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- Vixner, Linda, et al.
(författare)
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Acupuncture with manual and electrical stimulation for labour pain : a longitudinal randomised controlled trial
- 2014
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Ingår i: BMC Complementary and Alternative Medicine. - : BioMed Central (BMC). - 1472-6882. ; 14
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Tidskriftsartikel (refereegranskat)abstract
- Background: Acupuncture is commonly used to reduce pain during labour despite contradictory results. The aim of this study is to evaluate the effectiveness of acupuncture with manual stimulation and acupuncture with combined manual and electrical stimulation (electro-acupuncture) compared with standard care in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than standard care, and that electro-acupuncture was most effective.Methods: A longitudinal randomised controlled trial. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals . 303 nulliparous women with normal pregnancies were randomised to: 40 minutes of manual acupuncture (MA), electro-acupuncture (EA), or standard care without acupuncture (SC). Primary outcome: labour pain, assessed by Visual Analogue Scale (VAS). Secondary outcomes: relaxation, use of obstetric pain relief during labour and post-partum assessments of labour pain. The sample size calculation was based on the primary outcome and a difference of 15 mm on VAS was regarded as clinically relevant, this gave 101 in each group, including a total of 303 women.Results: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95% confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95% CI] -3.6-4.8). Fewer number of women in the EA group used epidural analgesia (46%) than women in the MA group (61%) and SC group (70%) (EA vs SC: odds ratio [OR] 0.35; [95% CI] 0.19-0.67).Conclusions: Acupuncture does not reduce women’s experience of labour pain, neither with manual stimulation nor with combined manual and electrical stimulation. However, fewer women in the EA group used epidural analgesia thus indicating that the effect of acupuncture with electrical stimulation may be underestimated.These findings were obtained in a context with free access to other forms of pain relief.
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| 2. |
- Vixner, Linda
(författare)
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Acupuncture with manual and electrical stimulation for labour pain: A longitudinal randomised controlled trial
- 2014
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Acupuncture using manual stimulation (MA) of the needles is commonly used to reduce labour pain despite contradictory results from studies of its effectiveness. A combination of manual and electrical stimulation (EA) could reduce labour pain more effectively than MA alone, by a higher treatment intensity.The aim was to evaluate the effectiveness of MA and EA compared with standard care without any acupuncture (SC) in reducing labour pain. Our hypothesis was that both acupuncture stimulation techniques were more effective than SC, and that EA was the most effective.MethodsNulliparous women (n=303) with a normal pregnancy were equally randomized to three groups receiving 40 minutes of either MA, EA or to SC. The recruitment of participants took place at the admission to the labour ward between November 2008 and October 2011 at two Swedish hospitals.The primary outcome was women’s assessment of labour pain; before and after the first treatment, every 30 minutes for five hours, and thereafter every hour until birth, or until epidural analgesia was administered. For the primary outcome, a linear mixed model for repeated measures was performed to investigate associations between treatment (MA, EA, SC) and pain scores on VAS over time. A difference of 15 mm on the visual analogue scale (VAS) was regarded as clinically relevant, and this required 41 women per group, and compensating for dropouts, in total 101 women in each group.Data on the primary outcome were obtained from 253 women: MA n=83, EA n=87, and SC n=83.Results Primary outcome: Mean estimated pain scores on VAS (SC: 69.0, MA: 66.4 and EA: 68.5), adjusted for: treatment, age, education, and time from baseline, with no interactions did not differ between the groups (SC vs MA: mean difference 2.6, 95 % confidence interval [CI] -1.7-6.9 and SC vs EA: mean difference 0.6 [95%CI] -3.6-4.8).Secondary outcomes:Use of epidural analgesia: MA 61%, EA 46%, SC 70%. EA vs SC: odds ratio (OR) 0.35; (95% CI) 0.19-0.67.EA vs MA: OR 0.57 (95% CI) 0.31-1.06.Duration of labour (min): MA 619, EA 500, SC 615. EA vs SC: Hazard Ratio (HR) 1.44; (95% CI) 1.06-1.97. EA vs MA: HR 1.41; (95% CI) 1.03-1.91.Sufficient pain relief (day after partus): MA 77%, EA 81%, SC 74% (ns).Positive experience of the midwife (day after partus): MA 100%, EA 97.5%, and SC 98.7% (ns).Support from the midwife to a high extent (day after partus): MA 77.2%, EA 83.5%, and SC 80% (ns).ConclusionsAcupuncture does not reduce women’s experience of labour pain, however, women receiving a combination of manual and electro-acupuncture (EA) used less additional pain relief, including epidural analgesia, and had shorter labour than women in the standard care group (SC). Despite the lower use of other pain relief, a majority of the women who used EA were equally satisfied with their pain relief as the women receiving manual acupuncture alone (MA) or SC. They were also equally satisfied with the support from the midwife.
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| 3. |
- Vixner, Linda, et al.
(författare)
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Manual and Electroacupuncture for Labour Pain : Study Design of a Longitudinal Randomized Controlled Trial
- 2012
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Ingår i: Evidence-based Complementary and Alternative Medicine. - : Hindawi Publishing Corporation. - 1741-427X .- 1741-4288. ; , s. Article ID 943198-
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Tidskriftsartikel (refereegranskat)abstract
- Introduction. Results from previous studies on acupuncture for labour pain are contradictory and lack important information on methodology. However, studies indicate that acupuncture has a positive effect on women's experiences of labour pain. The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain as the primary outcome. This paper will present in-depth information on the design of the study, following the CONSORT and STRICTA recommendations. Methods. The study was designed as a randomized controlled trial based on western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture, or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. A Visual Analogue Scale was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment. This trial is registered at ClinicalTrials.gov:NCT01197950.
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| 4. |
- Vixner, Linda
(författare)
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Manual and electroacupuncture for labour pain. Study design of a longitudinal randomized controlled trial
- 2013
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Results from previous acupuncture studies for labour pain are contradictory and lack important information on methodology. The sample sizes are in general small, information about the intervention such as needle placement, number of acupuncture points, type of stimulation, and duration of treatment, is often sparse or lacking However, studies indicate that acupuncture has a positive effect on women’s experiences of labour pain. Aim: The aim of the present study was to evaluate the efficacy of two different acupuncture stimulations, manual or electrical stimulation, compared with standard care in the relief of labour pain. Our hypothesis is that acupuncture with manual or electrical stimulation is more effective than standard care in the relief of labor pain, and that acupuncture with electrical stimulation is the most effective.Outcome measures: Primary outcome: Labour pain measured with visual analogue scale (VAS). Secondary outcomes are use of epidural analgesia, experience of relaxation, labour outcomes and infant outcomes. Biochemical markers of proinflammatory cytokines, memory of labour pain and overall childbirth experience.Methods: The study was designed as a randomized controlled trial based on Western medical theories. Nulliparous women with normal pregnancies admitted to the delivery ward after a spontaneous onset of labour were randomly allocated into one of three groups: manual acupuncture, electroacupuncture or standard care. Sample size calculation gave 101 women in each group, including a total of 303 women. VAS was used for assessing pain every 30 minutes for five hours and thereafter every hour until birth. Questionnaires were distributed before treatment, directly after the birth, and at one day and two months postpartum. Blood samples were collected before and after the first treatment.At the conference, information on the design of the study will be presented and the considerations of whether to use placebo controls or not will be discussed.ClinicalTrials.gov: NCT01197950
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