Associations between maternal characteristics and women's responses to acupuncture during labour: a secondary analysis from a randomised controlled trial

Linda Vixner, Erica Schytt, Lena B Mårtensson, Linda Vixner, Erica Schytt, Lena B Mårtensson

Abstract

Background: Patient characteristics are modulators of pain experience after acupuncture treatment for chronic pain. Whether this also applies to labour pain is unknown.

Aim: To examine for associations between maternal characteristics and response to acupuncture in terms of labour pain intensity in close proximity to the treatment (within 60 min) and over a longer time period (up to 240 min), and whether or not epidural analgesia is used, before and after adjustment for obstetric status upon admission to the labour ward.

Methods: Cohort study (n=253) using data collected for a randomised controlled trial. Associations were examined using linear mixed models and logistic regression analyses. Tests of interactions were also applied to investigate whether maternal characteristics were influenced by treatment group allocation.

Results: In close proximity to the treatment, advanced age and cervical dilation were associated with lower pain scores (mean difference (MD) -13.2, 95% CI -23.4 to -2.9; and MD -5.0, 95% CI -9.6 to -0.5, respectively). For the longer time period, labour pain was negatively associated with age (MD -11.8, 95% CI -19.6 to -3.9) and positively associated with dysmenorrhoea (MD 5.5, 95% CI 1.6 to 9.5). Previous acupuncture experience and advanced cervical dilatation were associated with higher and lower use of epidural analgesia (OR 2.7, 95% CI 1.3 to 5.9; and OR 0.3, 95% CI 0.1 to 0.5, respectively). No interactions with treatment allocation were found.

Conclusions: This study did not identify any maternal characteristics associated with women's responses to acupuncture during labour.

Trial registration number: NCT01197950; Post-results.

Keywords: ACUPUNCTURE; OBSTETRICS; PAIN MANAGEMENT.

Conflict of interest statement

Competing interests: None declared.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

