preparation, the physical birth environment, pain, immobility, medical interventions, and continuity of care, when women evaluate their childbirth experiences. The influences of pain, pain relief, and intrapartum medical interventions on subsequent satisfaction are neither as obvious, as direct, nor as powerful as the influences of the attitudes and behaviors of the caregivers.
              Article 0 comments Cited 196 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Linda Vixner: lvi@du.se
                Journal
                Journal ID (nlm-ta): BMC Complement Altern Med
                Journal ID (iso-abbrev): BMC Complement Altern Med
                Title: BMC Complementary and Alternative Medicine
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6882
                Publication date (Electronic): 12 June 2015
                Publication date PMC-release: 12 June 2015
                Publication date Collection: 2015
                Volume: 15
                Electronic Location Identifier: 180
                Affiliations
                [ ]Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Retzius väg 13A, Karolinska Institutet, 171 77 Stockholm, Sweden
                [ ]School of Health and Social Studies, Dalarna University, 791 88 Falun, Sweden
                [ ]School of Health and Education, University of Skövde, P.O. Box 408, 541 28 Skövde, Sweden
                [ ]Centre for Clinical Research Dalarna, Nissers väg 3, 791 82 Falun, Sweden
                Article
                Publisher ID: 708
                DOI: 10.1186/s12906-015-0708-2
                PMC ID: 4490752
                PubMed ID: 26066641
                SO-VID: c4ccb364-4e3e-4c03-b6e7-2a825b96e79b
                Copyright © © Vixner et al. 2015
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 18 June 2014
                Date accepted : 4 June 2015
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2015

                ScienceOpen disciplines: Complementary & Alternative medicine
                Data availability:
                ScienceOpen disciplines: Complementary & Alternative medicine

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