Acupuncture for Pelvic Pain during Pregnancy

Posted on June 24, 2016

Effects of acupuncture and stabilising exercises as adjunct to standard treatment in pregnant women with pelvic girdle pain: randomised single blind controlled trial

The main finding of this study was that acupuncture or stabilising exercises as an adjunct to standard treatment offer clear clinical advantages over standard treatment alone for reduction of pain in pregnant women with pelvic girdle pain. This is supported by the patients’ own estimates and by independent examiners. Our results are also supported by earlier findings that showed beneficial effects of stabilising exercises for women with pelvic girdle pain after pregnancy. The training was aimed at affecting dysfunction of the muscle-tendon-fascia system that controls force closure of the pelvis.  Exactly how the exercises influence this system is unknown, but research has shown that contraction of the transversus abdominis decreases the laxity of the sacroiliac joint. The exercises were intended to affect mainly the local stability system, but whether an addition of global stabilising muscle exercises could have provided the same effect is not known. No major differences exist between current recom- mendations about stabilisation training and the exercises given in our study.

The stabilisation group also got additional treatment of stretching exercises of specific muscles plus massage. All treatment was more or less multifactorial, and massage as well as stretching may have had some contributory effect. The main training, however, was the stabilisation exercises that were done on several occasions during the day, in contrast to the stretching or massage that was done only at the visits.

In the standard group, pain remained constant during treatment. This is in line with earlier findings that indicated lack of evidence for the effect of standard treatment for pelvic girdle pain.

Previous studies of acupuncture for low back pain in pregnancy reported pain relief.  However, these studies had methodological shortcomings, as the type of back pain was not clearly defined. Furthermore, the acupuncture stimulation given previously must be considered weak compared with that given in studies of men and non-pregnant women. One of the studies used almost exclusively auricular acupuncture; the other study used segmental points, but no extrasegmental points were used and no further stimulation after insertion was given. Our findings that acupuncture gives acceptable pain relief in women with pelvic girdle pain is supported by physiological models explaining the mechanisms in the treatment of both acute and chronic pain conditions.

Pain may be inhibited at the segmental level, and for this reason the acupuncture points were selected in muscle segments according to the patient’s pain drawing, including diagnostic palpation to identify sensitive spots. The aim was to establish control of pelvic pain to prevent dysfunction of muscles of the spine and pelvis. Speculatively, this was achieved through activation of both the segmental pain inhibitory system, involving the so called gate control mechanism, and the central pain inhibitory system, involving secretion of endogenous opioids.  Extra-segmental points to the lumbo-sacral area were used to strengthen and lengthen the effect of the central control systems. In addition, well known general pain relieving points were selected. Whether the choice of acupuncture points and the method of stimulation in this study are optimal remains to be elucidated.

Earlier research found that poor muscle function in the back and pelvis at the beginning of pregnancy is related to severe pain and disability throughout pregnancy. This could be the case for the patients in the standard and stabilising exercise groups, as the acupuncture group estimated significantly lower visual analogue scale ratings after treatment. The acupuncture treatment succeeded in establishing control of the pain, and this may have been important in preventing dysfunction of muscles. Our results are supported by earlier research on acupuncture for low back pain.

This study shows that methods other than structured physiotherapy may be effective in treating pelvic girdle pain in pregnancy and that acupuncture represents an effective alternative. A combination of several methods is probably even better. Each method needs to be evaluated individually, however, before combinations can be recommended for future research, and only after that should recommendations for treatment be made.

We conclude that acupuncture as well as stabilising exercises constitute effective complements to standard treatment for pregnant women with pelvic girdle pain. Acupuncture was superior to stabilising exercises in this study. The findings are of particular importance because no previous study has shown such marked treatment effects among pregnant women with well defined pelvic girdle pain.

Reference:

Above citation from BMJ, doi:10.1136/bmj.38397.507014.E0 (published 18 March 2005)