The effect of GB21 acupressure on pain intensity in the first stage of labor in primiparous women: A randomized controlled trial

Unveiling the latest evidence: an updated systematic review and meta-analysis and GRADE assessment on the effectiveness of acupressure in managing labor pain

BACKGROUND

Labor pain is a significant challenge during childbirth, highlighting the necessity for effective pain management strategies. Acupressure has been recognized as a non-pharmacological method; however, its efficacy requires comprehensive evaluation. This updated systematic review and meta-analysis seeks to consolidate the most recent evidence regarding the effectiveness of Acupressure in alleviating labor pain and to evaluate the quality of this evidence using the GRADE framework.

METHODS

An updated systematic review was conducted by querying multiple databases for randomized controlled trials (RCTs) that evaluated the impact of Acupressure on labor pain. Studies were included based on predefined eligibility criteria. The risk of bias was assessed using the Cochrane risk-of-bias method for randomized trials (RoB). Meta-analyses were performed to determine the overall effect size, and the GRADE approach was applied to assess the certainty of the evidence. Meta-analyses of all the data were done using RevMan 5.4.

RESULTS

A total of 37 studies met the inclusion criteria. The meta-analysis revealed that Acupressure significantly reduces labor pain compared to touch (MD = -1.19, 95% CI -1.66 to -0.72, p < 0.00001), Sham (MD = -1.41, 95% CI -2.55 to -0.27, p = 0.01), and no intervention group (MD = -2.32, 95% CI -2.87 to -1.76, p < 0.00001). Although both SP6 and LI4 Acupressure points reduced pain, SP6 had more of an impact compared to previous reviews. The funnel plot comparing the effect of Acupressure with a touch on labor pain intensity suggested a possible publication bias. The GRADE assessment indicated a moderate to low level of certainty regarding these results.

CONCLUSIONS

Acupressure seems to be a viable method for alleviating labor pain, supported by moderate to low-quality evidence. Additionally, it is advisable to conduct well-designed RCTs to enhance the validity of these findings and investigate the underlying mechanisms that contribute to the effectiveness of Acupressure in this setting.

The Effect of EX-B8 Acupressure on Labor Pain: A Randomized, Single-Blind, Sham-Controlled Trial

Context: Intense, uncontrolled pain during labor can have negative outcomes for both the mother and the baby, but this can be prevented by utilizing pain-relieving techniques. Childbirth is a natural physiological process, and it is important to prioritize non-pharmacological methods such as acupressure in managing the associated pain. Objective: The present research aims to determine the effects of acupressure on the eighth point of the extra-back meridian (EX-B8) for pain relief during childbirth in primiparous women. Design: This study was a randomized, single-blind, sham-controlled trial. Setting: This study was conducted at Shahid Rasulullah Hospital in Nikshahr, Sistan and Baluchistan Province, Iran. Patients or Other Participants: Ninety primiparous mothers in the active phase of the first stage of labor were selected and randomly divided into three groups: acupressure on EX-B8 (n = 30), sham (n = 30), and control group (n = 30). Intervention(s): The acupressure and sham groups received acupressure for 20 min during their uterine contractions at three different time points: when cervical dilatation was at 4-5 cm, 6-7 cm, and 8-10 cm, totaling 60 min. The control group received routine labor care. Main Outcome Measure(s): Pain intensity was assessed using a Numerical Rating Scale (NRS) before, 10 min after, and 20 min after the start of the intervention at three different time points. Results: Pain intensity was significantly lower in the EX-B8 acupressure group compared to the sham and control groups at all three time points of the intervention (p < 0.05). In the EX-B8 group, the greatest amount of pain relief was achieved during dilatation of 8-10 cm, compared to dilatations of 4-5 and 6-7 cm (p=0.0001). Maternal and neonatal outcomes did not differ significantly between the three groups (p > 0.05). Conclusion: The current study found that applying acupressure on EX-B8 effectively reduced pain during labor. Acupressure on this point can be recommended as an effective, low-cost, and accessible pain-relieving technique, especially at the end of the active phase of the first stage of labor. Further studies are needed to determine why acupressure on this point is more effective at the end of the active phase of labor. Trial Registration: Iranian Registry of Clinical Trials: IRCT20211108053006N1.

