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Meta-Analysis
. 2020 Sep 1;9(9):CD011216.
doi: 10.1002/14651858.CD011216.pub2.

Complementary and alternative therapies for post-caesarean pain

Sandra A Zimpel  1 , Maria Regina Torloni  2 , Gustavo Jm Porfírio  2 , Ronald Lg Flumignan  3 , Edina Mk da Silva  4
Affiliations
Meta-Analysis

Complementary and alternative therapies for post-caesarean pain

Sandra A Zimpel et al. Cochrane Database Syst Rev. .

Abstract

Background: Pain after caesarean sections (CS) can affect the well-being of the mother and her ability with her newborn. Conventional pain-relieving strategies are often underused because of concerns about the adverse maternal and neonatal effects. Complementary alternative therapies (CAM) may offer an alternative for post-CS pain.

Objectives: To assess the effects of CAM for post-caesarean pain.

Search methods: We searched Cochrane Pregnancy and Childbirth's Trials Register, LILACS, PEDro, CAMbase, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (6 September 2019), and checked the reference lists of retrieved articles.

Selection criteria: Randomised controlled trials (RCTs), including quasi-RCTs and cluster-RCTs, comparing CAM, alone or associated with other forms of pain relief, versus other treatments or placebo or no treatment, for the treatment of post-CS pain.

Data collection and analysis: Two review authors independently performed study selection, extracted data, assessed risk of bias and assessed the certainty of evidence using GRADE.

Main results: We included 37 studies (3076 women) which investigated eight different CAM therapies for post-CS pain relief. There is substantial heterogeneity among the trials. We downgraded the certainty of evidence due to small numbers of women participating in the trials and to risk of bias related to lack of blinding and inadequate reporting of randomisation processes. None of the trials reported pain at six weeks after discharge. Primary outcomes were pain and adverse effects, reported per intervention below. Secondary outcomes included vital signs, rescue analgesic requirement at six weeks after discharge; all of which were poorly reported, not reported, or we are uncertain as to the effect Acupuncture or acupressure We are very uncertain if acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus placebo plus analgesia) has any effect on pain because the quality of evidence is very low. Acupuncture or acupressure plus analgesia (versus analgesia) may reduce pain at 12 hours (standardised mean difference (SMD) -0.28, 95% confidence interval (CI) -0.64 to 0.07; 130 women; 2 studies; low-certainty evidence) and 24 hours (SMD -0.63, 95% CI -0.99 to -0.26; 2 studies; 130 women; low-certainty evidence). It is uncertain whether acupuncture or acupressure (versus no treatment) or acupuncture or acupressure plus analgesia (versus analgesia) has any effect on the risk of adverse effects because the quality of evidence is very low. Aromatherapy Aromatherapy plus analgesia may reduce pain when compared with placebo plus analgesia at 12 hours (mean difference (MD) -2.63 visual analogue scale (VAS), 95% CI -3.48 to -1.77; 3 studies; 360 women; low-certainty evidence) and 24 hours (MD -3.38 VAS, 95% CI -3.85 to -2.91; 1 study; 200 women; low-certainty evidence). We are uncertain if aromatherapy plus analgesia has any effect on adverse effects (anxiety) compared with placebo plus analgesia. Electromagnetic therapy Electromagnetic therapy may reduce pain compared with placebo plus analgesia at 12 hours (MD -8.00, 95% CI -11.65 to -4.35; 1 study; 72 women; low-certainty evidence) and 24 hours (MD -13.00 VAS, 95% CI -17.13 to -8.87; 1 study; 72 women; low-certainty evidence). Massage We identified six studies (651 women), five of which were quasi-RCTs, comparing massage (foot and hand) plus analgesia versus analgesia. All the evidence relating to pain, adverse effects (anxiety), vital signs and rescue analgesic requirement was very low-certainty. Music Music plus analgesia may reduce pain when compared with placebo plus analgesia at one hour (SMD -0.84, 95% CI -1.23 to -0.46; participants = 115; studies = 2; I2 = 0%; low-certainty evidence), 24 hours (MD -1.79, 95% CI -2.67 to -0.91; 1 study; 38 women; low-certainty evidence), and also when compared with analgesia at one hour (MD -2.11, 95% CI -3.11 to -1.10; 1 study; 38 women; low-certainty evidence) and at 24 hours (MD -2.69, 95% CI -3.67 to -1.70; 1 study; 38 women; low-certainty evidence). It is uncertain whether music plus analgesia has any effect on adverse effects (anxiety), when compared with placebo plus analgesia because the quality of evidence is very low. Reiki We are uncertain if Reiki plus analgesia compared with analgesia alone has any effect on pain, adverse effects, vital signs or rescue analgesic requirement because the quality of evidence is very low (one study, 90 women). Relaxation Relaxation may reduce pain compared with standard care at 24 hours (MD -0.53 VAS, 95% CI -1.05 to -0.01; 1 study; 60 women; low-certainty evidence). Transcutaneous electrical nerve stimulation TENS (versus no treatment) may reduce pain at one hour (MD -2.26, 95% CI -3.35 to -1.17; 1 study; 40 women; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce pain compared with placebo plus analgesia at one hour (SMD -1.10 VAS, 95% CI -1.37 to -0.82; 3 studies; 238 women; low-certainty evidence) and at 24 hours (MD -0.70 VAS, 95% CI -0.87 to -0.53; 108 women; 1 study; low-certainty evidence). TENS plus analgesia (versus placebo plus analgesia) may reduce heart rate (MD -7.00 bpm, 95% CI -7.63 to -6.37; 108 women; 1 study; low-certainty evidence) and respiratory rate (MD -1.10 brpm, 95% CI -1.26 to -0.94; 108 women; 1 study; low-certainty evidence). We are uncertain if TENS plus analgesia (versus analgesia) has any effect on pain at six hours or 24 hours, or vital signs because the quality of evidence is very low (two studies, 92 women).

