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Research: Preconception, pregnancy and childbirth





Back Pain, Pelivic Pain and Sciatica (Acupuncture)

Acupuncture - safe, effective for late pregnancy back pain

The researchers designed the study to evaluate the analgesic effect and possible adverse effects of acupuncture for pelvic and low-back pain during the last trimester of pregnancy.

Following individual informed consent, 72 pregnant women reporting pelvic or low-back pain were randomized during pregnancy weeks 24-37 to an acupuncture group (n = 37) or to a control group (n = 35) at three maternity wards in southern Sweden. Traditional acupuncture points and local tender points (TP) were chosen according to individual pain patterns and stimulated once or twice a week until delivery or complete recovery in acupuncture patients. Control patients were given no sham stimulation. Throughout the study period each patient made weekly visual analog scale (VAS) evaluations of maximal and minimal pain intensity as well as three-point assessments of pain intensity during various activities.

During the study period, VAS scores of pain intensity decreased over time in 60% of patients in the acupuncture group and in 14% of those in the control group. At the end of the study period, 43% of the acupuncture patients were less bothered than initially by pain during activity compared with 9% of control patients. No serious adverse effects of acupuncture were found in the patients, and there were no adverse effects at all in the infants.

Acupuncture relieves low-back and pelvic pain without serious adverse effects in late pregnancy.
Kvorning N, et al. Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta obstetricia et gynecologica Scandinavica 83(3):246-50.

Acupuncture for pelvic and back pain in pregnancy: a systematic review

The objective of THE study was to review the effectiveness of needle acupuncture in treating the common and disabling problem of pelvic and back pain in pregnancy. Two small trials on mixed pelvic/back pain and 1 large high-quality trial on pelvic pain met the inclusion criteria. Acupuncture, as an adjunct to standard treatment, was superior to standard treatment alone and physiotherapy in relieving mixed pelvic/back pain.

Women with well-defined pelvic pain had greater relief of pain with a combination of acupuncture and standard treatment, compared to standard treatment alone or stabilizing exercises and standard treatment. We used a narrative synthesis due to significant clinical heterogeneity between trials. Few and minor adverse events were reported. We conclude that limited evidence supports acupuncture use in treating pregnancy-related pelvic and back pain. Additional high-quality trials are needed to test the existing promising evidence for this relatively safe and popular complementary therapy.

Carolyn C. (Chinese Medicine/Human Biology), Eric Manheimer, Marie V. Pirotta and Adrian R. White. Department of General Practice, University of Melbourne, Melbourne, Australia; Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD; cPeninsula School of Medicine and Dentistry, University of Plymouth, Plymouth, UK.

Acupuncture for pregnant women with pelvic girdle pain


A recent randomized, single blind and controlled study was conducted in order to compare the effects of standard treatment, standard treatment with acupuncture, and standard treatment with stabilizing exercises for pelvic girdle pain during pregnancy. 386 pregnant women with pelvic girdle pain were randomly assigned to three groups: for six weeks with standard treatment (n=130), standard treatment plus acupuncture (n= 125), or standard treatment plus stabilizing exercises (n= 131). A visual analogue scale was used to measure the pain and an independent examiner did an assessment of the severity of the pain before and after treatment.

After treatment, the stabilizing exercise group had less pain than the standard group in the morning and in the evening. The acupuncture group also had less pain than the standard treatment group in the morning and in the evening. However, the acupuncture group had less pain in the evening than the stabilizing exercise group. Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group.

The study concluded that acupuncture and stabilizing exercises were effective complements to standard treatment for the management of pelvic girdle pain during pregnancy. Also, acupuncture was superior to stabilizing exercises in this study.

Elden H, Ladfors L, et al. Perinatal Center, Department of Obstetrics and Gynecology, Institute for the Health of Women and Children, Sahlgrenska Academy, East Hospital, 41685 Gothenburg, Sweden.


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Nausea and Vomiting (Acupuncture)

Acupuncture useful for treating morning sickness

In well controlled studies it was shown that acupuncture administered before the opioid premedication significantly reduced postoperative sickness for 6-8 hours. Non-invasive methods were effective for a shorter period of time, with nausea and/or vomiting often occurring after 2 hours. To be effective the treatment has to be given before the opioid. Its effect can be abolished by local anesthesia. Stimulation of a dummy point near the elbow is ineffective.

