The effects of acupuncture are rarely studied in pregnant women. A relevant systematic review did not include comparisons with sham acupuncture (SAcu).
Objective
To explore the effects of acupuncture, SAcu, and standard care (SC) on pregnancy-related low back pain.
Methods
We searched five medical literature databases for articles published from inception to September 30, 2022. The primary outcome was visual analog scale (VAS) intensity after the intervention. The secondary outcomes were the overall effects of treatment, quality of life (QOL), and QOL was evaluated by the Short Form-36 Health Survey Questionnaire (SF-36).
Results
The network meta-analysis included eight studies and 864 patients. Six trials were at low risk of bias and two studies had a high risk of bias due to allocation concealment and blinding. Acupuncture and SAcu were relatively more advantageous in terms of analgesic effects after intervention than SC, but there were no differences between them. In terms of overall effects in number of remissions and the SF-36, Acupuncture was found to be superior to other methods, and SAcu was better than SC. Acupuncture had the highest surface under the cumulative ranking curve, followed by SAcu and SC for all outcomes.
Conclusions
Acupuncture performs similarly to SAcu in pain relief and is more efficient than SC. Regarding the effectiveness of treatment and QOL, acupuncture therapy was superior to SAcu and SC.
WuWHMeijerOGUegakiK, et al.Pregnancy-related pelvic girdle pain (PPP), I: terminology, clinical presentation, and prevalence. Eur Spine J2004; 13: 575–589.
2.
Guerreiro da SilvaJBNakamuraMUCordeiroJA,et al.Acupuncture for low back pain in pregnancy - a prospective, quasi- randomised, controlled study. Acupunct Med2004; 22: 60–67.
3.
KovacsFMGarciaERoyuelaA, et al.Prevalence and factors associated with low back pain and pelvic girdle pain during pregnancy: a multicenter study conducted in the Spanish national health service. Spine (Phila Pa 1976)2012; 37: 1516–1533.
4.
BergströmCPerssonMMogrenI. Pregnancy-related low back pain and pelvic girdle pain approximately 14 months after pregnancy - pain status, self-rated health and family situation. BMC Pregnancy Childbirth2014; 14: 48.
5.
DavenportMHMarchandAAMottolaMF, et al.Exercise for the prevention and treatment of low back, pelvic girdle and lumbopelvic pain during pregnancy: a systematic review and meta-analysis. Br J Sports Med2019; 53: 90–98.
6.
Fontana CarvalhoAPDufresneSSRogerio de OliveiraM, et al.Effects of lumbar stabilization and muscular stretching on pain, disabilities, postural control and muscle activation in pregnant woman with low back pain. Eur J Phys Rehabil Med2020; 56: 297–306.
7.
GutkeABettenCDegerskärK, et al.Treatments for pregnancy-related lumbopelvic pain: a systematic review of physiotherapy modalities. Acta Obstet Gynecol Scand2015; 94: 1156–1167.
8.
ACOG Committee opinion No. 650: physical activity and exercise during pregnancy and the postpartum period. Obstet Gynecol2015; 126: e135–e142.
ZhouWBenharashP. Effects and mechanisms of acupuncture based on the principle of meridians. J Acupunct Meridian Stud2014; 7.
11.
WedenbergKMoenBNorlingA. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand2000; 79: 331–335.
12.
CoutauxA. Non-pharmacological treatments for pain relief: TENS and acupuncture. Joint Bone Spine2017; 84: 657–661.
13.
OndrejkovicovaAPetrovicsGSvitkovaK, et al.Why acupuncture in pain treatment?Neuro Endocrinol Lett2016; 37: 163–168.
14.
TangYYinHYRubiniP,et al.Acupuncture-Induced analgesia: a neurobiological basis in purinergic signaling. Neuroscientist. 2016; 22: 563–578.
15.
AmmendoliaCFurlanADImamuraM, et al.Evidence-informed management of chronic low back pain with needle acupuncture. Spine J2008; 8: 160–172.
16.
KvorningNHolmbergCGrennertL, et al.Acupuncture relieves pelvic and low-back pain in late pregnancy. Acta Obstet Gynecol Scand2004; 83: 246–250.
17.
WangSMDezinnoPLinEC, et al.Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study. Am J Obstet Gynecol2009; 201: 271.e1–271.e9.
18.
NicolianSButelTGambottiL, et al.Cost effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy: a randomized controlled trial. PLoS One2019; 14: e0214195.
19.