Authors' conclusions: Some CAM therapies may help reduce post-CS pain for up to 24 hours. The evidence on adverse events is too uncertain to make any judgements on safety and we have no evidence about the longer-term effects on pain. Since pain control is the most relevant outcome for post-CS women and their clinicians, it is important that future studies of CAM for post-CS pain measure pain as a primary outcome, preferably as the proportion of participants with at least moderate (30%) or substantial (50%) pain relief. Measuring pain as a dichotomous variable would improve the certainty of evidence and it is easy to understand for non-specialists. Future trials also need to be large enough to detect effects on clinical outcomes; measure other important outcomes as listed lin this review, and use validated scales.

Trial registration: ClinicalTrials.gov NCT01897311 NCT01049477 NCT03080506 NCT02129894 NCT03711994 NCT01786330 NCT02364167 NCT01383122 NCT03359798 NCT03829774 NCT02526186 NCT03604068 NCT00725569 NCT02365753.

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Conflict of interest statement

Sandra Zimpel: none known.

Maria Regina Torloni: none known.

Gustavo JM Porfirio: none known.

Ronald LG Flumignan: none known.

Edina MK da Silva: none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
3
3
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
1.1
1.1. Analysis
Comparison 1: Acupuncture versus no treatment, Outcome 1: Abdominal pain up to 24 hours (VAS)
1.2
1.2. Analysis
Comparison 1: Acupuncture versus no treatment, Outcome 2: Back pain up to 24 hours (VAS)
2.1
2.1. Analysis
Comparison 2: Acupuncture plus analgesia versus placebo plus analgesia, Outcome 1: Pain
2.2
2.2. Analysis
Comparison 2: Acupuncture plus analgesia versus placebo plus analgesia, Outcome 2: Rescue analgesic requirement (number of analgesic)
3.1
3.1. Analysis
Comparison 3: Acupuncture plus analgesia versus analgesia, Outcome 1: Pain ‐ up to 12 and 24 hours
3.2
3.2. Analysis
Comparison 3: Acupuncture plus analgesia versus analgesia, Outcome 2: Pain ‐ up to 48 hours
3.3
3.3. Analysis
Comparison 3: Acupuncture plus analgesia versus analgesia, Outcome 3: Adverse effects (pruritus)
3.4
3.4. Analysis
Comparison 3: Acupuncture plus analgesia versus analgesia, Outcome 4: Rescue analgesic requirement (cumulative dose)
3.5
3.5. Analysis
Comparison 3: Acupuncture plus analgesia versus analgesia, Outcome 5: Rescue analgesic requirement (number of analgesic)
4.1
4.1. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 1: Pain
4.2
4.2. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 2: Anxiety
4.3
4.3. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 3: Heart rate (bpm)
4.4
4.4. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 4: Diastolic blood pressure (mm Hg)
4.5
4.5. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 5: Systolic blood pressure (mm Hg)
4.6
4.6. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 6: Rescue analgesic requirement
4.7
4.7. Analysis
Comparison 4: Aromatherapy plus analgesia versus placebo plus analgesia, Outcome 7: Satisfaction
5.1
5.1. Analysis
Comparison 5: Electromagnetic therapy plus analgesia versus placebo plus analgesia, Outcome 1: Pain (VAS)
5.2
5.2. Analysis
Comparison 5: Electromagnetic therapy plus analgesia versus placebo plus analgesia, Outcome 2: Rescue analgesic requirement
5.3
5.3. Analysis
Comparison 5: Electromagnetic therapy plus analgesia versus placebo plus analgesia, Outcome 3: Satisfaction
6.1
6.1. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 1: Pain
6.2
6.2. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 2: Adverse effects (anxiety)
6.3
6.3. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 3: Heart rate
6.4
6.4. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 4: Respiratory rate (breaths per minute)
6.5
6.5. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 5: Systolic blood pressure
6.6
6.6. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 6: Diastolic blood pressure
6.7
6.7. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 7: Rescue analgesic requirement
6.8
6.8. Analysis
Comparison 6: Massage (foot and hand) plus analgesia versus analgesia, Outcome 8: Breastfeeding
7.1
7.1. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 1: Pain ‐ up to 1 hour
7.2
7.2. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 2: Pain ‐ up to 24 and 48 hours
7.3
7.3. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 3: Adverse effects (anxiety)
7.4
7.4. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 4: Heart hate (bpm)
7.5
7.5. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 5: Systolic blood pressure (mm Hg)
7.6
7.6. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 6: Diastolic blood pressure (mm Hg)
7.7
7.7. Analysis
Comparison 7: Music plus analgesia versus placebo plus analgesia, Outcome 7: Rescue analgesic requirement (dose)
8.1
8.1. Analysis
Comparison 8: Music plus analgesia versus analgesia, Outcome 1: Pain
8.2
8.2. Analysis
Comparison 8: Music plus analgesia versus analgesia, Outcome 2: Rescue analgesic requirement (cumulative dose)
8.3
8.3. Analysis
Comparison 8: Music plus analgesia versus analgesia, Outcome 3: Satisfaction
9.1
9.1. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 1: Pain
9.2
9.2. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 2: Adverse effects (anxiety)
9.3
9.3. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 3: Heart rate
9.4
9.4. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 4: Respiratory rate
9.5
9.5. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 5: Systolic blood pressure (mm Hg)
9.6
9.6. Analysis
Comparison 9: Reiki plus analgesia versus analgesia, Outcome 6: Diastolic blood pressure (mm Hg)
10.1
10.1. Analysis
Comparison 10: Relaxation versus standard care, Outcome 1: Pain
11.1
11.1. Analysis
Comparison 11: TENS versus no treatment, Outcome 1: Pain (NAS)
11.2
11.2. Analysis
Comparison 11: TENS versus no treatment, Outcome 2: Pain (measured with McGill pain questionnaire: higher score = more pain)
12.1
12.1. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 1: Pain ‐ up to one hour (VAS)
12.2
12.2. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 2: Pain ‐ 6, 12, 24 hours
12.3
12.3. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 3: Pain (NRS)
12.4
12.4. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 4: Heart rate
12.5
12.5. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 5: Respiratory rate
12.6
12.6. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 6: Systolic blood pressure [mm Hg]
12.7
12.7. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 7: Diastolic blood pressure
12.8
12.8. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 8: Rescue analgesic requirement (cumulative dose)
12.9
12.9. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 9: Rescue analgesic requirement (patients after 8 hours)
12.10
12.10. Analysis
Comparison 12: TENS plus analgesia versus placebo plus analgesia, Outcome 10: Rescue analgesic requirement (number of analgesic)
13.1
13.1. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 1: Pain (VAS) ‐ up to six hours
13.2
13.2. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 2: Pain (VAS)
13.3
13.3. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 3: Heart rate (bpm)
13.4
13.4. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 4: Respiratory rate
13.5
13.5. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 5: Systolic blood pressure [mm Hg]
13.6
13.6. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 6: Diastolic blood pressure
13.7
13.7. Analysis
Comparison 13: TENS plus analgesia versus analgesia, Outcome 7: Rescue analgesic requirement (cumulative dose)
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD011216

