The purpose of this systematic review is to examine the effects of PT versus CAM on post-episiotomy pain to offer women a comprehensive guide of the most effective treatments to expedite their recovery from this procedure.
A literature search was conducted in CINAHL, Cochrane Library, ProQuest, and PubMed. Search terms: (“women” OR “females”) AND (“postpartum” OR “post-delivery”) AND (“episiotomy”) AND (“physical therapy” OR “physiotherapy” OR “alternative medicine” OR “complementary medicine” OR “CAM”) AND (“pain”). Search limits: 2013- 2024, English, peer-reviewed, human subjects, RCTs. Selection criteria: postpartum women s/p episiotomy, ≥18 y/o, primary outcome of pain. Two reviewers independently assessed each article for methodological quality and came to consensus using PEDro guidelines.
A total of 56 articles were assessed for eligibility and 19 RCTs met the selection criteria. PEDro scores ranged from 5/10-10/10 (avg 7.47). Samples ranged from 30-147 subjects (N=1728) with an episiotomy (18-35 y/o). Six of the 19 articles were PT interventions, including low-level laser therapy (LLLT), cryotherapy, far-infrared radiation (FIR), light therapy, and dry and moist heat. Thirteen of the 19 articles were CAM interventions, including various ointments and creams, Reiki, acupuncture, mastic oleoresin, and acupressure. These were given one to three times daily (10-40 min/session) for one to 14 days. Primary outcome measures for pain included the Numeric Pain Rating Scale (NPRS), Visual Analogue Scale (VAS), Short-Form McGill Pain Questionnaire (SFMPQ), and Present Pain Intensity Scale (PPI). Three of the six PT interventions showed statistically significant NPRS or VAS pain score decreases between groups ranging from-1.93 to-7.6 pts. Nine of the 13 CAM interventions showed statistically significant NPRS or VAS pain score decreases between groups ranging from -1.07 to -5.98 pts. The average decrease in pain scores (NPRS, VAS) between PT and CAM interventions were -4.22 and -3.96, respectively.
There is moderate to high evidence that PT and CAM interventions are effective for treating post-episiotomy pain. Limitations included small sample size and limited follow-up. Future research should include larger sample sizes and more adequate follow-up.
Both CAM and PT are vital components of obstetric care as they provide the safest and least invasive methods for post-episiotomy pain control. Four of the six PT interventions and 11 of the 13 CAM interventions were clinically significant for improving post-episiotomy outcomes and met the MCID values for the NPRS (2 pts) or VAS (1.37 pts). This research informs PTs regarding the best evidence-based interventions for reducing post-episiotomy pain.
Physical therapy
Complementary and alternative medicine
