The Effect of Simultaneous Application of Transcutaneous Electrical Nerve Stimulation (TENS) on Specific Lumbar and Acupuncture Points on Labour Pain Relief: A Randomised Clinical Trial

Abstract

Introduction: Labour pain is among the most challenging experiences a woman could face during life. Non Pharmacological modalities like Transcutaneous Electrical Nerve Stimulation (TENS) are rather new methods, introduced for relieving this pain. Aim: To investigate the effect of concurrent use of TENS application on the labour pain relief. Materials and Methods: This is a double-blind randomised clinical trial study where, a total of 104 eligible pregnant women qualified for normal vaginal delivery. They were randomly divided into four groups treated with Lumbar-TENS or Acupuncture points-TENS as A: both inactive (placebo group), B: Active Acupuncture points TENS, C: Active Lumbar TENS and D: both active. TENS was applied on four points of toraco-lumbo sacral, while Acupuncture points-TENS was applied on Hegu and Sanyinjiao points. The pain scores were evaluated by Visual Analogue Scale (VAS) criteria, four times during the study for each individual. A questionnaire was used to evaluate the final impression of the subjects about the TENS method. The groups were compared using chi-square or Kruskal Wallis test. The trend of pain score over the study time points were assessed using Generalised Estimating Equation (GEE). Results: The mean age of the women were 27.86±5.92 years. There were no significant differences between the groups based on the pain scores over the study periods (p-value=0.588). There was a statistically significant difference between groups for satisfaction about the procedure and the placebo group had the lowest rate of tendency to reuse TENS at the future Labour (74%) compared to the other three groups (93-100%) (p-value=0.046). Conclusion: Lumbar or Acupuncture points-TENS had no significant relieving effects on Labour pain among the participants.

Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) As An Analgesic Intervention for Labor Pain: A Network Meta-analysis of Randomized Controlled Trials

“…There were 605 participants in the intervention groups and 609 in the comparison groups, with no significant differences in age and gestational age between both groups. Six trials [21][22][23][24][25][26] compared TEAS and control interventions, three [7,34,35] compared EA and controls, and one [36] compared TEAS and EA. In the comparison groups of RCTs in which TEAS served as an intervention, one group [21] adopted sham-TEAS, one [26] adopted routine care, and four [22][23][24][25] adopted blank control.…”

“…Six trials [21][22][23][24][25][26] compared TEAS and control interventions, three [7,34,35] compared EA and controls, and one [36] compared TEAS and EA. In the comparison groups of RCTs in which TEAS served as an intervention, one group [21] adopted sham-TEAS, one [26] adopted routine care, and four [22][23][24][25] adopted blank control. Seven acupoints were used in TEAS measures, including Hegu (LI4), Shenmen (HT7), Sanyinjiao (SP6), Neiguan (PC6), Ciliao (BL32), Jiaji (EX-B2), and an extra meridian point Neimadian (EX-LE29), with Hegu (LI4) and Sanyinjiao (SP6) being the most commonly used.…”

“…One study was considered as having high risk in terms of blinding participants and personnel because the author mentioned that blinding was unable to be performed owing to the different operations between TEAS and EA [36]. Regarding the blinding of outcome measures, three studies were assessed as having low risk [7,25,35], while those that were remaining had unclear risk as no details could be found in their articles. Only one study performed a rigorous triple-blinding method, in which parturients, investigators, obstetricians, and midwives were unable to assume the group to which they were assigned as the authors labeled their containers of injection with the study number only [35].…”

“…As no description of possible other bias had been reported, nine articles were considered to have unclear risk in terms of final other bias [7, 21-26, 34, 36]; however, one study was considered to have low risk as the obstetricians and midwives did not participate in the process of data collection to prevent potential bias [35]. In general, one study was considered to have low risk in all assessment terms [35], five had five terms considered to be low risk [7,21,22,25,34], and the remaining four had four low-risk terms [23,24,26,36].…”

“…Although TENS has been suggested as an alternative method for reducing labor pain [20], no systematic review has studied the efficacy and safety of TEAS in pain relief thus far. However, several randomized controlled trials (RCTs) have found that TEAS helps relieve labor pain [21][22][23][24][25][26].…”