References

References to studies included in this review

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    1. Sharifipour F, Sohailbaigi S, Dastmozd L. Comparison of the citrus arantium and salvia officinalis aroma impacts on post cesarean anxiety. Acta Medica Mediterranea 2016;32:977-81.
Sharma 2019 {published data only}
    1. Sharma K, Kumari R. Study to assess the effectiveness of foot and hand massage on reducing pain among post natal mothers who had undergone caesarean section. International Journal of Nursing Education 2019;11(1):79-84. [DOI: 10.5958/0974-9357.2019.00017.5] - DOI
Simonelli 2018 {published data only}
    1. Simonelli MC, Doyle LT, Columbia M, Wells PD, Benson KV, Lee CS. Effects of connective tissue massage on pain in primiparous women after cesarean birth. Journal of Obstetric, Gynecologic, and Neonatal Nursing 2018;47(5):591-601. [DOI: 10.1016/j.jogn.2018.07.006] - DOI - PubMed
Smith 1986 {published data only}
    1. Smith CM, Guralnick MS, Gelfand MM, Jeans ME. The effects of transcutaneous electrical nerve stimulation on post-cesarean pain. Pain 1986;27:181-93. [DOI: 10.1016/0304-3959(86)90209-5] - DOI - PubMed
Solehati 2015 {published data only}
    1. Solehati T, Rustina Y. Benson relaxation technique in reducing pain intensity in women after cesarean section. Anesthesiology and Pain Medicine 2015;5(3):e22236. [DOI: 10.5812/aapm.22236v2] - DOI - PMC - PubMed
Sousa 2009a {published data only}
    1. Sousa L, Gomes FA, Pitangui AC, Nakano AM. Assessment of transcutaneous electrical nerve stimulation for pain relief after cesarean section: a randomized clinical trial [Avaliação da estimulação elétrica transcutânea do nervo para o alívio de dor após cesareana: ensaio clínico randomizado]. Revista Brasileira de Saúde Maternal Infantil 2009;9(1):49-57.
Varghese 2014 {published data only}
    1. Varghese J, George J, Gowda YS. A randomized control trial to determine the effect of foot reflexology in intensity of pain and quality of sleep in post caesarean mothers. IOSR Journal of Nursing and Health Science 2014;3(1):39-43.
Wu 2009 {published data only}
    1. Wu HC, Liu YC, Ou KL, Chang YH, Hsieh CL, Tsai AH, et al. Effects of acupuncture on post-cesarean section pain. Chinese Medical Journal 2009;122(15):1743-8. [PMID: ] - PubMed
Yang 2019 {published data only}
    1. Yang GY, Chen QZ, Fu HY, Chen CH. Effect of auricular acupuncture on postpartum rehabilitation of primipara with cesarean. Zhongguo Zhen Jiu = Chinese Acupuncture & Moxibustion 2019;39(7):717-20. [DOI: 10.13703/j.0255-2930.2019.07.010 ] - PubMed

