Latest Developments in the Application of Complementary and Alternative Therapies in Pregnancy-related Low Back Pain

doi:10.12114/j.issn.1007-9572.2020.00.615

Abstract

Abstract: Pregnancy-related low back pain（PLBP） refers to pain between the twelfth rib and the gluteal fold caused by pregnancy，and the incidence is as high as 50%.PLBP is associated with physical dysfunction，sleep disorders，increased risk of adverse delivery outcomes and postpartum depression.It is of great significance to take tailored interventions to prevent and alleviate PLBP.Due to the restrictions on drug use during pregnancy，complementary and alternative medicine （CAM） plays an important role in the treatment of pregnancy-related diseases.This article reviewed recently published literature on the application of CAM therapies in the prevention and treatment of PLBP，such as exercise，manual，acupuncture，and physical therapies，to provide a reference for the prevention and alleviation of this disease in China.

Key words: Pregnancy, Low back pain, Complementary therapies, Complementary and alternative medicine, Review

摘要： 妊娠相关下腰痛（PLBP）是指妊娠引起的第十二肋骨与臀折区域之间的疼痛，其发生率高达50%。PLBP可导致孕妇躯体功能障碍、睡眠障碍，增加不良分娩结局和产后抑郁发生风险等。采取具有针对性的干预措施对预防和缓解PLBP具有重要意义。由于妊娠期用药特殊性，补充替代医学（CAM）在妊娠相关疾病的治疗中发挥着重要作用。本文对CAM治疗PLBP相关研究进行综述，分别阐述运动疗法、手法治疗、针灸疗法、物理因子疗法等对PLBP预防及干预策略的研究进展，旨在为国内开展预防和缓解PLBP的研究提供借鉴。

关键词: 妊娠, 腰痛, 补充疗法, 补充替代医学, 综述

SHI Zhiyi,LU Ying,LIU Weihua, et al. Latest Developments in the Application of Complementary and Alternative Therapies in Pregnancy-related Low Back Pain　[J]. Chinese General Practice, 2021, 24(9): 1095-1101. DOI: 10.12114/j.issn.1007-9572.2020.00.615.
石志宜,卢颖,刘纬华等. 补充替代医学治疗在妊娠相关下腰痛患者中应用的研究进展[J]. 中国全科医学, 2021, 24(9): 1095-1101. DOI: 10.12114/j.issn.1007-9572.2020.00.615.

