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A. Svahn Ekdahl1, M. Fagevik Olsén1,2, T. Jendman3, A. Gutke1
1University of Gothenburg, Dept. of Health and Rehabilitation; Physiotherapy, Gothenburg, Sweden, 2Sahlgrenska University Hospital, Physiotherapy, Gothenburg, Sweden, 3Physiotherapy Clinic "I Rörelse", Gothenburg, Sweden

Background: Pain in the pelvic girdle (PGP) and/or lower back is reported by >50% of pregnant women and affects women´s functioning in their everyday life in a negative way. The pain may also limit physical activity, work ability and be a reason for sick leave during pregnancy. Physical activity (PA) during pregnancy can reduce the risk of complications such as diabetes. Few pregnant women meet the general recommendations for PA and PGP is a common reason for reduced PA.

Purpose: To investigate if there are differences between acupuncture and transcutaneous electric nerve stimulation (TENS) as treatment for PGP in pregnancy in order to manage pain and thus maintain health and functioning in daily activities and PA.

Methods: Pregnant women (n=113) with clinically verified PGP in gestational weeks 12–28 randomized into two groups. The intervention lasted 5 weeks and consisted of either ten acupuncture sessions or home-based TENS. The acupuncture points were chosen, based on the woman´s symptoms, from a protocol tested in a previous study. The women randomized to TENS got instructions from a physiotherapist and used the device at home for at least 30 minutes per day during five weeks. Electrodes were placed in the area of pain with high-frequency stimulation (80 Hz).
Primary outcome variables: disability, functioning, work ability and PA. Secondary outcomes: functioning related to PGP, evening pain intensity, concern about pain, health, symptoms of depression and/or catastrophizing.

Results: No clinically important differences were detected between the groups. As pregnancy proceeds, women with PGP tends to experience more pain and to further reduce their level of physical activity. This was not the case in the present study. Both groups managed to preserve their functioning and PA level at follow up. This may be due to significantly (p<0.05) reduced evening pain intensity measured by a Numeric Rating Scale (NRS); acupuncture -0.96 (CI -1.91; -0.01), TENS (-1.29 (CI -2.13; -0.44) and concern about pain (NRS); acupuncture -1.44 (CI -2.31; -0.57), TENS -1.99 (CI -2.81; -1.17).

Conclusion(s): Treating PGP with acupuncture or TENS resulted in maintenance of functioning and physical activity as well as less pain and concern about pain. Either intervention could be recommended as a non-pharmacological alternative for pain relief and may enable pregnant women to stay active.

Implications: Previous studies show that there is evidence for acupuncture but limited evidence for TENS when treating PGP. In this study, both acupuncture and TENS gave significant pain relief and this may have helped the women to stay active. No differences between groups were detected, which indicates that the treatment can be chosen based on the individual woman´s needs and preferences. 

Funding, acknowledgements: This study was financed by Region Västra Götaland, Sweden (No. VGFOUREG-310521).

Keywords: Pregnancy-related pelvic girdle pain, Acupuncture, Transcutaneous electric nerve stimulation

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes
Institution: N/A
Committee: The Regional Ethical Review Board in Gothenburg, Sweden
Ethics number: No. 308-13

All authors, affiliations and abstracts have been published as submitted.

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