While acupressure reduces morning sickness, the pressure has to be applied for 5 minutes every 2 hours. There is probably a large psychological element in this. The most rewarding results are obtained when P6 stimulation is used in conjunction with standard antiemetics before cancer chemotherapy. Here again the invasive approach is more effective than non-invasive. Recent studies have involved self-stimulation using a portable battery-operated square wave stimulator fixed at 10 Hz, and a large EKG surface electrode on the P6 point. Stimulation is applied for 5 minutes every two hours.

While modern antiemetics can control vomiting, they are relatively ineffective against nausea, but this can be controlled by regular use of the stimulator. The results are most promising.

Acupuncture and Electro-Therapeutics Research, 1990, 15(3-4):211-5. (UI: 91188941) Pub type: Journal Article; Review; Review, Tutorial. AT: UCLA siomed W1 AC999T (PE title: Acupuncture & electro-therapeutics research.)

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Heartburn (Acupuncture)

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Headaches & Migraines (Acupuncture)

General intro headaches

Headaches can be due to a multitude of factors; arthritis of the neck, dental problems, sinusitis, stress and tension, and head injury are a few of the many causes. Headaches have been dealt with as a separate section because they are so common and they span many of the 'body systems'.

Migraine is a particular type of headache and worthy of special mention. Migraine can be induced by a variety of stimuli such as foods, noise and stress, and such headaches are usually accompanied by severe incapacitating pain, nausea, vomiting, and visual patterns or flashes in front of the eyes. Many people describe severe 'tension headaches' as migraines and although these headaches are not strictly migraines, the dividing line between other headaches and migraine is frequently rather woolly. Migraine is probably best thought of as a severe headache associated with nausea.

Headaches are a common complaint and a notoriously difficult one to treat effectively, and they can be the cause of a considerable amount of distress and marital disharmony. Acupuncture has been used to treat a wide variety of headaches, particularly migrainous headaches, and the results obtained have been very encouraging. The published work suggests that between 65-95 per cent of all headache sufferers obtain significant and long lasting pain relief from acupuncture treatment. Migraines seem to respond as well as, if not better than, other types of headache.

Acupuncture therapy for headaches may cause the headaches to vanish completely, or occur with a markedly decreased intensity and/or frequency. The pain relief resulting from acupuncture can sometimes be maintained for some years and re-treatment is usually required less frequently for headaches: than for other conditions such as osteoarthritis. You can find positive findings and scientific research confirming the effectiveness of acupuncture in this condition on the BBC news website: Arthritis and How acupuncture may reduce pain.

Acupuncture instead of drugs for migraine

Women who opt for acupuncture instead of a drug to prevent migraines report feeling fewer symptoms, fewer attacks, and less side effects from the treatment, new study findings report. The study, carried out at the Woman's Headache Centre at the University of Turin, Italy, compared the effect of acupuncture with oral flunarizine in preventing non-aura migraine over a 6-month period. The 160 women enrolled in the study had experienced headaches at least twice a month in the year prior to the study and had had no previous experience of acupuncture.

Acupuncture was given once a week for the first 2 months and then once a month for the next 4 months. The flunarizine group received the drug daily for the first 2 months and then for 20 days per month for the next 4 months. The frequency of headaches and the use of symptomatic drugs significantly decreased during treatment in both groups, however the number of attacks after 2 and 4 months of treatment was significantly lower in the acupuncture group, as was analgesic consumption after 2 months of treatment. At six months however, no such differences existed between the two treatment groups.

Pain intensity was significantly reduced only by acupuncture treatment and side effects were significantly less frequent in the acupuncture group - overall, women taking flunarizine were more likely than those receiving acupuncture to drop out of the study, for reasons that included depression, weight gain and sleepiness. (Headache 2002, Vol. 42(9) p.855-861).

BBC News website

Positive findings and scientific research confirming the effectiveness of acupuncture taken from BBC news website:Headaches

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Constipation & Dental Pain (Acupuncture)

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Varicose Veins (Acupuncture)

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Haemorrhoids (Acupuncture)

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Carpal Tunnel Syndrome (Acupuncture)

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Oedema (Acupuncture)

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Anxiety (Acupuncture)

Acupuncture for depression during pregnancy

Sixty-one pregnant women with major depressive disorder were randomly assigned to one of three treatments over an eight week period. Twenty women received active acupuncture, twenty-one received active control acupuncture, and twenty received massage. Acupuncture treatments were standardized, but individually tailored, and were provided in a double-blind fashion. The response rates at the end of the acute phase were statistically significantly higher for the group that received active acupuncture (69%) than for the women who received massage (32%), with an intermediate response rate (47%). The active acupuncture group also showed a significantly higher average rate of reduction in BDI scores from baseline to the end of the first month of treatment than the massage group. In conclusion, acupuncture holds promise for the treatment of depression during pregnancy.

