Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20190014
Brazilian Journal of Pain
Review Article

Non-pharmacological therapies for postpartum analgesia: a systematic review

Terapias não farmacológicas para analgesia no pós-parto: uma revisão sistemática

Larissa Ramalho Dantas Varella Dutra; Alane Macatrão Pires de Holanda Araújo; Maria Thereza Albuquerque Barbosa Cabral Micussi

http://dx.doi.org/10.5935/2595-0118.20190014 BrJP, vol.2, n1, p.72-80, 2019
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Abstract

BACKGROUND AND OBJECTIVES: Abdominal and pelvic pain is a prevalent condition among women in the immediate postpartum period. Non-pharmacological therapies are of great importance for the treatment of this condition since they do not cause systemic side effects, such as drowsiness, irritability, and changes in the composition of breast milk. This article aims to identify and evaluate the efficacy of non-pharmacological analgesic therapies used in the immediate puerperium in abdominal-pelvic pain.

CONTENTS: Searches were carried out in the main databases from September to October 2017 using the following descriptors "treatment" AND "pain" AND "postpartum"; "Treatment" AND "pain" AND "postpartum" AND "analgesics" AND "non-pharmacological". Controlled and randomized clinical trials published between January 2007 and August 2017, in Portuguese, English, and Spanish were included. Of the 1737 studies found in the databases, 42 were selected by the title. According to the eligibility criteria, 13 studies were included. The total sample size of the studies ranged from 21 to 266. In the intervention groups, the sample ranged from 11 to 126 women who underwent cryotherapy, transcutaneous electrical stimulation, LASER, acupuncture and ear acupressure.

CONCLUSION: Interventional practices such as transcutaneous electrical nervous stimulation and cryotherapy presented significant data relevant to the reduction of abdominal and pelvic pain. The techniques of acupuncture and ear acupressure still present inconclusive data. Despite the relief of perineal pain, laser therapy showed no statistically significant effect on pain relief when compared to the placebo group.

Keywords

Analgesics, Cesarean section, Pain, Physiotherapy

Resumo

JUSTIFICATIVA E OBJETIVOS: Dor abdominal e pélvica são condições prevalentes entre as puérperas no período pós-parto. As terapias não farmacológicas nesses casos são de grande importância, tendo em vista a ausência de efeitos adversos sistêmicos, tais como sonolência, irritabilidade e modificações no leite materno. O objetivo deste estudo foi identificar e avaliar a eficácia das terapias analgésicas não farmacológicas utilizadas no puerpério imediato na dor abdominal e pélvica.

CONTEÚDO: Realizou-se buscas nas principais bases de dados, no período de setembro a outubro de 2017, utilizando-se as combinações: "treatment" AND "pain" AND "postpartum"; "treatment" AND "pain" AND "postpartum" AND "analgesics" AND "non-pharmacological". Foram incluídos ensaios clínicos controlados e randomizados, publicados no período de janeiro de 2007 a agosto de 2017, nos idiomas português, inglês e espanhol. Dos 1.737 estudos encontrados nas bases de dados, 42 foram selecionados pelo título. De acordo com os critérios de elegibilidade, incluiu-se 13 estudos. O tamanho total das amostras dos estudos variou entre 21 e 266. Nos grupos com intervenção, a amostra variou entre 11 e 126 mulheres que foram submetidas a crioterapia, estimulação elétrica nervosa transcutânea, LASER, acupuntura e auriculoterapia.

CONCLUSÃO: As práticas intervencionistas como a eletroestimulação elétrica nervosa transcutânea e a crioterapia apresentaram dados significativos relevantes na redução da dor abdominal e pélvica. As técnicas de acupuntura e auriculoterapia ainda apresentam dados inconclusivos. Apesar de provocar alívio da dor perineal, a laserterapia não mostrou efeito estatisticamente significativo para alívio da dor quando comparada com o grupo placebo.

