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Labor, Pain Management, and Acupuncture: A Cochrane Review

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Cochrane, an international, nonprofit organization dedicated to providing unbiased reviews of medical research in healthcare, serves patients, providers, researchers and “anyone interested in using high-quality information to make health care decisions.” The well-stocked Cochrane Library online database holds reviews of more than 8,000 medical interventions, more than 2,000 protocols, and more than 160,000 medical trials. 1

Smith et al contribute to this knowledge base with a fresh look at the role of acupuncture and acupressure in pain management during labor. This work updates the 2011 Cochrane review. Conclusions in 2011 were that while both acupuncture and acupressure had suggestive evidence of a role in managing pain during labor, including mitigating pain intensity, increasing satisfaction of pain management, and reducing pharmacological interventions, significant bias and poor-quality evidence did not allow firm recommendations. 2

For this 2020 review, 28 studies (including 11 from the 2011 review) incorporating data from 3,960 women are covered. In addition, a newer method of determining quality of the acupuncture or acupressure intervention is employed (the National Institute for Complementary Medicine Acupuncture Network scale). This metric permits a more nuanced view of the quality of the studies and a standardized approach to evaluation by reviewers. 3 Evidence from the studies is weighed using the Grading of Recommendations, Assessment, Development and Evaluations approach — providing a reliable algorithm to determine the strength of evidence and compare among studies. 4

Pain during labor has multifactorial origins, with physiological, psychological, and even cultural components and influences. Most studies in the field agree that individualization of pain management is important. 5 Smith et al explain that consideration of both pain control efficacy and effectiveness is a major factor in evaluating responses. For example, efficacy trials usually compare acupuncture or acupressure to a sham treatment, while effectiveness trials typically compare the intervention(s) to standard...