References

［1］CLARK C J，CARR E C，WAY S.Pregnancy-related lumbopelvic pain：prevalence，persistence，risk factors and management implications［J］．Br J Midwifery，2013，21（5）：323-330．DOI：10.12968/bjom.2013.21.5.323.
［2］GUTKE A，BOISSONNAULT J，BROOK G，et al．The severity and impact of pelvic girdle pain and low-back pain in pregnancy：a multinational study［J］．J Womens Health （Larchmt），2018，27（4）：510-517．DOI：10.1089/jwh.2017.6342.
［3］STUGE B.Current knowledge on low back pain and pelvic girdle pain during pregnancy and after childbirth：a narrative review［J］．Curr Wom Heal Rev，2015，11（1）：68-74．DOI：10.2174/157340481101150914201838.
［4］MACKENZIE J，MURRAY E，LUSHER J.Women's experiences of pregnancy related pelvic girdle pain：a systematic review［J］．Midwifery，2018，56：102-111．DOI：10.1016/j.midw.2017.10.011.
［5］FISHBURN S，COOPER T.Pelvic girdle pain：are we missing opportunities to make this a problem of the past?［J］．Br J Midwifery，2015，23（11）：774-778．DOI：10.12968/bjom.2015.23.11.774.
［6］MALMQVIST S，KJAERMANN I，ANDERSEN K，et al．The association between pelvic girdle pain and sick leave during pregnancy；a retrospective study of a Norwegian population［J］．BMC Pregnancy Childbirth，2015，15：237．DOI：10.1186/s12884-015-0667-0.
［7］ANTONUCCI R，ZAFFANELLO M，PUXEDDU E，et al．Use of non-steroidal anti-inflammatory drugs in pregnancy：impact on the fetus and newborn［J］．Curr Drug Metab，2012，13（4）：474-490．DOI：10.2174/138920012800166607.
［8］National Center for Complementary and Integrative Health （NCCIH）.Complementary，alternative，or integrative health：what's in a name?［EB/OL］．［2020-02-04］．https：//nccih.nih.gov/health/ integrative-health.
［9］潘元青.非药物补充替代医学辅助治疗乳腺癌术后不良反应的循证研究［D］．兰州：兰州大学，2015.
［10］潘元青，杨克虎，于润泽，等．非药物补充替代医学对乳腺癌术后不良反应康复治疗的循证研究进展［J］．中国科技成果，2018，19（18）：65-68．DOI：10.3772/j.issn.1009-5659.2018.18.025.
［11］徐一喆，杜懿杰，董竞成.非药物补充替代医学治疗肿瘤患者的焦虑与抑郁的研究进展［J］．老年医学与保健，2019，25（2）：251-254．DOI：10.3969/j.issn.1008-8296.2019.02.030.
［12］BABBAR S，WILLIAMS K B，MAULIK D.Complementary and alternative medicine use in modern obstetrics：a survey of the central association of obstetricians & gynecologists members［J］．J Evid Based Complementary Altern Med，2017，22（3）：429-435．DOI：10.1177/2156587216671215.
［13］KINSER P A，PAULI J，JALLO N，et al．Physical activity and Yoga-based approaches for pregnancy-related low back and pelvic pain［J］．J Obstet Gynecol Neonatal Nurs，2017，46（3）：334-346．DOI：10.1016/j.jogn.2016.12.006.
［14］AKMESE Z B，ORAN N T.Effects of progressive muscle relaxation exercises accompanied by music on low back pain and quality of life during pregnancy［J］．J Midwifery Womens Health，2014，59（5）：503-509．DOI：10.1111/jmwh.12176.
［15］MARTINS R F，PINTO E SILVA J L.Treatment of pregnancy-related lumbar and pelvic girdle pain by the Yoga method：a randomized controlled study［J］．J Altern Complement Med，2014，20（1）：24-31．DOI：10.1089/acm.2012.0715.
［16］SKLEMPE KOKIC I，IVANISEVIC M，UREMOVIC M，et al．Effect of therapeutic exercises on pregnancy-related low back pain and pelvic girdle pain：secondary analysis of a randomized controlled trial［J］．J Rehabil Med，2017，49（3）：251-257．DOI：10.2340/16501977-2196.
［17］STAFNE S N，SALVESEN K ?，ROMUNDSTAD P R，et al．Does regular exercise during pregnancy influence lumbopelvic pain? A randomized controlled trial［J］．Acta Obstet Gynecol Scand，2012，91（5）：552-559．DOI：10.1111/j.1600-0412.2012.01382.x.
［18］毛立伟，赵梦飞，王静静，等．抗阻训练联合有氧训练治疗孕期下腰痛的效果观察［J］．中国康复理论与实践，2016，22（7）：848-851．DOI：10.3969/j.issn.1006-9771.2016.07.026.
［19］GUTKE A，BETTEN C，DEGERSK?R K，et al．Treatments for pregnancy-related lumbopelvic pain：a systematic review of physiotherapy modalities［J］．Acta Obstet Gynecol Scand，2015，94（11）：1156-1167．DOI：10.1111/aogs.12681.
［20］EGGEN M H，STUGE B，MOWINCKEL P，et al．Can supervised group exercises including ergonomic advice reduce the prevalence and severity of low back pain and pelvic girdle pain in pregnancy? A randomized controlled trial［J］．Phys Ther，2012，92（6）：781-790．DOI：10.2522/ptj.20110119.
