Kimber L, McNabb M, Mc Court C, Haines A, Brocklehurst P
Horton Maternity Unit, Oxford Road, Banbury, Oxfordshire 0X16 9AL, UK.
Eur J Pain. 2008 Nov;12(8):961-9. doi: 10.1016/j.ejpain.2008.01.004. Epub 2008 Mar 4.
Research on massage therapy for maternal pain and anxiety in labour is currently limited to four small trials. Each used different massage techniques, at different frequencies and durations, and relaxation techniques were included in three trials. Given the need to investigate massage interventions that complement maternal neurophysiological adaptations to labour and birth pain(s), we designed a pilot randomised controlled trial (RCT) to test the effects of a massage programme practised during physiological changes in pain threshold, from late pregnancy to birth, on women's reported pain, measured by a visual analogue scale (VAS) at 90 min following birth. To control for the potential bias of the possible effects of support offered within preparation for the intervention group, the study included 3 arms--intervention (massage programme with relaxation techniques), placebo (music with relaxation techniques) and control (usual care). The placebo offered a non-pharmacological coping strategy, to ensure that use of massage was the only difference between intervention and placebo groups. There was a trend towards slightly lower mean pain scores in the intervention group but these differences were not statistically significant. No differences were found in use of pharmacological analgesia, need for augmentation or mode of delivery. There was a trend towards more positive views of labour preparedness and sense of control in the intervention and placebo groups, compared with the control group. These findings suggest that regular massage with relaxation techniques from late pregnancy to birth is an acceptable coping strategy that merits a large trial with sufficient power to detect differences in reported pain as a primary outcome measure.
目前,关于按摩疗法对产妇分娩时疼痛和焦虑影响的研究仅限于四项小型试验。每项试验所采用的按摩技术、频率和时长均有所不同,且有三项试验纳入了放松技巧。鉴于需要研究能够辅助产妇神经生理适应分娩疼痛的按摩干预措施,我们设计了一项初步随机对照试验(RCT),以测试一种按摩方案在从妊娠晚期到分娩疼痛阈值发生生理变化期间实施,对产妇产后90分钟时通过视觉模拟量表(VAS)测量的自述疼痛的影响。为了控制干预组准备过程中所提供支持可能产生的潜在偏差影响,该研究包括三个组——干预组(采用放松技巧的按摩方案)、安慰剂组(采用放松技巧的音乐)和对照组(常规护理)。安慰剂提供了一种非药物应对策略,以确保干预组和安慰剂组之间的唯一区别在于是否使用按摩。干预组的平均疼痛评分有略低的趋势,但这些差异无统计学意义。在药物镇痛的使用、加强分娩或分娩方式方面未发现差异。与对照组相比,干预组和安慰剂组对分娩准备和控制感的看法有更积极的趋势。这些发现表明,从妊娠晚期到分娩进行定期的放松技巧按摩是一种可接受的应对策略,值得进行一项有足够效力以检测自述疼痛差异作为主要结局指标的大型试验。
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