References to studies excluded from this review

Abadi 2018 {published data only}
    1. Abadi F, Abadi F, Fereidouni Z, Amirkhani M, Karimi S, Najafi Kelyani M. Effect of acupressure on preoperative cesarean section anxiety. Journal of Acupuncture and Meridian Studies 2018;11(6):361-6. [PMID: ] - PubMed
    1. IRCT20171015036784N3. The effect of acupressure on anxiety before cesarean section and nausea, vomiting and pain after cesarean section in woman admitted to hospital. en.irct.ir/trial/27409 (first received 29 January 2018).
Abu Bakar 2015 {published data only}
    1. Abu Bakar MR, Abdul Kadir A, Abdul Wahab SZ, Abdul Karim AH, Nik Hussain NH, Mohd Noor N, et al. Randomized controlled trial on the effect of channa striatus extract on measurement of the uterus, pulsatility index, resistive index of uterine artery and superficial skin wound artery in post lower segment caesarean section women. PLOS One 2015;10(7):e0133514. [PMID: ] - PMC - PubMed
Agah 2007 {published data only}
    1. Agah M, Sadeghi H, Roodneshin F. The efficacy of favorite music on pain after cesarean section. Regional Anesthesia and Pain Medicine 2008;33(5 Suppl 1):183.
    1. Agah M, Sadeghi H. The efficacy of favourite music on pain after cesarean section. Iranian Journal of Obstetrics, Gynecology and Infertility 2007;10(1):41-6.
Ali 2017 {published data only}
    1. Ali AJ, IRCT2017092814049N7. Comparing effectiveness of Damask rose and lavender scent on severity of pain and anxiety after Cesarean section, through women. en.irct.ir/trial/13755 2017.
Allameh 2013 {published data only}
    1. Allameh T, JabalAmeli M, Lorestani K, Akbari M. The efficacy of quran sound on anxiety and pain of patients under cesarean section with regional anesthesia: A randomized case-controlled clinical trial. Journal of Isfahan Medical School 2013;31(235):601-10.
Amin‐Hanjani 1992 {published data only}
    1. Amin-Hanjani S, Corcoran J, Chatwani A. Cold therapy in the management of postoperative cesarean section pain. American Journal of Obstetrics and Gynecology 1992;167(1):108-9. - PubMed
Beiranvand 2014 {published data only}
    1. Beiranvand S, Noparast M, Eslamizade N, Saeedikia S. The effects of religion and spirituality on postoperative pain, hemodynamic functioning and anxiety after cesarean section. Acta Medica Iranica 2014;52(12):909-15. - PubMed
Blackburn 2011 {published data only}
    1. Blackburn K, Scott P, Wilson C, Lanier K, Borges A, Curtis E, et al. The effects of music therapy on women's anxiety before and during cesarean delivery. Reproductive Sciences 2011;18(4):374A.
    1. Denney JM, Blackburn KL, Bleach CC, Martinez AR, Philips JB, Lanier K, et al. The effects of music intervention on women's anxiety before and after cesarean delivery: a Randomized Controlled Trial. Music and Medicine 2018;10(4).
    1. NCT01049477. The effects of music therapy on women's anxiety before and during cesarean delivery. clinicaltrials.gov/ct2/show/record/NCT01049477 (first received 14 Janaury 2010).
Cal 2016 {published data only}
    1. Cal E, Cakiroglu B, Kurt AN, Hartiningsih SS, Suryani, Dane S. The potential beneficial effects of hand and foot bathing on vital signs in women with caesarean section. Clinical & Investigative Medicine - Medecine Clinique et Experimentale 2016;39(6):S86-8. - PubMed
Chang 2005 {published data only}
    1. Chang SC, Chen CH. Effects of music therapy on women's physiologic measures, anxiety, and satisfaction during cesarean delivery. Research in Nursing & Health 2005;28(6):453-61. [PMID: ] - PubMed
Chaowalit 2018 {published data only}
    1. Chaowalit M, TCTR20190605007. Cold therapy for pain relief in postoperative cesarean section ; randomized controlled trial. http://www.clinicaltrials.in.th/index.php?tp=regtrials&menu=trialsea... (first received 18 December 2018).
Charoenkwan 2017 {published data only}
    1. Charoenkwan K, NCT03080506. Effect of elastic abdominal binder on pain and functional recovery after cesarean delivery: a randomized controlled trial. clinicaltrials.gov/ct2/show/NCT03080506 (first received 15 March 2017).
Chen 2005 {published data only}
    1. Chen HM, Chang FY, Hsu CT. Effect of acupressure on nausea, vomiting, anxiety and pain among post-cesarean section women in Taiwan. Kaohsiung Journal of Medical Sciences 2005;21(8):341-50. - PMC - PubMed
Citak 2012 {published data only}
    1. Citak Karakaya I, Yuksel I, Akbayrak T, Demirturk F, Karakaya MG, Ozyuncu O, et al. Effects of physiotherapy on pain and functional activities after cesarean delivery. Archives of Gynecology and Obstetrics 2012;285(3):621-7. [PMID: ] - PubMed
Fazel 2017 {published data only}
    1. Fazel N, Pejhan A, Tabarraei Y, Taghizadeh M, Sharifi N. Effects of anethum graveolens L. (dill) essential oil on the intensity of retained intestinal gas, flatulence and pain after cesarean section: a randomized, double-blind placebo-controlled trial. Journal of Herbal Medicine 2017;8:8-13. [DOI: 10.1016/j.hermed.2017.01.002] - DOI
    1. IRCT2013061212438N3. The effect of oral dill drop on flatulence in patient post cesarean in Sabzevar Mobini hospital. en.irct.ir/trial/12491 (first received 07 July 2013).
