Appears superior to standard treatment alone in treating mixed pelvic/back pain.
By Kathryn Feather, Senior Associate Editor
A study recently published in the American Journal of Obstetrics and Gynecology sought to establish the effectiveness of needle acupuncture in treating the common and often disabling issue of pelvic and back pain during pregnancy.
According to the study authors, "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."
Estimates of pelvic and back pain among pregnant women range from 24 percent to 90 percent who seek medical attention and complain of this "minor" problem. The large range is attributed to different definitions of the condition. According to the study authors, 25 percent of women with pelvic pain in pregnancy will seek medical help for their pain, 8 percent are severely disabled and 7 percent continue to have pain beyond the pregnancy. The majority of women with back pain in pregnancy report disturbed sleep from their pain. Disability often involves simple activities of daily living and can result in significant absenteeism from work. Back pain in pregnancy also increases the risk of postpartum back pain."
More than a third of the U.S. population utilizes complementary and alternative therapies, even during pregnancy, with 60 percent of women with lower back pain in pregnancy reporting they would try one of these alternative options for the treatment of their pain. Currently, more than 2 million people use acupuncture annually in the U.S.
In this study, two small trials on mixed pelvic/back pain and one large high-quality trial on pelvic pain met the inclusion criteria. In the first small trial, conducted in 2000, auricular points plus body acupuncture points (if needed) was provided for four weeks. The control group received physiotherapy plus physical therapies (defined as pelvic belt, warmth, massage or soft-tissue mobilization) for six to eight weeks. The study found a statistically significant reduction of pain in both groups, however there was greater pain relief reported by the acupuncture group. A total of 46 people completed this study (28 in the acupuncture group and 18 in the control group).
In the second small trial conducted in 2004, a total of 72 people participated. The acupuncture group received Chinese acupuncture plus tender points, and the control group received no additional treatment. However, physiotherapy and analgesics were allowed in both groups. More women in the acupuncture group reported a decrease in pain (60 percent in the acupuncture group vs. 14 percent in the control group).
In the third and largest study, conducted in 2005, a total of 321 people were either placed in the acupuncture group, the control group or a stabilizing exercise group. The acupuncture group received mixed Western and Chinese acupuncture plus standard treatment for six weeks. The control group received standard treatment (defined as advice, education, exercises and pelvic belt) for six weeks. The third group received stabilizing exercises and standard treatment for six weeks.
Acupuncture proved to be the best option in each of these studies. The authors conclude that while more evidence-based studies should be done, "Overall, our review finds limited, though promising evidence for the effectiveness of acupuncture in managing pelvic and back pain in pregnancy. In particular, there seems to be good evidence that acupuncture, in addition to standard treatment, is superior to standard treatment alone and stabilizing exercises for well-defined pregnancy-related pelvic pain.
"Given that acupuncture is a relatively safe procedure, these findings should encourage primary health care providers, obstetricians and midwives to consider referring women to trained acupuncturists for management of this common, painful and disabling condition."