Acupuncture for Pelvic Girdle Pain in Pregnancy
Acupuncture for Pelvic Girdle Pain in Pregnancy
By Yoon Hang Kim, MD, MPH, DABMA, ABHM Dr. Kim is Dean of Integrative Medicine, Acupuncture and Integrative Medicine College, Berkeley, CA. Dr. Kim reports no consultant, stockholder, speaker's bureau, research, or other financial relationships with companies having ties to this field of study.
Source: Elden H, et al. Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: Randomized single-blind controlled trial. BMJ 2005;330: 761-765.
Abstract: The objective of this trial was to compare the efficacy of standard treatment, standard treatment plus acupuncture, and standard treatment plus stabilizing exercises for pelvic girdle pain during pregnancy. This randomized single-blind controlled trial was conducted at East Hospital, Gothenburg, and 27 maternity care centers in Sweden. The participants (n = 386) were pregnant women with pelvic girdle pain who were treated for six weeks with standard treatment (n = 130), standard treatment plus acupuncture (n = 125), or standard treatment plus stabilizing exercises (n = 131). The primary outcome measure was pain (visual analogue scale); the secondary outcome measure was assessment of severity of pelvic girdle pain by an independent examiner 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, in turn, had less pain in the evening than the stabilizing exercise group. Furthermore, the acupuncture group had less pain than the standard treatment group in the morning and in the evening. Attenuation of pelvic girdle pain as assessed by the independent examiner was greatest in the acupuncture group. The authors concluded that acupuncture and stabilizing exercises constitute efficient complements to standard treatment for the management of pelvic girdle pain during pregnancy. Acupuncture was superior to stabilizing exercises in this study.
Comments
Pelvic girdle pain is common among pregnant women, with one in three affected by severe pain.1 Pain is experienced between the posterior iliac crest and the gluteal fold around the sacroiliac joints with pain radiating to posterior thigh. The result is decreased ability to stand, walk, and sit for prolonged periods of time leading to loss of quality of life and productivity.2 The standard treatments of pelvic girdle pain during pregnancy include wearing a pelvic belt, exercising, and education. However, a recent systematic review demonstrated a questionable efficacy of the standard treatments.3
Acupuncture is a popular alternative medicine modality in the United States, with an estimated 8.2 million adults having been treated with acupuncture.4 Acupuncture is used during pregnancy to treat nausea and vomiting, to induce labor, and to treat pelvic and back pain.5 The Cochrane Review of interventions for preventing and treating pelvic and back pain in pregnancy concludes that although both physiotherapy and acupuncture reduced back and pelvic pain, individual acupuncture sessions were rated as more helpful than group physiotherapy sessions.6 Other Cochrane reviews of acupuncture interventions during pregnancy include labor pain7 and breech presentation.8
Despite the fact that many studies often do not distinguish between back pain and pelvic girdle pain, the treatment of pelvic girdle pain with back pain treatments may result in worsening of the symptoms.
In this study, Elden et al conducted a single-blind, controlled trial comparing the effectiveness of standard treatment alone, standard treatment plus acupuncture, and standard treatment plus stabilizing exercises for pregnancy-related pelvic girdle pain.9
Women in the standard treatment group received patient education about pelvic girdle pain, advice about daily activities, a pelvic belt, and a home exercise program designed to increase abdominal and gluteal strength. The standard treatment plus acupuncture group also received 30-minute sessions of acupuncture twice a week for six weeks. The standard treatment plus stabilizing exercises group received six hours of training over the course of six weeks; exercises were aimed at stabilizing the pelvis, back, and hips, and participants were given instructions to integrate these exercises in their daily activities; each training session included massage and stretching.
The diagnosis of pelvic girdle pain was confirmed by a series of diagnostic tests conducted by a physical therapist. Twice a day, the participants self-rated and scored their intensity of pelvic pain on a scale of 1-100. In addition, an independent examiner assessed each participant's recovery from symptoms of pelvic girdle pain.
The results showed that in the standard treatment group, pelvic girdle pain remained constant during treatment. Both the acupuncture and the stabilizing exercise groups showed significant benefits over the standard treatment group. Specifically, compared with the standard treatment group, the stabilizing exercise group had a nine-point reduction in pain in the morning (95% confidence interval [CI] 1.7-12.8; P = 0.312) and a 13-point reduction in the evening (CI 2.7-17.5; P = 0.0245).
The acupuncture group had even more pronounced reductions, with a 12-point reduction in the morning (CI 5.9-17.3; P < 0.0001) and a 27-point reduction in the evening (CI 13.3-29.5; P < 0.001). And when compared to the stabilizing exercise group, the acupuncture group had significantly less pain in the evening, with a 14-point reduction in pain (CI -18.1 to -3.3; P = 0.0130).
Despite the complexity of multiple intervention, the study design is simple and elegant. The results demonstrate that both the acupuncture and exercise groups reported improvement of pain. The degree of improvement is superior with acupuncture when compared to exercise.
However, this study suffers from a limitation arising from its single-blind design. The women in the acupuncture group were not compared to another group of women receiving "sham" acupuncture, nor were the women in the stabilizing exercises group compared to women performing "sham" exercises. One cannot rule out the possibility that the women receiving acupuncture or stabilizing exercises may have created a favorable expectation and subsequently reported less pain unrelated to the effects of the treatments. In addition, collecting multiple baselines, including functionality and quality-of-life measurements, would have provided additional dimensions of possible effects. Another group that may have been interesting to study would be a combined intervention group consisting of acupuncture and stabilization exercises, which could tease out possible additive vs. synergistic relationships.
In conclusion, the study demonstrates the benefit of using either acupuncture or stabilization exercises for treating pelvic girdle pain during pregnancy within the limitations of a single-blind study. Furthermore, acupuncture proved to be superior to stabilization exercises for relief of pelvic girdle pain. The study contributes to the growing body of evidence suggesting the usefulness of acupuncture for treating conditions experienced during pregnancy.
References
1. Bjorklund K, Bergstrom S. Is pelvic pain in pregnancy a welfare complaint? Acta Obstet Gynencol Scand 2000;79:24-30.
2. Wu WH, et al. Pregnancy related pelvic girdle pain (PPP): Terminology, presentation, and prevalence. Eur Spine J 2004;13:575-589.
3. Stuge B, et al. Physical therapy for pregnancy-related low back and pelvic pain: A systematic review. Acta Obstet Gynecol Scand 2003;82:983-990.
4. Barnes PM, et al. Complementary and alternative medicine use among adults: United States, 2002. CDC Advance Data Report #343. 2004.
5. Tamayo C. Acupuncture and pregnancy. Altern Ther Women's Health 2003;5:41-46.
6. Young G, Jewell D. Interventions for preventing and treating pelvic and back pain in pregnancy. The Cochrane Database of Systematic Reviews 2002; Issue 1. Art No: CD001139.
7. Smith CA, et al. Complementary and alternative therapies for pain management in labour. The Cochrane Database of Systematic Reviews 2003; Issue 2. Art No: CD003521.
8. Coyle ME, et al. Cephalic version by moxibustion for breech presentation. The Cochrane Database of Systematic Reviews 2005; Issue 2. Art No: CD003928.pub2.
9. Elden H, et al. Effects of acupuncture and stabilizing exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: Randomized single-blind controlled trial. BMJ 2005;330:761-765.
Kim Y-H. Acupuncture for pelvic girdle pain in pregnancy. Altern Ther Women's Health 2005;7(12):93-95.Subscribe Now for Access
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