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New Labor Pain Treatment Options

  • Other Pain (N Vadivelu and A Kaye, Section Editors)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Presently, the gold standard for pain control in laboring patients is neuraxial blockade, which includes a spinal, epidural, or a combined spinal-epidural technique. In conjunction with neuraxial blockade or by itself, some of the other agents employed related to labor pain include opioids, non-opioids, nitrous oxide, patient-controlled analgesia (PCA), and distraction therapy. Alternative treatments include acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques. This review will focus on current updates and recent trends in labor pain management. Neuraxial management, pharmacotherapy, and newer alternative methods to mitigate labor pain are reviewed. Newer techniques in epidural analgesia include the dural puncture epidural technique, which needs further evaluation. There are limited published data on the use of acupuncture, hypnotism, yoga, exercise during pregnancy, hydrotherapy, transcutaneous electronic nerve stimulation, massage, and relaxation techniques in the alleviation of labor pain. These alternative therapies maybe considered as an adjuvant as the analgesic efficiency is inferior to that provided by typical standard pharmacotherapy. Future studies are warranted to evaluate the role of immersion virtual reality in alleviating labor pain.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gaskin IM. Ina May’s guide to childbirth: updated with new material, vol. 19. Random House Publishing Group, 2008.

  2. Jones L, Othman M, Dowswell T, Alfirevic Z, Gates S, Newburn M, et al. Pain management for women in labour: an overview of systematic reviews. Cochrane Database Syst Rev. 2012;3:CD009234.

    PubMed  Google Scholar 

  3. Shnol H, Paul N, Belfer I. Labor pain mechanisms. Int Anesthesiol Clin. 2014;52(3):1–17.

    Article  PubMed  Google Scholar 

  4. Schmitz R. Friedrich Wilhelm Sertürner and the discovery of morphine. Pharm Hist. 1985;27(2):61–74.

    CAS  PubMed  Google Scholar 

  5. Cohen J. Doctor James Young Simpson, Rabbi Abraham De Sola, and Genesis Chapter 3, verse 16. Obstet Gynecol. 1996;88(5):895–8.

    Article  CAS  PubMed  Google Scholar 

  6. Wong CA. Advances in labor analgesia. Int J Womens Health. 2010;1:139–54.

    PubMed Central  PubMed  Google Scholar 

  7. Moir DD, Willocks J. Management of incoordinate uterine action under continuous epidural analgesia. Br Med J. 1967;3(5562):396–400.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Carvalho B, Zheng M, Aiono-Le Tagaloa L. A prospective observational study evaluating the ability of prelabor psychological tests to predict labor pain, epidural analgesic consumption, and maternal satisfaction. Anesth Analg. 2014;119(3):632–40.

    Article  CAS  PubMed  Google Scholar 

  9. Bucklin BA, Hawkins JL, Anderson JR, Ullrich FA. Obstetric anesthesia workforce survey: twenty-year update. Anesthesiology. 2005;103(3):645–53.

    Article  PubMed  Google Scholar 

  10. Ullman R, Smith LA, Burns E, Mori R, Dowswell T. Parenteral opioids for maternal pain relief in labour. Cochrane Database Syst Rev. 2010;(9):CD007396.

  11. Bricker L, Lavender T. Parenteral opioids for labor pain relief: a systematic review. Am J Obstet Gynecol. 2002;186(5 Suppl Nature):S94–109.

    Article  CAS  PubMed  Google Scholar 

  12. Mattingly JE, D’Alessio J, Ramanathan J. Effects of obstetric analgesics and anesthetics on the neonate : a review. Paediatr Drugs. 2003;5(9):615–27.

    Article  PubMed  Google Scholar 

  13. Fleet J, Belan I, Jones MJ, Ullah S, Cyna AM. A comparison of fentanyl with pethidine for pain relief during childbirth: a randomised controlled trial. BJOG. 2015;122(7):983–92. Investigators found that intranasal and subcutaneous administration of fentanyl was as effective as intramuscularly administered pethidine in relieving labor pain. The use of fentanyl was associated with greater satisfaction, less sedation, shorter labor, fewer nursery admissions, and fewer difficulties in establishing breast feeding.

    Article  CAS  PubMed  Google Scholar 

  14. Leong WL, Sng BL, Sia ATH. A comparison between remifentanil and meperidine for labor analgesia: a systematic review. Anesth Analg. 2011;113(4):818–25.

