Maintenance of physical activity level, functioning and health after non-pharmacological treatment of pelvic girdle pain with either transcutaneous electrical nerve stimulation or acupuncture: a randomised controlled trial

Abstract

ObjectiveTo investigate if there are differences between acupuncture and transcutaneous electrical nerve stimulation (TENS) as treatment for pelvic girdle pain (PGP) in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and physical activity (PA).DesignRandomised controlled trial.Setting and participantsPregnant women (n=113) with clinically verified PGP in gestational weeks 12–28, recruited from maternity healthcare centres, randomised (1:1) into two groups. Exclusion criteria: any obstetrical complication, systemic disease or previous disorder that could contradict tests or treatment.InterventionsThe intervention consisted of either 10 acupuncture sessions (two sessions per week) provided by a physiotherapist or daily home-based TENS during 5 weeks.Primary outcome variablesDisability (Oswestry Disability Index), functioning (Patient Specific Functional Scale), work ability (Work Ability Index) and PA-level according to general recommendations.Secondary outcome variablesFunctioning related to PGP (Pelvic Girdle Questionnaire), evening pain intensity (Numeric Rating Scale, NRS), concern about pain (NRS), health (EuroQoL 5-dimension), symptoms of depression/catastrophising (Edinburgh Postnatal Depression Scale/Coping Strategies Questionnaire).ResultsNo mean differences were detected between the groups. Both groups managed to preserve their functioning and PA level at follow-up. This may be due to significantly (p<0.05) reduced within groups evening pain intensity; acupuncture −0.96 (95% CI −1.91 to −0.01; p=0.049), TENS −1.29 (95% CI −2.13 to −0.44; p=0.003) and concern about pain; acupuncture −1.44 (95% CI −2.31 to −0.57; p=0.0012), TENS −1.99 (95% CI −2.81 to −1.17; p<0.0001). The acupuncture group showed an improvement in functioning at follow-up; 0.82 (95% CI 0.01 to 1.63; p=0.048)ConclusionTreating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity and also less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active.Trial registration number12726. https://www.researchweb.org/is/sverige/project/127261

Analgesic Efficacy of Acupuncture on Chronic Pelvic Pain: A Systemic Review and Meta-Analysis Study

“…All included studies were published between April 2011 and September 2022. Ten studies were published in Chinese [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ] and 7 studies were published in English [ 33 , 34 , 35 , 36 , 37 , 38 , 39 ].…”

“… Summary for the items of risk of bias in each included study [ 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 ]. …”

“… Meta-analysis of the studies evaluating the pain management effect of acupuncture using VAS/NRS and subgroup analysis with different acupuncture interventions [ 24 , 25 , 26 , 29 , 30 , 31 , 33 , 35 , 38 , 39 ]. …”

“… Subgroup analysis of therapeutic strategy on ( a ) total pain scores of NIH-CPSI [ 23 , 27 , 28 , 32 , 34 , 36 , 37 ] and ( b ) VAS/NRS [ 24 , 25 , 26 , 29 , 30 , 31 , 33 , 35 , 38 , 39 ]. …”

Pregnancy-Related Lumbopelvic Pain and Current Physiotherapy Methods

“…Gebelikte pelvik kuşak ağrısının tedavisinde, akupunktur ile TENS uygulamasının etkinliğini belirlemek amacıyla 12-28. gebelik haftalarında olan kadınlar üzerinde yapılan çalışmada, müdahale gruplarından birine, hafta da iki seans 10 kez akupunktur uygulanmış, diğer müdahale grubunda ise 5 hafta boyunca günlük ev tabanlı TENS uygulaması yapılmıştır. Çalışmanın sonucunda her iki yönteminde etkili olduğu bildirilmiştir 42 . Gebeliğin 3. trimesterinde yaşanan bel ağrısını tedavi etmek için, asetaminofen, TENS ve egzersizin etkinliğini karşılaştırmak amacıyla 56 gebe üzerinde yapılan çalışmada, TENS uygulamasının gebelikte bel ağrısının giderilmesinde etkili olduğu ve herhangi bir yan etkisinin olmadığı belirtilmiştir 43 .…”