References

    1. Vixner L, Schytt E, Stener-Victorin E, et al. . Acupuncture with manual and electrical stimulation for labour pain: a longitudinal randomised controlled trial. BMC Complement Altern Med 2014;14:187 10.1186/1472-6882-14-187
    1. Melzack R. The myth of painless childbirth (the John J. Bonica lecture). Pain 1984;19:321–37. 10.1016/0304-3959(84)90079-4
    1. Lowe NK. Differences in 1st and 2nd stage labor pain between nulliparous and multiparous women. J Psychosom Obstet Gynecol 1992;13:243–53. 10.3109/01674829209009197
    1. Rowlands S, Permezel M. Physiology of pain in labour. Baillieres Clin Obstet Gynaecol 1998;12:347–62. 10.1016/S0950-3552(98)80071-0
    1. Lowe NK. The nature of labor pain. Am J Obstet Gynecol 2002;186:S16–24. 10.1016/S0002-9378(02)70179-8
    1. Melzack R. Labor pain as a model of acute pain. Pain 1993;53:117–20. 10.1016/0304-3959(93)90071-V
    1. Waldenstrom U, Bergman V, Vasell G. The complexity of labor pain: experiences of 278 women. J Psychosom Obstet Gynaecol 1996;17:215–28. 10.3109/01674829609025686
    1. Melzack R, Kinch R, Dobkin P, et al. . Severity of labor pain—influence of physical as well as psychologic variables. Can Med Assoc J 1984;130:579–84.
    1. Fridh G, Kopare T, Gastonjohansson F, et al. . Factors associated with more intense labor pain. Res Nurs Health 1988;11:117–24. 10.1002/nur.4770110207
    1. Brown ST, Campbell D, Kurtz A. Characteristics of labor pain at two stages of cervical-dilation. Pain 1989;38:289–95. 10.1016/0304-3959(89)90215-7
    1. Lowe NK. Critical predictors of sensory and affective pain during 4 phases of labor. J Psychosom Obstet Gynecol 1991;12:193–208. 10.3109/01674829109078001
    1. Melzack R, Bélanger E. Labor pain—correlations with menstrual pain and acute low-back-pain before and during pregnancy. Pain 1989;36:225–9. 10.1016/0304-3959(89)90027-4
    1. Lally JE, Murtagh MJ, Macphail S, et al. . More in hope than expectation: a systematic review of women's expectations and experience of pain relief in labour. BMC Med 2008;6:7. 10.1186/1741-7015-6-7
    1. Jones L, Othman M, Dowswell T, et al. . Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev 2012(3):CD009234 10.1002/14651858.CD009234.pub2
    1. Levett KM, Smith CA, Dahlen HG, et al. . Acupuncture and acupressure for pain management in labour and birth: a critical narrative review of current systematic review evidence. Complement Ther Med 2014;22:523–40. 10.1016/j.ctim.2014.03.011
    1. Smith C, Collins C, Crowther C, et al. . Acupuncture or acupressure for pain management in labour. Cochrane Database Syst Rev 2011(Issue 7): Art. No.: CD009232.
    1. Cho S, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. Br J Obstet Gynaecol 2010;117:907–20. 10.1111/j.1471-0528.2010.02570.x
    1. Lee H, Ernst E. Acupuncture for labor pain management: a systematic review. Am J Obstet Gynecol 2004;191:1573–9. 10.1016/j.ajog.2004.05.027
    1. Huntley AL, Thompson J, Ernst E. Complementary and alternative medicine for labor pain: a systematic review. Am J Obstet Gynecol 2004;191:36–44. 10.1016/j.ajog.2003.12.008
    1. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008;85:355–75. 10.1016/j.pneurobio.2008.05.004
    1. White A, Cummings M, Filshie J. An introduction to Western medical acupuncture. 1st edn Edinburgh: Churchill Livingstone/Elsevier Limited, 2008.
    1. Witt CM, Schützler L, Lüdtke R, et al. . Patient characteristics and variation in treatment outcomes which patients benefit most from acupuncture for chronic pain? Clin J Pain 2011;27:550–5. 10.1097/AJP.0b013e31820dfbf5
    1. Vixner L, Mårtensson LB, Stener-Victorin E, et al. . Manual and electroacupuncture for labour pain: study design of a longitudinal randomized controlled trial. Evid Based Complement Alternat Med 2012;2012:943198 10.1155/2012/943198
    1. Vixner L, Mårtensson LB, Schytt E. Acupuncture with manual and electrical stimulation for labour pain: a two month follow up of recollection of pain and birth experience. BMC Complement Altern Med 2015;15:180 10.1186/s12906-015-0526-6
    1. Green JM, Baston HA. Feeling in control during labor: concepts, correlates, and consequences. Birth-Issue Perinat. Care 2003;30:235–47. 10.1046/j.1523-536X.2003.00253.x
    1. White A, Editorial Board Acupuncture M. Western medical acupuncture: a definition. Acupunct Med 2009;27:33–5. 10.1136/aim.2008.000372
    1. Choinière M, Melzack R, Girard N, et al. . Comparisons between patients’ and nurses’ assessment of pain and medication efficacy in severe burn injuries. Pain 1990;40:143–52. 10.1016/0304-3959(90)90065-L
    1. Joyce CR, Zutshi DW, Hrubes V, et al. . Comparison of fixed interval and visual analogue scales for rating chronic pain. Eur J Clin Pharmacol 1975;8:415–20.. 10.1007/BF00562315
    1. Nesheim B, Kinge R, Berg B, et al. . Acupuncture during labor can reduce the use of meperidine: a controlled clinical study. Clin J Pain 2003;19:187–91. 10.1097/00002508-200305000-00006
    1. Borup L, Wurlitzer W, Hedegaard M, et al. . Acupuncture as pain relief during delivery: a randomized controlled trial. Birth 2009;36:5–12. 10.1111/j.1523-536X.2008.00290.x
    1. Hantoushzadeh S, Alhusseini N, Lebaschi A. The effects of acupuncture during labour on nulliparous women: a randomised controlled trial. Aust N Z J Obstet Gynaecol 2007;47:26–30. 10.1111/j.1479-828X.2006.00674.x
    1. Mårtensson L, Stener-Victorin E, Wallin G. Acupuncture versus subcutaneous injections of sterile water as treatment for labour pain. Acta Obstet Gynecol Scand 2008;87:171–7. 10.1080/00016340701797799
    1. Ziaei S, Hajipour L. Effect of acupuncture on labor. Int J Gynaecol Obstet 2006;92:71–2. 10.1016/j.ijgo.2005.09.008
    1. Skilnand E, Fossen D, Heiberg E. Acupuncture in the management of pain in labor. Acta Obstet Gynecol Scand 2002;81:943–8. 10.1034/j.1600-0412.2002.811008.x
    1. Napadow V, Makris N, Liu J, et al. . Effects of electroacupuncture versus manual acupuncture on the human brain as measured by fMRI. Hum Brain Mapp 2005;24:193–205. 10.1002/hbm.20081
    1. Peyron R, Laurent B, Garcia-Larrea L. Functional imaging of brain responses to pain. A review and meta-analysis (2000). Neurophysiol Clin 2000;30:263–88. 10.1016/S0987-7053(00)00227-6
    1. Barclay-Goddard R, Epstein JD, Mayo NE. Response shift: a brief overview and proposed research priorities. Qual Life Res 2009;18:335–46. 10.1007/s11136-009-9450-x
    1. Granot M, Yarnitsky D, Itskovitz-Eldor J, et al. . Pain perception in women with dysmenorrhea. Obstet Gynecol 2001;98:407–11. 10.1016/s0029-7844(01)01465-x
    1. Iacovides S, Avidon I, Baker FC. What we know about primary dysmenorrhea today: a critical review. Hum Reprod Update 2015;21:762–78. 10.1093/humupd/dmv039
    1. Waldenström U, Aasheim V, Britt AB, et al. . Adverse pregnancy outcomes related to advanced maternal age compared with smoking and being overweight. Obstet Gynecol 2014;123:104–12. 10.1097/AOG.0000000000000062
    1. Gibson SJ, Farrell F. A review of age differences in the neurophysiology of nociception and the perceptual experience of pain. Clin J Pain 2004;20:227–39. 10.1097/00002508-200407000-00004
    1. Hodnett ED. Pain and women's satisfaction with the experience of childbirth: a systematic review. Am J Obstet Gynecol 2002;186(5 Suppl Nature):S160–S72.
    1. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603–16. 10.1089/acm.2007.7040

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