Palavras-chave

Analgesia, Cesariana, Dor, Fisioterapia

References

Woods AB, Crist B, Kowalewski S, Carroll J, Warren J, Robertson J. A cross-sectional analysis of the effect of patient-controlled epidural analgesia versus patient controlled analgesia on postcesarean pain and breastfeeding. J Obstet Gynecol Neonatal Nurs. 2012;41(3):339-46.

Mathias AE, Pitangui AC, Vasconcelos AM, Silva SS, Rodrigues PS, Dias TG. Perineal pain measurement in the immediate vaginal postpartum period. Rev Dor. 2015;16(4):267-71.

Mascarello KC, Matijasevich A, Santos ID, Silveira MF. Early and late puerperal complications associated with the mode of delivery in a cohort in Brazil. Rev Bras Epidemiol. 2018;21.

Cardoso PO, Alberti LR, Petroianu A. Neonatal and maternal morbidity related to the type of delivery. Cien Saude Colet. 2010;15(2):427-35.

Kainu JP, Sarvela J, Tiippana E, Halmesmäki E, Korttila KT. Persistent pain after caesarean section and vaginal birth: a cohort study. Int J Obstet Anesth. 2010;19(1):4-9.

Christianson LM, Bovbjerg VE, McDavitt EC, Hullfish KL. Risk factors for perineal injury during delivery. Am J Obstet Gynecol. 2003;189(1):255-60.

Çitak Karakaya I, Yüksel I, Akbayrak T, Demirtürk F, Karakaya MG, Ozyüncü Ö. Effects of physiotherapy on pain and functional activities after cesarean delivery. Arch Gynecol Obstet. 2012;285(3):621-7.

Buhagiar L, Cassar OA, Brincat MP, Buttigieg GG, Inglott AS, Adami MZ. Predictors of post-caesarean section pain and analgesic consumption. J Anaesthesiol Clin Pharmacol. 2011;27(2):185-91.

Abbaspoor Z, Akbari M, Najar S. Effect of foot and hand massage in post-cesarean section pain control: a randomized control trial. Pain Mang Nurs. 2014;15(1):132-6.

Steen M, Cooper K, Marchant P, Griffiths-Jones M, Walker J. A randomized controlled trial to compare the effectiveness of icepacks and Epifoam with cooling maternity gel pads at alleviating postnatal perineal trauma. Midwifery. 2000;16(1):48-55.

Verhagen AP, de Vet HC, de Bie RA, Kessels AG, Boers M, Bouter LM. The Delphi list: a criteria list for quality assessment of randomised clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235-41.

Moher D, Liberati A, Tetzlaff J, Altman DG. principais itens para relatar revisões sistemáticas e meta-análises: a recomendação PRISMA. Epidemiol Serv Saúde. 2015;24(2):335-42.

Olsén MF, Elden H, Janson ED, Lilja H, Stener-Victorin E. A comparison of high- versus low-intensity, high-frequency transcutaneous electric nerve stimulation for painful postpartum uterine contractions. Acta Obstet Gynecol Scand. 2007;86(3):310-4.

Kwan WS, Li WW. Effect of ear acupressure on acute postpartum perineal pain: a randomised controlled study. J Clin Nurs. 2014;23(7-8):1153-64.

Lu YY, Su ML, Gau ML, Lin KC, Au HK. The efficacy of cold-gel packing for relieving episiotomy pain - a quasi-randomised control trial. Contemp Nurse. 2015;50(1):26-35.

Oliveira SM, Silva FM, Riesco ML, Latorre Mdo R, Nobre MR. Comparison of application times for ice packs used to relieve perineal pain after normal birth: a randomised clinical trial. J Clin Nurs. 2012;21(23-24):3382-91.

Leventhal LC, de Oliveira SM, Nobre MR, da Silva FM. Perineal analgesia with an ice pack after spontaneous vaginal birth: a randomized controlled trial. J Midwifery Womens Health. 2011;56(2):141-6.

Morais I, Lemos A, Katz L, Melo LF, Maciel MM, Amorim MM. Perineal pain management with cryotherapy after vaginal delivery: a randomized clinical trial. Rev Bras Ginecol Obst. 2016;38(7):325-32.