Ghana 2017 {published data only}
    1. Ghana S, Hakimi S, Mirghafourvand M, Abbasalizadeh F, Behnampour N. Randomized controlled trial of abdominal binders for postoperative pain, distress, and blood loss after cesarean delivery. International Journal of Gynaecology and Obstetrics 2017;37(3):271-6. - PubMed
    1. Ghana S, Hakimi S, Mirghafourvand M, Abbasalizadeh F, Behnampour N. The effects of abdominal binder on wound healing and consumed pain medications after cesarean section: a randomized control trial. Iranian Red Crescent Medical Journal 2017;19(4):e44119. [DOI: 10.5812/ircmj.44119] - DOI
    1. IRCT2015042521917N2. Comparison of the effects using abdominal binder and routine medical care on clinical outcomes of cesarean section: a randomized controlled trial. http://www.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2015042521917N2 2015.
Gillier 2016 {published data only}
    1. Gillier CM, Sparks JR, Kriner R, Anasti JN. A randomized controlled trial of abdominal binders for the management of postoperative pain and distress after cesarean delivery. International Journal of Gynaecology and Obstetrics 2016;133:188-91. - PubMed
    1. NCT02129894. The use of abdominal binders in patients undergoing cesarean sections: a randomized controlled trial. clinicaltrials.gov/ct2/show/record/NCT02129894 (first received 2 May 2014).
Gist 2018 {published data only}
    1. Gist W, NCT03711994. Cold therapy for pain control following caesarean section. Available at clinicaltrials.gov/ct2/show/NCT03711994 (first received 19 October 2018).
Gursen 2016 {published data only}
    1. Gursen C, Inanoglu D, Kaya S, Akbayrak T, Baltaci G. Effects of exercise and Kinesio taping on abdominal recovery in women with cesarean section: a pilot randomized controlled trial. Archives of Gynecology and obstetrics 2016;293(3):557-65. [PMID: ] - PubMed
Gustafson 2018 {published data only}
    1. Gustafson JL, Dong F, Duong J, Kuhlmann ZC. Elastic abdominal binders reduce cesarean pain postoperatively: a randomized controlled pilot trial. Kansas Journal of Medicine 2018;11(2):1-19. - PMC - PubMed
    1. Gustafson JL, Kuhlmann ZC, Frazier LM, Duong J. Do elastic abdominal binders reduce postoperative pain and blood loss? A randomized controlled trial.. Obstetrics & Gynecology 2015;125(5 Suppl):51S.
    1. NCT01786330. Do elastic abdominal binders reduce post operative pain and blood loss? clinicaltrials.gov/ct2/show/NCT01786330 (first received 7 February 2013).
Henkel 2018 {published data only}
    1. Henkel B, Hesse T, Klausenitz C, Hahnenkamp K, Mustea A, Usichenko TI. Acupuncture for pain control after cesarean section - a randomized, placebo-controlled investigation. Journal of Acupuncture & Meridian Studies 2018;11(4):248. [DOI: 10.1016/j.jams.2018.08.172] - DOI
    1. NCT02364167. Acupuncture vs. placebo acupuncture and vs. standard therapy for pain control after elective caesarean section - a randomized controlled trial. Available at clinicaltrials.gov/ct2/show/NCT02364167 (first received 16 February 2015).
Ho 1996 {published data only}
    1. Ho CH, Hseus SS, Lee T, Lee, TY. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief. Acta Anaesthesiologica Scandinavica 1996;40:372-5. [DOI: 10.1111/j.1399-6576.1996.tb04448.x] - DOI - PubMed
Hollinger 1986 {published data only}
    1. Hollinger JL. Transcutaneous electrical nerve stimulation after cesarean birth. Physical Therapy 1986;66(1):36-8. - PubMed
Hong 2003 {published data only}
    1. Hong JY, Yoon HJ. The effects of preoperative information and hand massage on postoperative satisfaction score after cesarean section under combined spinal-epidural anesthesia. Korean Journal of Anesthesiology 2003;45(4):492-7.
Houshyar 2015 {published data only}
    1. Houshyar AE, Rezaie HH, Jahani Y, Kazemi M, Monfared S. Comparison of two methods of aromatherapy with lavender essence and Transcutaneous Electrical Nerve Stimulation (TENS) on cesarean postoperative pain. Iranian Journal of Obstetrics, Gynecology and Infertility 2015;18(146):6-12. [DOI: 10.22038/IJOGI.2015.4422] - DOI
Kerai 2011 {published data only}
    1. Kerai S, Saxena KN, Anand R, Dali JS, Taneja B. Comparative evaluation of transversus abdominis plane block with transcutaneous electrical nerve stimulation for postoperative analgesia following lower segment caesarean section. Journal of Obstetric Anaesthesia and Critical Care 2011;1(1):30-4.
Keshavarz 2010 {published data only}
    1. Keshavarz M. Comparison the effect of skin to skin contact and music during skin to skin contact on maternal state anxiety in cesarean section unit. Available at irct.ir/trial/1959 (first received: 31 October 2009).
Khezri 2017 {published data only}
    1. IRCT2014040617138N1. Comparison of gabapentin plus vitamin B - complex and gabapentin alone on pain after spinal anesthesia for cesarean section. Available at en.irct.ir/trial/15834 (first received 21 September 2014).