Effect of Acupressure on Anxiety and Pain Levels in Primiparous Women During Normal Labor: A Randomized Controlled Trial

Background: Normal labor is stressful, and the intense pain and anxiety can have an adverse effect on the mother, the fetus, and the delivery procedure. This study aimed to determine how acupressure applied to multiple acupoints during normal labor affected labor pain and anxiety in primiparous women. Method: This study was a double-blinded randomized controlled trial that involved 43 primiparous women aging 20-30 years who were referred for normal labor. Subjects were randomly allocated to one of two groups: acupressure or control. Acupressure was administered to the Large Intestine 4 (LI4), Heart 7 (He-7), and Spleen 6 (SP6) acupoints in the acupressure group, whereas sham acupressure was administered to the control group. The study assessed the mothers' anxiety levels using the Spielberger Inventory questionnaire and measured their pain levels using the visual analog scale before and after the intervention. In addition, pulse rate and blood pressure were also measured. Result: In the acupressure group, both the anxiety score and pain level showed a substantial improvement (p < 0.001), but in the control group, only the anxiety score showed a significant improvement (p < 0.001). After the intervention, the difference in anxiety and pain scores between the two groups is statistically significant (p < 0.001). Furthermore, neither group's blood pressure nor pulse rate showed any significant changes (p < 0.05). Conclusion: According to the study's findings, acupressure targeting LI4, He-7, and SP6 acupoints was effective in relieving anxiety and pain during labor. Compared with the sham acupressure group, the acupressure group showed a greater decrease in both anxiety and pain levels. As such, acupressure may be recommended as an effective, affordable, and accessible technique for managing pain and anxiety during labor. This study has been registered in the database of clinical trials under the identifier Clinicaltrials.gov NCT05411289.

The effects of acupressure on post-dressing pain in burn patients: A clinical randomized trial

BACKGROUND AND OBJECTIVES

Burns often cause severe pain, especially during dressing changes. This study aimed to investigate the effect of acupressure on pain during dressing changes in burn patients.

METHODS

This randomized clinical trial was conducted on 76 burn patients. The eligible patients were randomly assigned to the intervention and control groups after obtaining informed consent. Eligible patients were randomly assigned to the intervention and control groups by blocking. The study was conducted over two days using the same method. Before entering the dressing room, acupressure was performed in the intervention group for 10 min in acupressure points and the control group in other points. Pain intensity was measured in two groups 30 min before entering the dressing room and 15 and 30 min after leaving the dressing room using VAS. Finally, the data were analyzed using SPSS software 25th edition.

RESULTS

Pain scores were similar for the two groups before the dressing change. The results of this study revealed a significant decrease in the patient's pain intensity mean in the test group following acupressure compared to the control group on day one which remained on day two (P < 0.05).

CONCLUSION

Considering the experience of severe pain in burn patients, acupressure is recommended as a complementary method along with modern medicine to reduce these patients' pains.

A Comparison of the Effects of Acupressure and Music on Venipuncture Pain Intensity in Children: A Randomized Controlled Clinical Trial

Pain from injections is common in children of all ages, and more than 90% of hospitalized children experience invasive and painful procedures such as venipuncture. In light of the complications associated with pain relief medications, nonpharmacological and complementary medicine approaches have gained attention. This study aims to compare the effects of acupressure and music on venipuncture pain intensity in children. This randomized controlled clinical trial involved 180 children aged 3-6 years who sought treatment at the Children's Medical Center Hospital Emergency Department at Tehran University of Medical Sciences, Iran. The children were randomly assigned to one of three groups: acupressure, music, or control. The interventions were given within 5 minutes, starting 3 minutes before the venipuncture and continuing until completion. The interventions included playing music through headphones and applying acupressure to the Hugo point. Venipuncture was carried out under identical conditions using an Angiocath 24G needle. Pain intensity was assessed using the Oucher scale. Data were analyzed using SPSS 24, employing the Kruskal-Wallis, chi-square, and Bonferroni pairwise comparison tests, with a significance level of 0.05. The mean pain intensity was 3.32 ± 1.44 in the music group, 4.82 ± 1.51 in the acupressure group, and 8.32 ± 1.10 in the control group. Pain intensity significantly differed among the three groups (p < 0.001). Specifically, pain intensity was lower in the music group compared to both the acupressure (p < 0.001) and control (p < 0.001) groups. Furthermore, pain intensity was lower in the acupressure group than in the control group (p < 0.001). Based on the results, music and acupressure methods effectively reduce pain intensity during venipuncture in children. Considering that music demonstrated a more pronounced effect in alleviating venipuncture pain than acupressure, the recommendation is to utilize music as a method of pain management during venipuncture in children. Iranian Registry of Clinical Trials, Trial No. IRCT20120109008665N15, was registered on 6 December 2021.

Non-Pharmacological Pain Management in Labor: A Systematic Review

Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.

Effects of combined spinal-epidural anesthesia on anxiety, labor analgesia and motor blocks in women during natural delivery

BACKGROUND

The background of this study was analgesia in natural delivery. The combined spinal-epidural anesthesia has obvious analgesic effect on the parturients in natural labor, and combined spinal-epidural anesthesia has been widely used in anesthesia for various diseases.

AIM

To study the effects of combined spinal-epidural anesthesia on anxiety, labor analgesia, and motor blocks in parturients during natural delivery.