［21］HAAKSTAD L A，B? K.Effect of a regular exercise programme on pelvic girdle and low back pain in previously inactive pregnant women：a randomized controlled trial［J］．J Rehabil Med，2015，47（3）：229-234．DOI：10.2340/16501977-1906.
［22］OZDEMIR S，BEBIS H，ORTABAG T，et al．Evaluation of the efficacy of an exercise program for pregnant women with low back and pelvic pain：a prospective randomized controlled trial［J］．J Adv Nurs，2015，71（8）：1926-1939．DOI：10.1111/jan.12659.
［23］STUGE B.Evidence of stabilizing exercises for low back- and pelvic girdle pain——a critical review［J］．Braz J Phys Ther，2019，23（2）：181-186．DOI：10.1016/j.bjpt.2018.11.006.
［24］Committee opinion no.650 summary：physical activity and exercise during pregnancy and the postpartum period［J］．Obstet Gynecol，2015，126（6）：1326-1327．DOI：10.1097/AOG.0000000000001209.
［25］NASCIMENTO S L，SURITA F G，CECATTI J G.Physical exercise during pregnancy：a systematic review［J］．Curr Opin Obstet Gynecol，2012，24（6）：387-394．DOI：10.1097/GCO.0b013e328359f131.
［26］Educational Council on Osteopathic Principles of the American Association of Colleges of Osteopathic Medicine.Glossary of osteopathic terminology［M］．Washington， D.C：American Association of College of Osteopathic Medicine，2011：1-60.
［27］宋成宪，王润妹，李太良，等．妊娠相关下腰痛的流行病学特征及治疗进展［J］．中华全科医学，2017，15（4）：659-662．DOI：10.16766/j.cnki.issn.1674-4152.2017.04.036.
SONG C X，WANG R M，LI T L，et al．Epidemiological characteristics and therapeutic progress of pregnancy-related low back pain［J］．Chinese Journal of General Practice，2017，15（4）：659-662．DOI：10.16766/j.cnki.issn.1674-4152.2017.04.036.
［28］CARDINALE M，BOCCIA G，GREENWAY T，et al．The acute effects of spinal manipulation on neuromuscular function in asymptomatic individuals：a preliminary study［J］．Phys Ther Sport，2015，16（2）：121-126．DOI：10.1016/j.ptsp.2014.06.004.
［29］HENSEL K L，CARNES M S，STOLL S T.Pregnancy research on osteopathic manipulation optimizing treatment effects：the PROMOTE study protocol［J］．J Am Osteopath Assoc，2016，116（11）：716-724．DOI：10.7556/jaoa.2016.142.
［30］FRANKE H，FRANKE J D，BELZ S，et al．Osteopathic manipulative treatment for low back and pelvic girdle pain during and after pregnancy：a systematic review and meta-analysis［J］．J Bodyw Mov Ther，2017，21（4）：752-762．DOI：10.1016/j.jbmt.2017.05.014.
［31］RUFFINI N，D'ALESSANDRO G，CARDINALI L，et al．Osteopathic manipulative treatment in gynecology and obstetrics：a systematic review［J］．Complement Ther Med，2016，26：72-78．DOI：10.1016/j.ctim.2016.03.005.
［32］SHERATON A，STRECKFUSS J，GRACE S.Experiences of pregnant women receiving osteopathic care［J］．J Bodyw Mov Ther，2018，22（2）：321-327．DOI：10.1016/j.jbmt.2017.09.007.
［33］Task Force on the Low Back Pain Clinical Practice Guidelines.American osteopathic association guidelines for osteopathic manipulative treatment （OMT） for patients with low back pain［J］．J Am Osteopath Assoc，2016，116（8）：536-549．DOI：10.7556/jaoa.2016.107.
［34］LICCIARDONE J C，ARYAL S.Prevention of progressive back-specific dysfunction during pregnancy：an assessment of osteopathic manual treatment based on Cochrane Back Review Group criteria［J］．J Am Osteopath Assoc，2013，113（10）：728-736．DOI：10.7556/jaoa.2013.043.
［35］GHASEMI C，AMIRI A，SARRAFZADEH J，et al．Comparative study of muscle energy technique，craniosacral therapy，and sensorimotor training effects on postural control in patients with nonspecific chronic low back pain［J］．J Family Med Prim Care，2020，9（2）：978-984．DOI：10.4103/jfmpc.jfmpc_849_19.
［36］ELDEN H，?STGAARD H C，GLANTZ A，et al．Effects of craniosacral therapy as adjunct to standard treatment for pelvic girdle pain in pregnant women：a multicenter，single blind，randomized controlled trial［J］．Acta Obstet Gynecol Scand，2013，92（7）：775-782．DOI：10.1111/aogs.12096.
［37］GUTKE A，BETTEN C，DEGERSK?R K，et al．Treatments for pregnancy-related lumbopelvic pain：a systematic review of physiotherapy modalities［J］．Acta Obstet Gynecol Scand，2015，94（11）：1156-1167．DOI：10.1111/aogs.12681.