    1. Khezri MB, Nasseh N, Soltanian G. The comparative preemptive analgesic efficacy of addition of vitamin B complex to gabapentin versus gabapentin alone in women undergoing cesarean section under spinal anesthesia: a prospective randomized double-blind study. Medicine 2017;96(15):e6545. [DOI: 10.1097/MD.0000000000006545] - DOI - PMC - PubMed
Khoshtarash 2012 {published data only}
    1. IRCT138812021174N4. The effect of foot reflexology on pain and physiological parameters after cesarean section in patients referring to Alzahra educational center in Rasht. en.search.irct.ir/view/2414 (first received 10 April 2011).
    1. Khoshtarash M, Ghanbari A, Yeganeh MR, Kazemnejhad E, Rezasoltani P. Effects of foot reflexology on pain and physiological parameters after cesarean section. Koomesh 2012;14(1):109-16.
    1. Khoshtarash M, Ghanbari A, Yeganeh MR, Kazemnejhad E, Rezasoltani P. Survey the effect of foot reflexology on pain and physiological parameters after cesarean section in patients referring to Alzahra Educational Center in Rasht. Holistic Nursing and Midwifery 2010;20(2):27-33.
Krum 2006 {published data only}
    1. Krum LL, Fin M, Ford R, Badger T, Wesley M. Effect of conservative physical therapy management status post cesarean section: a randomized control group design. Journal of Women’s Health Physical Therapy 2006;30(2):27-8. [DOI: 10.1097/01274882-200630020-00010] - DOI
Kuo 2016 {published data only}
    1. Kuo SY, Tsai SH, Chen SL, Tzeng YL. Auricular acupressure relieves anxiety and fatigue, and reduces cortisol levels in post-caesarean section women: a single-blind, randomised controlled study. International Journal of Nursing Studies 2016;53:17-26. [DOI: 10.1016/j.ijnurstu.2015.10.006] - DOI - PubMed
Kurdi 2018 {published data only}
    1. Kurdi MS, Gasti V. Intraoperative meditation music as an adjunct to subarachnoid block for the improvement of postoperative outcomes following cesarean section: a randomized placebo-controlled comparative study. Anesthesia, Essays and Researches 2018;12(3):618-24. [PMID: ] - PMC - PubMed
Kushnir 2012 {published data only}
    1. Kushnir J, Friedman A, Ehrenfeld M, Kushnir T. Coping with preoperative anxiety in cesarean section: physiological, cognitive, and emotional effects of listening to favorite music. Birth 2012;39(2):121-7. [PMID: ] - PubMed
Li 2012a {published data only}
    1. Li Y, Dong Y. Preoperative music intervention for patients undergoing cesarean delivery. International Journal of Gynecology and Obstetrics 2012;119(1):81-3. [DOI: 10.1016/j.ijgo.2012.05.017] - DOI - PubMed
Li 2012b {published data only}
    1. Li JZ, Li XZ, Wang MS, Li JP, Shi F, Yu HF. Effects of transcutaneous electrical stimulation of auricular Shenmen point on postoperative nausea and vomiting and patient-controlled epidural analgesia in cesarean section. Chinese Medical Journal 2012;92(27):1892-5. [PMID: ] - PubMed
Mahishale 2014 {published data only}
    1. Mahishale A, CTRI/2014/06/004662. Effect of post maternity abdominal corset on pain and functional independence in early postpartum women undergone caesarean section- a randomized controlled trial. ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=7701 (first received 10 June 2014).
Mohseni 2018 {published data only}
    1. IRCT2016040516110N3. Clinical trial of the effect of amniotic membrane on post cesarean pain. Available at irct.ir/trial/15170 (first received 30 June 2016).
    1. Mohseni F, Saem J, Sekhavati E, Molazem Z, Tabrizi R. Amniotic membrane for pain control after cesarean section. Crescent Journal of Medical and Biological Sciences 2018;5(3):198-202. [cjmb.org/uploads/pdf/pdf_CJMB_65.pdf]
Mokhtari 2010 {published data only}
    1. IRCT138904124299N1. Comparison of impact of foot reflexology massage and bensone relaxation on severity of pain after cesarean section. Available at en.irct.ir/trial/4553 (first received: 29 August 2010).
    1. Mokhtari NJ, Sirati NM, Sadegui SM, Ghanbari Z, Babatabar DH, Mahmoudi H. Comparison of impact of foot reflexology massage and bensone relaxation on severity of pain after cesarean section. Payesh 2010;9(3):289-98. [payeshjournal.ir/article-1-567-en.html]
Mousavi 2017 {published data only}
    1. IRCT20180526039845N1. Study of the effect of auriculotherapy on nausea and vomiting in women following elective cesarean section. Available at irct.ir/trial/33603 (firste received 27 June 2019).
    1. Mousavi FS, Golmakani N, Taghanaki HR, Saki A, Akhlaghi F. Effects of auriculotherapy on post cesarean anxiety. Iranian Journal of Obstetrics, Gynecology and Infertility 2017;20(6):50-60. [DOI: 10.22038/ijogi.2017.9325] - DOI
Myers 2014 {published data only}
    1. Myers JR, Gillier CM, Kriner RM, Constant AD, Wetzel LA, Anasti JN. The use of abdominal binders in patients undergoing cesarean delivery: a prospective randomized controlled trial. Obstetrics & Gynecology 2014;123(5 Suppl):160S. [DOI: 10.1097/01.aog.0000447160.43489.c7] - DOI
Norouzi 2013 {published data only}
    1. Norouzi F, Keshavarz M, SeyedFatemi N, Montazeri A. The impact of kangaroo care and music on maternal state anxiety. Complementary Therapies in Medicine 2013;21(5):468-72. [DOI: 10.1016/j.ctim.2013.07.006] - DOI - PubMed