    Article  CAS  PubMed  Google Scholar 

  15. Schnabel A, Hahn N, Broscheit J, Muellenbach RM, Rieger L, Roewer N, et al. Remifentanil for labour analgesia: a meta-analysis of randomised controlled trials. Eur J Anaesthesiol. 2012;29(4):177–85.

    Article  CAS  PubMed  Google Scholar 

  16. Pandya ST. Labour analgesia: recent advances. Indian J Anaesth. 2010;54(5):400–8.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Van de Velde M. Patient-controlled intravenous analgesia remifentanil for labor analgesia: time to stop, think and reconsider. Curr Opin Anaesthesiol. 2015;28(3):237–9.

    Article  PubMed  Google Scholar 

  18. Shen MK, Wu ZF, Zhu AB, He LL, Shen XF, Yang JJ, et al. Remifentanil for labour analgesia: a double-blinded, randomised controlled trial of maternal and neonatal effects of patient-controlled analgesia versus continuous infusion. Anaesthesia. 2013;68(3):236–44.

    Article  CAS  PubMed  Google Scholar 

  19. Othman M, Jones L, Neilson JP. Non-opioid drugs for pain management in labour. Cochrane Database Syst Rev. 2012;7:CD009223.

    PubMed  Google Scholar 

  20. Osterman MJK, Martin JA. Epidural and spinal anesthesia use during labor: 27-state reporting area, 2008. Natl Vital Stat Rep. 2011;59(5):1–13.

    Google Scholar 

  21. Anim-Somuah M, Smyth RM, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011;(12):CD000331.

  22. Sng BL, Leong WL, Zeng Y, Siddiqui FJ, Assam PN, Lim Y, et al. Early versus late initiation of epidural analgesia for labour. Cochrane Database Syst Rev. 2014;10:CD007238.

    PubMed  Google Scholar 

  23. Halpern SH, Carvalho B. Patient-controlled epidural analgesia for labor. Anesth Analg. 2009;108(3):921–8. Studies have shown that patient controlled epidural analgesia reduces the incidence of unscheduled clinician interventions, reduces the total dose of local anesthetic, and reduces the incidence of lower extremity motor block when compared with continuous epidural infusion.

    Article  CAS  PubMed  Google Scholar 

  24. Okutomi T, Saito M, Mochizuki J, Amano K, Hoka S. A double-blind randomized controlled trial of patient-controlled epidural analgesia with or without a background infusion following initial spinal analgesia for labor pain. Int J Obstet Anesth. 2009;18(1):28–32.

    Article  CAS  PubMed  Google Scholar 

  25. Heesen M, Böhmer J, Klöhr S, Hofmann T, Rossaint R, Straube S. The effect of adding a background infusion to patient-controlled epidural labor analgesia on labor, maternal, and neonatal outcomes: a systematic review and meta-analysis. Anesth Analg. 2015;121(1):149–58.

    Article  PubMed  Google Scholar 

  26. Sia AT, Lim Y, Ocampo CE. Computer-integrated patient-controlled epidural analgesia: a preliminary study on a novel approach of providing pain relief in labour. Singap Med J. 2006;47(11):951–6.

    CAS  Google Scholar 

  27. Sng BL, Sia ATH, Lim Y, Woo D, Ocampo C. Comparison of computer-integrated patient-controlled epidural analgesia and patient-controlled epidural analgesia with a basal infusion for labour and delivery. Anaesth Intensive Care. 2009;37(1):46–53.

    CAS  PubMed  Google Scholar 

  28. Loubert C, Hinova A, Fernando R. Update on modern neuraxial analgesia in labour: a review of the literature of the last 5 years. Anaesthesia. 2011;66(3):191–212.

    Article  CAS  PubMed  Google Scholar 

  29. Simmons SW, Taghizadeh N, Dennis AT, Hughes D, Cyna AM. Combined spinal-epidural versus epidural analgesia in labour. Cochrane Database Syst Rev. 2012;10:CD003401.

    PubMed  Google Scholar 

  30. Sng BL, Kwok SC, Sia ATH. Modern neuraxial labour analgesia. Curr Opin Anaesthesiol. 2015;28(3):285–9.

    Article  CAS  PubMed  Google Scholar 

  31. Patel NP, El-Wahab N, Fernando R, Wilson S, Robson SC, Columb MO, et al. Fetal effects of combined spinal-epidural vs epidural labour analgesia: a prospective, randomised double-blind study. Anaesthesia. 2014;69(5):458–67.