［38］BERNARD M，TUCHIN P.Chiropractic management of pregnancy-related lumbopelvic pain：a case study［J］．J Chiropr Med，2016，15（2）：129-133．DOI：10.1016/j.jcm.2016.04.003.
［39］MELKERSSON C，NASIC S，STARZMANN K，et al．Effect of foot manipulation on pregnancy-related pelvic girdle pain：a feasibility study［J］．J Chiropr Med，2017，16（3）：211-219．DOI：10.1016/j.jcm.2017.05.003.
［40］BUCHBERGER B，KRABBE L.Evaluation of outpatient acupuncture for relief of pregnancy-related conditions［J］．Int J Gynaecol Obstet，2018，141（2）：151-158．DOI：10.1002/ijgo.12446.
［41］BISHOP A，OGOLLAH R，BARTLAM B，et al．Evaluating acupuncture and standard care for pregnant women with back pain：the EASE Back pilot randomised controlled trial （ISRCTN49955124）［J］．Pilot Feasibility Stud，2016，2：72．DOI：10.1186/s40814-016-0107-6.
［42］VAS J，CINTADO M C，ARANDA-REGULES J M，et al．Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle：a multicenter randomized clinical trial［J］．Acta Obstet Gynecol Scand，2019，98（10）：1307-1317．DOI：10.1111/aogs.13635.
［43］NICOLIAN S，BUTEL T，GAMBOTTI L，et al．Cost-effectiveness of acupuncture versus standard care for pelvic and low back pain in pregnancy：a randomized controlled trial［J］．PLoS One，2019，14（4）：e0214195．DOI：10.1371/journal.pone.0214195.
［44］BISHOP A，HOLDEN M A，OGOLLAH R O，et al．Current management of pregnancy-related low back pain：a national cross-sectional survey of U.K.physiotherapists［J］．Physiotherapy，2016，102（1）：78-85．DOI：10.1016/j.physio.2015.02.003.
［45］MCDOWELL J M，KOHUT S H，BETTS D.Safe acupuncture and dry needling during pregnancy：New Zealand physiotherapists' opinion and practice［J］．J Integr Med，2019，17（1）：30-37．DOI：10.1016/j.joim.2018.11.006.
［46］WATERFIELD J，BARTLAM B，BISHOP A，et al．Physical therapists' views and experiences of pregnancy-related low back pain and the role of acupuncture：qualitative exploration［J］．Phys Ther，2015，95（9）：1234-1243．DOI：10.2522/ptj.20140298.
［47］WU L C，WENG P W，CHEN C H，et al．Literature review and meta-analysis of transcutaneous electrical nerve stimulation in treating chronic back pain［J］．Reg Anesth Pain Med，2018，43（4）：425-433．DOI：10.1097/AAP.0000000000000740.
［48］KESKIN E A，ONUR O，KESKIN H L，et al．Transcutaneous electrical nerve stimulation improves low back pain during pregnancy［J］．Gynecol Obstet Invest，2012，74（1）：76-83．DOI：10.1159/000337720.
［49］陈伟业，王爱群，张立贤.韩氏穴位神经刺激仪对妊娠晚期下腰痛的影响［J］．中国疼痛医学杂志，2011，17（9）：546-548．DOI：10.3969/j.issn.1006-9852.2011.09.010.
CHEN W Y，WANG A Q，ZHANG L X.The effect of hans acupoint nerve timulator（Hans） on the low back pain in late pregnancy［J］．Chinese Journal of Pain Medicine，2011，17（9）：546-548．DOI：10.3969/j.issn.1006-9852.2011.09.010.
［50］MOSTAFAVIFAR M，WERTZ J，BORCHERS J.A systematic review of the effectiveness of kinesio taping for musculoskeletal injury［J］．Phys Sportsmed，2012，40（4）：33-40．DOI：10.3810/psm.2012.11.1986.
［51］WILLIAMS S，WHATMAN C，HUME P A，et al．Kinesio taping in treatment and prevention of sports injuries：a meta-analysis of the evidence for its effectiveness［J］．Sports Med，2012，42（2）：153-164．DOI：10.2165/11594960-000000000-00000.
［52］KACHANATHU S J，ALENAZI A M，SEIF H E，et al．Comparison between kinesio taping and a traditional physical therapy program in treatment of nonspecific low back pain［J］．J Phys Ther Sci，2014，26（8）：1185-1188．DOI：10.1589/jpts.26.1185.
［53］KAPLAN S，ALPAYCI M，KARAMAN E，et al．Short-term effects of kinesio taping in women with pregnancy-related low back pain：a randomized controlled clinical trial［J］．Med Sci Monit，2016，22：1297-1301．DOI：10.12659/msm.898353.
［54］SHIRAZI M，MOHEBITABAR S，BIOOS S，et al．The effect of topical rosa damascena （Rose） oil on pregnancy-related low back pain：a randomized controlled clinical trial［J］．J Evid Based Complementary Altern Med，2017，22（1）：120-126．DOI：10.1177/2156587216654601.

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