Ohashi 2012 {published data only}
    1. NCT01383122. The efficacy of pulsed electromagnetic field therapy for management of post-operative pain following cesarean delivery. Available at clinicaltrials.gov/show/NCT01383122 (first received 24 June 2011). [ClinicalTrials.gov: NCT01383122]
    1. Ohashi Y, Downey K, Berstein P, Guest S, Carvalho JC. The efficacy of pulsed electromagnetic field therapy for management of postoperative pain following cesarean section: a randomized, double blind, placebo controlled study. In: Society for Obstetric Anesthesia and Perinatology (SOAP) 44th Annual Meeting; 2015 May 2-5; Monterey, USA. 2012:S-1.
Rasuli 2017 {published data only}
    1. Rasuli S, IRCT2017041216325N5. Clinical trials of checking the effect of music therapy during cesarean section on serum ß endorphin, Vital Sign and postoperative pain on pregnant women. Available at en.irct.ir/trial/15310 (first received 28 July 2017).
Razmjoo 2012 {published data only}
    1. Razmjoo N, lotfabadi LH, Yousefi F, Esmaeeli H, Azizi H, Lotfalizadeh M. Effect of foot reflexology on pain and anxiety in women following elective cesarean section. Iranian Journal of Obstetrics, Gynecology and Infertility 2012;15(1):8-16. [DOI: 10.22038/ijogi.2012.5746] - DOI
Reynolds 1987 {published data only}
    1. Reynolds RA, Gladstone N, Ansari AH. Transcutaneous electrical nerve stimulation for reducing narcotic use after cesarean section. Journal of Reproductive Medicine 1987;32:843-6. [PMID: ] - PubMed
Reza 2007 {published data only}
    1. Reza N, Ali SM, Saeed K, Abul-Qasim A, Reza TH. The impact of music on postoperative pain and anxiety following cesarean section. Middle East Journal of Anesthesiology 2007;19(3):573-86. [PMID: ] - PubMed
Robinson 2017 {published data only}
    1. Robinson JN, NCT03359798. The effect of a counseling intervention on post-cesarean section narcotic use: a randomized controlled trial. Available at clinicaltrials.gov/ct2/show/NCT03359798 (first recevied 19 September 2019).
Saberkari 2009 {published data only}
    1. Saberkari MR, Nia KN. Transcutaneous electrical nerve stimulation (TENS) on postcesarean section pain. Pain Practice 2009;9(Suppl 1):150. [DOI: 10.1111/j.1533-2500.2009.00267.x] - DOI
Sadeghi 2019 {published data only}
    1. Sadeghi T, IRCT20150713023190N8. Investigating the effect of auriculotherapy on shoulder pain after cesarean section. Available at en.irct.ir/trial/36298 (first received 20 January 2019).
Sen 2009 {published data only}
    1. Sen H, Sizlan A, Yanarates O, Kilic E, Ozkan S, Dagli G. The effect of musical therapy on postoperative analgesia. Pain Practice 2009;9:151.
    1. Sen H, Sizlan A, Yanarates O, Kilic E, Ozkan S, Dagli G. The effect of musical therapy on postoperative analgesia. TAF Preventive Medicine Bulletin 2009;8(2):107-12.
Shabanian 2017 {published data only}
    1. Shabanian G, IRCT2016110112101N2. Evaluating the effect of Dill (Anethum graveolens L.) seed essence on pain after cesarean delivery: a clinical trial. Available at en.irct.ir/trial/12228 (first received 23 March 2017).
Sharifi 2013 {published data only}
    1. Sharifi A, Alipour A, Baharloei S. Comparison of the effect of instrumental music and voices of Holy Quran on anxiety of woman before cesarean. Journal of Urmia Nursing and Midwifery Faculty 2013;106:841-7.
Sharifipour 2015b {published data only}
    1. Sharifipour F, Bakhteh A, Mirmohammad M. Effects of citrus aurantium aroma on post-cesarean anxiety. Iranian Journal of Obstetrics, Gynecology and Infertility 2015;18(169):12-20. [DOI: 10.22038/IJOGI.2015.6131] - DOI
Tarasov 1995 {published data only}
    1. Tarasov A, Alahuhta S, Salomaki T, Nuutinen L. Acupuncture for the premedication and postoperative pain control in obstetric surgery. Acta Anaesthesiologica Scandinavica 1995;39:164. [DOI: 10.1111/j.1399-6576.1995.tb04298.x] - DOI
vanderVaart 2011 {published data only}
    1. ISRCTN79265996. The effect of reiki on pain in women undergoing non-emergency caesarean sections. isrctn.com/ISRCTN79265996 (first received 27 May 2009). [ISRCTN79265996]
    1. Vandervaart S, Berger H, Tam C, Goh I, Gijsen V, Wildt SN, et al. The effect of reiki on pain in women after elective caesarean section-a double blinded randomized controlled trial. Canadian Journal of Clinical Pharmacology 2010;17(1):e221.
    1. Vandervaart S, Berger H, Tam C, Goh I, Gijsen VM, Wildt SN, et al. The effect of distant reiki on pain in women after elective caesarean section: a double-blinded randomised controlled trial. BMJ Open 2011;1(1):e000021. [DOI: 10. 1136/bmjopen-2010- 000021] - PMC - PubMed
    1. Vandervaart S. A Double-Blinded Randomized Controlled Trial on the Effect of Distant Reiki on Pain after Non-Emergency Caesarean Section and the Effect of CYP2D6 Variation on Codeine Analgesia [thesis]. Toronto: University of Toronto, 2011.
Xue 2016 {published data only}
    1. Xue M, Fan L, Ge LN, Zhang Y, Ge JL, Gu J, et al. Postoperative foot massage for patients after caesarean delivery. Zeitschrift fur Geburtshilfe und Neonatologie 2016;220(4):173-8. [DOI: 10.1055/s-0042-104802] - DOI - PubMed