Manber R, et al. Department of Psychiatry and Behavioral Sciences, Stanford University. 401, Quarry Rd., Stanford, CA 94305, United States.

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Breech Presentation (Acupuncture)

Effectiveness of acupuncture-type interventions versus expectant management to correct breech presentation: a systematic review

Objective

A systematic review of studies assessing the effectiveness of acupuncture-type interventions (moxibustion, acupuncture, or electro-acupuncture) on acupuncture point BL 67 to correct breech presentation compared to expectant management, based on controlled trials.

Data sources

Articles published from 1980 to May 2007 in databases of Medline, EMBASE, the Cochrane Central Register of Controlled Trials, AMED, NCCAM, Midirs and reference lists.

Study selection

Studies included were original articles; randomised controlled trials (RCT) or controlled cohort studies; acupuncture-type intervention on BL 67 compared with expectant management; ultrasound confirmed breech presentation and position of the fetus after treatment confirmed with ultrasound, position at delivery, and/or the proportion of caesarean sections reported.

Data extraction

Three reviewers independently extracted data. Disagreements were resolved by consensus.

Data synthesis

Of 65 retrieved citations, six RCT's and three cohort studies fulfilled the inclusion criteria. Data were pooled using random-effects models. In the RCT's the pooled proportion of breech presentations was 34% (95% CI: 20–49%) following treatment versus 66% (95% CI: 55–77%) in the control group (OR 0.25 95% CI: 0.11–0.58). The pooled proportion in the cohort studies was 15% (95% CI: 1–28%) versus 36% (95% CI: 14–58%), (OR 0.29, 95% CI: 0.19–0.43). Including all studies the pooled proportion was 28% (95% CI: 16–40%) versus 56% (95% CI: 43–70%) (OR 0.27, 95% CI: 0.15–0.46).

Conclusions

Our results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. Some studies were of inferior quality to others and further RCT's of improved quality are necessary to adequately answer the research question.
Ineke van den Berg, Johanna L. Bosch, Ben Jacobs, Irene Bouman, Johannes J. Duvekot and M.G. Myriam Hunink. Department of Epidemiology and Biostatistics, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands. The Rotterdam Institution for Training Midwives, Rotterdam, The Netherlands. Department of Radiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands. Department of Obstetrics and Gynaecology, Erasmus Medical Center Academic Hospital Rotterdam, Rotterdam, The Netherlands. Program in Health Decision Sciences, Department of Health Policy and Management, Harvard School of Public Health, Boston, United States. Clinic for Complementary Medicine, Praktijk Rodenrijs, Berkel Rodenrijs, The Netherlands.

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Labour (Acupuncture)

Acupoint stimulation can help induce labour

Acupuncture is being increasingly used in Western medical practice. The authors review the various applications of acupuncture during labor in this paper. This ancient therapeutic technique can be employed with a significant percentage of positive results to induce labor in post-term pregnancies, to strengthen uterine contractility and to favor cervical maturation.

The electrostimulating acupoints LI 4 Hegu and SP 6 Sanyinjiao is the most frequently used treatment in labor induction and in increasing the frequency and duration of uterine contractions. Moreover, the authors’ experience indicates that the BL 67 Zhiyin can be helpful in accelerating the dilation of the cervix: the treatment is effective in about 75% of patients.

The studies on the use of acupuncture to achieve pain relief and analgesia during labor are more controversial, mainly due to the great heterogeneity of applied treatments and some methodological biases. Nevertheless, the general evidence seems to be positive also for this application.

Allais, G., et al. Acupuncture in labor management. Minerva ginecologica 55(6): 503-10.

Acupuncture and hypnosis may be beneficial for pain during labour

Complementary pain management is very popular for women in labour who wish to avoid pharmacological or invasive methods. The authors reviewed existing evidence to study whether alternative medicine is actually effective in this setting. They based their criteria on whether the mothers were satisfied with their experience, whether additional pharmacological pain relief was used, and whether there were any complications involving the mother or child. A small body of literature indicated that mothers found acupuncture and hypnosis useful for moderating their pain. Aromatherapy, music and audio analgesia had no effects on the women.

Smith, C.A., et al. Complementary and alternative therapies for pain management in labour (Cochrane Review). Cochrane database of systematic reviews (Online : Update Software) :CD003521.

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