VasJCintadoMCAranda-RegulesJM, et al.Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle: a multicenter randomized clinical trial. Acta Obstet Gynecol Scand2019; 98: 1307–1317.
20.
FosterNEBishopABartlamB, et al.Evaluating acupuncture and standard care for pregnant women with back pain (EASE back): a feasibility study and pilot randomised trial. Health Technol Assess2016; 20: 1–236.
21.
EkdahlLPeterssonK. Acupuncture treatment of pregnant women with low back and pelvic pain—an intervention study. Scand J Caring Sci2010; 24: 175–182.
22.
LiRChenLRenY, et al.Efficacy and safety of acupuncture for pregnancy-related low back pain: a systematic review and meta-analysis. Heliyon2023; 9: e18439.
23.
ChunmeiDYongCLongG, et al.Self efficacy associated with regression from pregnancy-related pelvic girdle pain and low back pain following pregnancy. BMC Pregnancy Childbirth2023; 23: 122.
24.
MogrenIM. BMI, pain and hyper-mobility are determinants of long-term outcome for women with low back pain and pelvic pain during pregnancy. Eur Spine J2006; 15: 1093–1102.
25.
MacDonaldLAJohnsonCYLuML, et al.Physical job demands in pregnancy and associated musculoskeletal health and employment outcomes: a systematic review. Am J Obstet Gynecol2024; 230: 583–599.e16.
26.
AlbertHGodskesenMWestergaardJ. Evaluation of clinical tests used in classification procedures in pregnancy-related pelvic joint pain. Eur Spine J2000; 9: 161–166.
27.
BuraniEMarrugantiSGiglioniG, et al.Predictive factors for pregnancy-related persistent pelvic girdle pain (PPGP): a systematic review. Medicina (Kaunas)2023; 59: 2123.
28.
MehtaNLarsonL. Pharmacotherapy in pregnancy and lactation. Clin Chest Med2011; 32: 43–52.
29.
LiddleSDPennickV. Interventions for preventing and treating low-back and pelvic pain during pregnancy. Cochrane Database Syst Rev2015; 2015: CD001139.
30.
CloseCSinclairMLiddleSD, et al.A systematic review investigating the effectiveness of complementary and alternative medicine (CAM) for the management of low back and/or pelvic pain (LBPP) in pregnancy. J Adv Nurs2014; 70: 1702–1716.
31.
YaoXLiCGeX, et al.Effect of acupuncture on pregnancy related low back pain and pelvic pain: a systematic review and meta-analysis. Int J Clin Exp Med2017; 9: 5903–5912.
32.
CherkinDCShermanKJAvinsAL, et al.A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med2009; 169: 858–866.
33.
GiovanardiCMGonzalez-LorenzoMPoiniA, et al.Acupuncture as an alternative or in addition to conventional treatment for chronic non-specific low back pain: a systematic review and meta-analysis. Integr Med Res2023; 12: 100972.
34.
HoRSWongCHWuJC, et al.Non-specific effects of acupuncture and sham acupuncture in clinical trials from the patient's perspective: a systematic review of qualitative evidence. Acupunct Med2021; 39: 3–19.
35.
FinnissDGKaptchukTJMillerF,et al.Biological, clinical, and ethical advances of placebo effects. Lancet2010; 375: 686–695.
36.
SchedlowskiMEnckPRiefW,et al.Neuro-bio-behavioral mechanisms of placebo and nocebo responses: implications for clinical trials and clinical practice. Pharmacol Rev2015; 67: 697–730.
37.
KongJTPuetzCTianL, et al.Effect of electroacupuncture vs sham treatment on change in pain severity among adults with chronic low back pain: a randomized clinical trial. JAMA Netw Open2020; 3: e2022787.
38.
PaiMYBHohlASouzaLRC, et al.Acupuncture for pregnancy-related pain in the lower back and posterior pelvic girdle. Rev Assoc Med Bras (1992)2023; 69: e2023S101.
39.
ParkJSohnYWhiteAR,et al.The safety of acupuncture during pregnancy: a systematic review. Acupunct Med2014; 32: 257–266.
40.
ClarksonCEO'MahonyDJonesDE. Adverse event reporting in studies of penetrating acupuncture during pregnancy: a systematic review. Acta Obstet Gynecol Scand2015; 94: 453–464.
41.
SongCYLinSFHuangCY, et al.Validation of the brief pain inventory in patients with low back pain. Spine (Phila Pa 1976)2016; 41: E937–E942.
42.
MelzackR. The short-form McGill pain questionnaire. Pain1987; 30: 191–197.