Kayman-Kose S, Arioz DT, Toktas H, Koken G, Kanat-Pektas M, Kose M. Transcutaneous electrical nerve stimulation (TENS) for pain control after vaginal delivery and cesarean section. J Matern Fetal Neonatal Med. 2014;27(15):1572-5.

Pitangui AC, Araújo RC, Bezerra MJ, Ribeiro CO, Nakano AM. Low and high-frequency TENS in post-episiotomy pain relief: a randomized, double-blind clinical trial. Braz J Phys Ther. 2014;18(1):72-8.

Pitangui AC, de Sousa L, Gomes FA, Ferreira CH, Nakano AM. High-frequency TENS in post-episiotomy pain relief in primiparous puerpere: A randomized, controlled trial. J Obstet Gynaecol Res. 2012;38(7):980-7.

Lima LE, Lima AS, Rocha CM, dos Santos GM, Bezerra AJ, Hazime AF. High and low frequency transcutaneous electrical nerve stimulation in post-cesarean pain intensity. Fisioter Pesqui. 2014;21(3):243-8.

Santos JdeO, de Oliveira SM, da Silva FM, Nobre MR, Osava RH, Riesco ML. Low-level laser therapy for pain relief after episiotomy: a double-blind randomised clinical trial. J Clin Nurs. 2012;21(23-24):3513-22.

Santos JdeO, Oliveira SM, Nobre MR, Aranha AC, Alvarenga MB. A randomised clinical trial of the effect of low-level laser therapy for perineal pain and healing after episiotomy: A pilot study. Midwifery. 2012;28(5):e653-9.

Marra C, Pozzi I, Ceppi L, Sicuri M, Veneziano F, Regalia AL. Wrist-ankle acupuncture as perineal pain relief after mediolateral episiotomy: a pilot study. J Altern Complement Med. 2011;17(3):239-41.

Han JS, Chen XH, Sun SL, Xu XJ, Yuan Y, Yan SC. Effect of low- and high-frequency TENS on Met-enkephalin-Arg-Phe and dynorphin A immunoreactivity in human lumbar CSF. Pain. 1991;47(33):295-8.

Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150(3699):971-9.

Mello LF, Nóbrega LF, Lemos A. Estimulação elétrica transcutânea no alívio da dor do trabalho de parto:revisão sistemática e meta-análise. Rev Bras Fisioter. 2011;15(3):175-84.

Platon B, Mannheimer C, Andréll P. Effects of high-frequency, high-intensity transcutaneous electrical nerve stimulation versus intravenous opioids for pain relief after gynecologic laparoscopic surgery: a randomized controlled study. Korean J Anesthesiol. 2018;71(2):149-56.

Kymplová J, Navrátil L, Knízek J. Contribution of phototherapy to the treatment of episiotomies. J Clin Laser Med Surg. 2003;21(1):35-9.

Bertolini GR, Silva TS, Ciena AP, Trindade DL. Efeitos do laser de baixa potência sobre a dor e edema no trauma tendíneo de ratos. Rev Bras Med Esporte. 2008;14(4):362-6.

Chow RT, Johnson MI, Lopes-Martins RA, Bjordal JM. Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised, placebo and active-treatment controlled trials. Lancet. 2009;374(9705):1897-908.

Huang YY, Chen AC, Carroll JD, Hamblin MR. Biphasic dose response in low level light therapy. Dose Response. 2009;7(4):358-83.

Knight KL. Cryotherapy in Sport Injury Management. 1995.

Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.

Murakami M, Fox L, Dijkers MP. Ear Acupuncture for immediate pain relief-a systematic review and meta-analysis of randomized controlled trials. Pain Med. 2016;18(3):551-64.

Hou PW, Hsu HC, Lin YW, Tang NY, Cheng CY, Hsieh CL. The History, mechanism, and clinical application of auricular therapy in traditional Chinese medicine. Evid Based Complement Alternat Med. 2015;2015.

Submitted date:
07/09/2018

Accepted date:
12/20/2018

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