References to ongoing studies

Bagherzadeh 2019 {published data only}
    1. Bagherzadeh R, IRCT20190122042453N1. Investigating the effect of reflexology and relaxation of Benson on pain, physiological symptoms, lactation and weight of newborn in women undergoing cesarean section. n.irct.ir/trial/38249 (first received 5 April 2019).
Balachandran 2019 {published data only}
    1. Balachandran V, NCT03829774. To study and evaluate the eEffectiveness of treatment by Percutaneous Electrical NeuroStimulation (PENS) for post-operative pain in cesarean section patients using primary relief v 2.0. clinicaltrials.gov/ct2/show/NCT03829774 (first received 4 February 2019).
Hakimi 2018 {published data only}
    1. Hakimi S, IRCT20150424021917N9. Effect of eremostachys laciniata suppository on post secarean section pain and distress. en.irct.ir/trial/32929 (first received 31 October 2018).
Jahdi 2015 {published data only}
    1. Jahdi F, IRCT201507252248N18. The effect of calendula ointment on healing and pain localized wound cesarean section in nulliparous women. en.irct.ir/trial/1890 (first received 5 November 2015).
Joghataei 2015 {published data only}
    1. Joghataei R, IRCT2014122920475N1. Comparison of the effect of foot reflexology and auriculotherapy on pain and anxiety in women following elective cesarean section. en.irct.ir/trial/18154 (first received 6 November 2015).
Kazemi 2019 {published data only}
    1. Kazemi M, IRCT20131228015965N15. Comparative study of the effects of reflexology and auriculotherapy on the pain after cesarean section. en.irct.ir/trial/34483 (first received 30 July 2019).
Kim 2015 {published data only}
    1. Kim MJ, NCT02526186. Battlefield auricular acupuncture for control of post-partum pain. clinicaltrials.gov/ct2/show/record/NCT02526186 (first received 18 August 2015).
Klinger 2018 {published data only}
    1. Klinger R, DRKS00013123. Extent of analgesic effects of transcutaneous electrical nerve stimulation in patients after caesarean section. drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00... (first received 2 May 2018).
Latifi 2012 {published data only}
    1. Latifi S, IRCT201112248498N1. The impact of foot and hand massage on cesarean postoperative pain. en.irct.ir/trial/8957 (first received 24 January 2012).
Maassarani 2018 {published data only}
    1. Maassarani M, NCT03604068. Protocol for the randomized controlled trial of pulsed short wave therapy in cesarean section. clinicaltrials.gov/ct2/show/NCT03604068 (first received 27 July 2018).
Mobaraki 2019 {published data only}
    1. Mobaraki F, IRCT20181226042137N1. The examining of the effect of foot massage with orange essence on grade pain and anxiety women under cesarean section. en.irct.ir/trial/38076 (first received 27 April 2019).
Mojalli 2017 {published data only}
    1. Mojalli M, IRCT2017052834169N1. Chammomil fragrance impact on anxiety and pain after cesarean section in nulliparous women. en.irct.ir/trial/26178 (first recevied 5 September 2017).
Oberbaum 2008 {published data only}
    1. Oberbaum M, NCT00725569. Homeopathy for post-operative (c. section) recovery. clinicaltrials.gov/show/NCT00725569 (first received 29 July 2008).
Pakseresht 2016 {published data only}
    1. Pakseresht S, IRCT2016072529063N1. The survey effect of lavender aromatherapy on the pain level after cesarean section among women referred to Al-Zahra hospital in Rasht in 2016- 2017. en.irct.ir/trial/23447 (first received 19 September 2016).
Phillibert 2015 {published data only}
    1. Phillibert D, NCT02365753. Effect of pulsed electromagnetic field therapy on pain after cesarean delivery. clinicaltrials.gov/ct2/show/NCT02365753 (first received 19 February 2015).
Santana 2014 {published data only}
    1. Santana JM, Lotti RC, RBR-459y54. Effect of TENS in pain after cesarean. ensaiosclinicos.gov.br/rg/RBR-459y54/ (first recevied 15 September 2014).
Shahoei 2017 {published data only}
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Zardosht 2016 {published data only}
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References to other published versions of this review

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