METHODS

A total of 120 women who gave birth at Changning District Maternal and Child Health Hospital between December 2021 to December 2022 were included; a random number table approach was employed to divide the women into a control group and a joint group, with each group consisting of 60 women. The control group was given epidural anesthesia, while the joint group was given combined spinal-epidural anesthesia. The visual analog scale (VAS) was used to evaluate the degree of maternal pain. Comparisons were made between the two groups’ conditions of childbirth and the duration of labor. Apgar scores were used to evaluate the status of the newborns at birth; Self-rating Anxiety Scale (SAS) and General Self-Efficacy Scale (GSES) scores, umbilical artery blood gas analysis indices and stress indices were compared between the two groups; and the frequencies of motor block and postpartum complications were analyzed.

RESULTS

In comparison to the control group, in the joint group, the VAS scores for the first, second, and third stages of labor were lower (P < 0.05). The rates of conversion to cesarean section and postpartum blood loss in the joint group were lower than those in the control group (P < 0.05). No significant differences were observed in the Apgar score, the duration of the first stage of labor, or the total duration of labor between the two groups (P > 0.05). The second and third stages of labor in the joint group were shorter than those in the control group (P < 0.05). When compared to the control group, the postpartum SAS score of the joint group was lower, while the GSES score was greater (P < 0.05). Between the control group and the joint group, the differences observed in pH, arterial carbon dioxide partial pressure, arterial oxygen partial pressure, or arterial hydrogen ion concentration were not significant (P > 0.05). Nitric oxide, cortisol, and adrenaline levels were lower in the joint group than in the control group (P < 0.05). There were no substantial differences in Bromage grade or rate of complications between the two groups (P > 0.05).

CONCLUSION

For parturients during natural delivery, combined spinal-epidural anesthesia can reduce anxiety, provide labor analgesia, shorten labor time, and reduce postoperative stress levels but did not result in a motor block.

Effects of Acupressure on Maternal and Neonatal Obstetric Outcomes during Labor: Study Protocol

BACKGROUND

A Cochrane review found that there is insufficient evidence to determine the effectiveness of acupressure for pain relief. One of the problems detected is the methodological variability reported.

OBJECTIVE

To assess the impact of the application of acupressure on obstetric and neonatal outcomes of labor, pain experience, and mother's satisfaction with the experience.

METHOD

Design of a protocol to carry out a two-arm multicenter single-blinded randomized controlled trial. Intervention (pressure on LI4 of the left hand, B6 of the left leg, GB21 of the left shoulder, and then the same sequence on the right side) and placebo (application of the technique on points not identified by acupuncture as key points) will be performed by a single researcher.

RESULTS

The recruitment began in April 2021 and, to date, there has been the participation of 40 women, divided into 17 included in the experimental group and 23 in the control. Communication of future results will be made in accordance with the CONSORT checklist.

CONCLUSIONS

The designed protocol could methodologically improve some aspects of previous studies while maintaining adequate statistical power. The effectiveness of acupressure for one or more outcomes proposed (time and pain in labor) could support the inclusion of a new therapeutic tool in the clinical practice of midwives that would allow them to assist pregnant women, improving their experience both physically and psycho-emotionally.

The Effect of Using Endorphin Massage for Decreasing Pain at First Stage in Normal Labor

Labor pain is a subjective experience of physical sensations associated with uterine contractions, dilation, thinning cervix and fetal descent during labor. To resolve the pain of labor, it has been implemented in a nonpharmacological method which is endorphin massage, in understanding endorphin massage for pressing pain in the first stage, in an active phase of normal multiparous mothers' deliveries. This research aims to research endorphin massage's influence on suppressing pain during the active phase of normal labor of multiparous mothers. This study is quasi-experimental with a cross-sectional approach. The study population of all women giving birth administered the purposive sampling data capture techniques, and it was obtained 132 multiparous mothers with normal labor in the observation sheet. Data were examined by administering a T-test. The majority of the pain intensity in the first stage of active phase multiparous mothers with normal labor, before the breath relaxation, is severe, with up to 49% experiencing severe pain. The majority of the percentage of moderate pain in the first stage of active phase multiparous mothers with normal labor, after breath relaxation, is as high as 42%. Meanwhile, the pain intensity of the first stage in active phase multiparous mothers with normal labor, prior to endorphin massage, is as high as 73.3%. Pain intensity of the first stage in active phase multiparous mothers normal labor after endorphin massage, the majority of the percentage is moderate pain up to 53.3%. Statistical test results obtained p-value is 0.004 endorphin massage. In conclusion, there is an effect of breath relaxation on the intensity of pain during normal labor in multiparous mothers. Furthermore, researchers can do a combination of endorpine massage with other treatments to treat pain during the I active phase of labor and pain intensity checks can be done by testing cortisol levels.