    Article  CAS  PubMed  Google Scholar 

  32. Cappiello E, O’Rourke N, Segal S, Tsen LC. A randomized trial of dural puncture epidural technique compared with the standard epidural technique for labor analgesia. Anesth Analg. 2008;107(5):1646–51.

    Article  PubMed  Google Scholar 

  33. Moore JM. Continuous spinal anesthesia. Am J Ther. 2009;16(4):289–94.

    Article  PubMed  Google Scholar 

  34. Cohn J, Moaveni D, Sznol J, Ranasinghe J. Complications of 761 short-term intrathecal macrocatheters in obstetric patients: a retrospective review of cases over a 12-year period. Int J Obstet Anesth. 2015. This recent retrospective review demonstrated that there were no serious complications including meningitis, epidural or spinal abscess, hematoma, arachnoiditis, or cauda equina syndrome, associated with intrathecal catheters.

  35. Tao W, Grant EN, Craig MG, McIntire DD, Leveno KJ. Continuous spinal analgesia for labor and delivery: an observational study with a 23-gauge spinal catheter. Anesth Analg. 2015;121(5):1290–4.

    Article  CAS  PubMed  Google Scholar 

  36. Klomp T, van Poppel M, Jones L, Lazet J, Di Nisio M, Lagro-Janssen ALM. Inhaled analgesia for pain management in labour. Cochrane Database Syst Rev. 2012;9:CD009351.

    PubMed  Google Scholar 

  37. Likis FE, Andrews JC, Collins MR, Lewis RM, Seroogy JJ, Starr SA, et al. Nitrous oxide for the management of labor pain: a systematic review. Anesth Analg. 2014;118(1):153–67.

    Article  CAS  PubMed  Google Scholar 

  38. Smith CA, Collins CT, Crowther CA, Levett KM. Acupuncture or acupressure for pain management in labour. Cochrane Database Syst Rev. 2011;(7):CD009232.

  39. Cho S-H, Lee H, Ernst E. Acupuncture for pain relief in labour: a systematic review and meta-analysis. BJOG. 2010;117(8):907–20.

    Article  PubMed  Google Scholar 

  40. Finlayson K, Downe S, Hinder S, Carr H, Spiby H, Whorwell P. Unexpected consequences: women’s experiences of a self-hypnosis intervention to help with pain relief during labour. BMC Pregnancy Childbirth. 2015;15(1):229.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Madden K, Middleton P, Cyna AM, Matthewson M, Jones L. Hypnosis for pain management during labour and childbirth. Cochrane Database Syst Rev. 2012;11:CD009356.

    PubMed  Google Scholar 

  42. Downe S, Finlayson K, Melvin C, Spiby H, Ali S, Diggle P, et al. Self-hypnosis for intrapartum pain management in pregnant nulliparous women: a randomised controlled trial of clinical effectiveness. BJOG. 2015;122(9):1226–34.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  43. Werner A, Uldbjerg N, Zachariae R, Rosen G, Nohr EA. Self-hypnosis for coping with labour pain: a randomised controlled trial. BJOG. 2013;120(3):346–53.

    Article  CAS  PubMed  Google Scholar 

  44. Chuntharapat S, Petpichetchian W, Hatthakit U. Yoga during pregnancy: effects on maternal comfort, labor pain and birth outcomes. Complement Ther Clin Pract. 2008;14(2):105–15.

    Article  PubMed  Google Scholar 

  45. Babbar S, Parks-Savage A, Chauhan S. Yoga during pregnancy: a review. Am J Perinatol. 2012;29(06):459–64.

    Article  PubMed  Google Scholar 

  46. Makvandi S, Latifnejad Roudsari R, Sadeghi R, Karimi L. Effect of birth ball on labor pain relief: a systematic review and meta-analysis. J Obstet Gynaecol Res. 2015;41(11):1679–86.

    Article  PubMed  Google Scholar 

  47. Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009;(2):CD000111.

  48. Derry S, Straube S, Moore RA, Hancock H, Collins SL. Cochrane database of systematic reviews, vol. 1. Chichester: Wiley; 1996.

