Larki Mona, Karimi Leila, Jahanfar Shayesteh, Mohammadi Solmaz, Makvandi Somayeh
Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
BMC Complement Med Ther. 2025 May 10;25(1):170. doi: 10.1186/s12906-025-04908-9.
Labor pain is a significant challenge during childbirth, highlighting the necessity for effective pain management strategies. Acupressure has been recognized as a non-pharmacological method; however, its efficacy requires comprehensive evaluation. This updated systematic review and meta-analysis seeks to consolidate the most recent evidence regarding the effectiveness of Acupressure in alleviating labor pain and to evaluate the quality of this evidence using the GRADE framework.
An updated systematic review was conducted by querying multiple databases for randomized controlled trials (RCTs) that evaluated the impact of Acupressure on labor pain. Studies were included based on predefined eligibility criteria. The risk of bias was assessed using the Cochrane risk-of-bias method for randomized trials (RoB). Meta-analyses were performed to determine the overall effect size, and the GRADE approach was applied to assess the certainty of the evidence. Meta-analyses of all the data were done using RevMan 5.4.
A total of 37 studies met the inclusion criteria. The meta-analysis revealed that Acupressure significantly reduces labor pain compared to touch (MD = -1.19, 95% CI -1.66 to -0.72, p < 0.00001), Sham (MD = -1.41, 95% CI -2.55 to -0.27, p = 0.01), and no intervention group (MD = -2.32, 95% CI -2.87 to -1.76, p < 0.00001). Although both SP6 and LI4 Acupressure points reduced pain, SP6 had more of an impact compared to previous reviews. The funnel plot comparing the effect of Acupressure with a touch on labor pain intensity suggested a possible publication bias. The GRADE assessment indicated a moderate to low level of certainty regarding these results.
Acupressure seems to be a viable method for alleviating labor pain, supported by moderate to low-quality evidence. Additionally, it is advisable to conduct well-designed RCTs to enhance the validity of these findings and investigate the underlying mechanisms that contribute to the effectiveness of Acupressure in this setting.
分娩时的产痛是一项重大挑战，凸显了有效疼痛管理策略的必要性。穴位按压已被公认为一种非药物方法；然而，其疗效需要全面评估。这项更新的系统评价和荟萃分析旨在整合关于穴位按压缓解产痛有效性的最新证据，并使用GRADE框架评估该证据的质量。
通过查询多个数据库进行一项更新的系统评价，纳入评估穴位按压对产痛影响的随机对照试验（RCT）。根据预先确定的纳入标准纳入研究。使用Cochrane随机试验偏倚风险方法（RoB）评估偏倚风险。进行荟萃分析以确定总体效应大小，并应用GRADE方法评估证据的确定性。使用RevMan 5.4对所有数据进行荟萃分析。
共有37项研究符合纳入标准。荟萃分析显示，与触摸（MD = -1.19，95%CI -1.66至-0.72，p < 0.00001）、假按压（MD = -1.41，95%CI -2.55至-0.27，p = 0.01）和无干预组（MD = -2.32，95%CI -2.87至-1.76，p < 0.00001）相比，穴位按压能显著减轻产痛。虽然三阴交和合谷穴按压均能减轻疼痛，但与以往的综述相比，三阴交的影响更大。比较穴位按压与触摸对产痛强度影响的漏斗图表明可能存在发表偏倚。GRADE评估表明这些结果的确定性为中低水平。
穴位按压似乎是一种缓解产痛的可行方法，有中低质量证据支持。此外，建议开展设计良好的RCT以提高这些发现的有效性，并研究在这种情况下导致穴位按压有效性的潜在机制。
