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With Comments from John La Puma, MD, FACP
Source: Thomas CT, Napolitano PG. Use of acupuncture for managing chronic pelvic pain in pregnancy. A case report. J Reprod Med 2000;45:944-946.
Chronic pelvic pain is a health problem that affects many reproductive-age women. During reproduction the dilemma is even more challenging. The growing uterus often exacerbates pain, and treatment is limited by the effect on the fetus. A multispecialty approach and alternative medicine are often effective. Recently, the FDA announced the use of acupuncture and acupressure as officially recognized modalities for treatment of chronic pain in oncology patients.
We report a case of chronic pelvic pain in a 23-year-old primigravida at 27 weeks’ gestation on narcotics. After organic causes were ruled out, acupuncture was employed successfully. Outpatient management for the duration of the pregnancy included acupuncture and narcotics for breakthrough pain while maintaining activities of daily living. Spontaneous vaginal delivery without complications at 38 5/7 weeks produced a 3,305 g female infant. The pain resolved immediately following delivery.
We believe that this case demonstrates the benefit of combined allopathic with alternative forms of medicine. With the use of acupuncture, narcotic use was limited in this gravida while adding to her quality of life by allowing her to maintain normal activity.
This case, reported by a captain and a major at Travis Air Force Base Medical Center, is worth noting both for the patient’s clinical course and for the potential it has for stirring the thinking of hospitalists and those who employ them.
A 27-year-old with laparoscopy-diagnosed endometriosis since age 15 and on Lupron® prior to conception, the patient presented with right flank pain and hematuria. Nephrolithiasis was diagnosed. She had three days of intravenous narcotics and five subsequent in-hospital days of 7-10 tablets/d of oral oxycodone/acetaminophen, without complete pain relief. Biofeedback for a day, followed by trigger point injections, was also unsuccessful.
On the 11th hospital day, acupuncture at the helix of the ear was performed. The needles were left in place for eight hours, without the need for pain medicine. The patient required four treatments over three days, and was discharged. Outpatient acupuncture treatment occurred two to five times weekly, with the addition of three to five oxycodone/acetaminophen tablets until delivery.
Though it is unclear from the report whether the pain treated was that of a renal stone or of underlying endometriosis, if acupuncture can shorten hospital stays and reduce narcotic use in pregnancy, it may emerge as an available procedure in obstetric and gynecologic suites where women have a choice.
Whether acupuncture works by increasing endogenous opioid release and changing sympathetic tone, and whether it alters the perception of pain or actually changes its level is unknown. But it probably does work for some people in some circumstances. And it seldom does any harm, when carefully administered. That should be music to the ears of those who count dollars and days in acute care settings, and set the scene for local, innovative, community hospital-based research trials.
Keep an open mind about acupuncture and pain relief.