    Google Scholar 

  49. Hutton EK, Kasperink M, Rutten M, Reitsma A, Wainman B. Sterile water injection for labour pain: a systematic review and meta-analysis of randomised controlled trials. BJOG. 2009;116(9):1158–66.

    Article  CAS  PubMed  Google Scholar 

  50. Smith CA, Levett KM, Collins CT, Jones L. Cochrane database of systematic reviews, vol. 2. Chichester: Wiley; 1996.

    Google Scholar 

  51. Dowswell T, Bedwell C, Lavender, Neilson JP. Transcutaneous electrical nerve stimulation (TENS) for pain relief in labour. Cochrane Database Syst Rev. 2009;(2):CD007214.

  52. Marhofer P, Harrop-Griffiths W, Willschke H, Kirchmair L. Fifteen years of ultrasound guidance in regional anaesthesia: part 2—recent developments in block techniques. Br J Anaesth. 2010;104(6):673–83.

    Article  CAS  PubMed  Google Scholar 

  53. Lee A. Ultrasound in obstetric anesthesia. Semin Perinatol. 2014;38(6):349–58.

    Article  PubMed  Google Scholar 

  54. Arzola C, Mikhael R, Margarido C, Carvalho JCA. Spinal ultrasound versus palpation for epidural catheter insertion in labour: a randomised controlled trial. Eur J Anaesthesiol. 2015;32(7):499–505.

    Article  PubMed  Google Scholar 

  55. Sahota JS, Carvalho JCA, Balki M, Fanning N, Arzola C. Ultrasound estimates for midline epidural punctures in the obese parturient: paramedian sagittal oblique is comparable to transverse median plane. Anesth Analg. 2013;116(4):829–35.

    Article  PubMed  Google Scholar 

  56. Shaikh F, Brzezinski J, Alexander S, Arzola C, Carvalho JCA, Beyene J, et al. Ultrasound imaging for lumbar punctures and epidural catheterisations: systematic review and meta-analysis. BMJ. 2013;346(mar26_1):f1720. This review and meta-analysis concluded that the use of ultrasound imaging for epidural catheter placement reduced the risk of failed procedures, the risk of traumatic procedures, the number of insertion attempts, and the number of needle redirections.

    Article  PubMed  Google Scholar 

  57. Wallace DH, Currie JM, Gilstrap LC, Santos R. Indirect sonographic guidance for epidural anesthesia in obese pregnant patients. Reg Anesth. 17(4):233–6.

  58. Stiffler KA, Jwayyed S, Wilber ST, Robinson A. The use of ultrasound to identify pertinent landmarks for lumbar puncture. Am J Emerg Med. 2007;25(3):331–4.

    Article  PubMed  Google Scholar 

  59. Balki M, Lee Y, Halpern S, Carvalho JCA. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg. 2009;108(6):1876–81.

    Article  PubMed  Google Scholar 

  60. Ecimovic P, Loughrey JPR. Ultrasound in obstetric anaesthesia: a review of current applications. Int J Obstet Anesth. 2010;19(3):320–6.

    Article  CAS  PubMed  Google Scholar 

  61. Wiederhold BK, Soomro A, Riva G, Wiederhold MD. Future directions: advances and implications of virtual environments designed for pain management. Cyberpsychol Behav Soc Netw. 2014;17(6):414–22.

    Article  PubMed Central  PubMed  Google Scholar 

  62. Triberti S, Repetto C, Riva G. Psychological factors influencing the effectiveness of virtual reality-based analgesia: a systematic review. Cyberpsychol Behav Soc Netw. 2014;17(6):335–45.

    Article  PubMed  Google Scholar 

  63. Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ, et al. Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med. 2011;41(2):183–91.

    Article  PubMed Central  PubMed  Google Scholar 

  64. Wiederhold MD, Wiederhold BK. Virtual reality and interactive simulation for pain distraction. Pain Med. 2007;8(s3 Computer and):S182–8.

    Article  Google Scholar 

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Correspondence to Alan D. Kaye.

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Veerandra Koyyalamudi, Gurleen Sidhu, Elyse M. Cornett, Viet Nguyen, Carmen Labrie-Brown, Charles J. Fox, and Alan D. Kaye declare that they have no conflict of interest.

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Koyyalamudi, V., Sidhu, G., Cornett, E.M. et al. New Labor Pain Treatment Options. Curr Pain Headache Rep 20, 11 (2016). https://doi.org/10.1007/s11916-016-0543-2

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