分娩時の疼痛管理のためのバイオフィードバック
Abstract
Background
Labour is often associated with pain and discomfort caused by a complex and subjective interaction of multiple factors, and should be understood within a multi‐dimensional and multi‐disciplinary framework. Within the non‐pharmacological approach, biofeedback has focused on the acquisition of control over some physiological responses with the aid of electronic devices, allowing individuals to regulate some physical processes (such as pain) which are not usually under conscious control. The role of this behavioural approach for the management of pain during labour, as an addition to the standard prenatal care, has been never assessed systematically. This review is one in a series of Cochrane reviews examining pain relief in labour, which will contribute to an overview of systematic reviews of pain relief for women in labour (in preparation).
Objectives
To examine the effectiveness of the use of biofeedback in prenatal lessons for managing pain during labour.
Search methods
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 March 2011), CENTRAL (The Cochrane Library 2011, Issue 1), PubMed (1950 to 20 March 2011), EMBASE (via OVID) (1980 to 24 March 2011), CINAHL (EBSCOhost) (1982 to 24 March 2011), and PsycINFO (via Ovid) (1806 to 24 March 2011). We searched for further studies in the reference lists of identified articles.
Selection criteria
Randomised controlled trials of any form of prenatal classes which included biofeedback, in any modality, in women with low‐risk pregnancies.
Data collection and analysis
Two authors independently assessed trial quality and extracted data.
Main results
The review included four trials (186 women) that hugely differed in terms of the diversity of the intervention modalities and outcomes measured. Most trials assessed the effects of electromyographic biofeedback in women who were pregnant for the first time. The trials were judged to be at a high risk of bias due to the lack of data describing the sources of bias assessed. There was no significant evidence of a difference between biofeedback and control groups in terms of assisted vaginal birth, caesarean section, augmentation of labour and the use of pharmacological pain relief. The results of the included trials showed that the use of biofeedback to reduce the pain in women during labour is unproven. Electromyographic biofeedback may have some positive effects early in labour, but as labour progresses there is a need for additional pharmacological analgesia.
Authors' conclusions
Despite some positive results shown in the included trials, there is insufficient evidence that biofeedback is effective for the management of pain during labour.
PICOs
一般語訳
分娩時の疼痛に対するバイオフィードバック
バイオフィードバックとは、シグナルを発する電子機器の助けを借りて、女性が身体からのシグナル、例えば心拍数、筋肉の緊張、体温などを意識し、最終的に身体反応の変化に気づくように訓練することを目指した療法である。例えば、呼吸の速さ、リズム、タイプに意識を集中することによって、女性が自身の身体反応をコントロールできるようにし、疼痛など複数の健康上の問題に対する行動療法とすることを目指す代替アプローチである。このレビューの目的は、妊婦教室で教えられたバイオフィードバックに分娩時の疼痛を緩和する効果があるかどうかを確認することである。このレビューは、4つの試験を対象としている（初産の妊婦186例）。個々のランダム化比較試験における差が大きく、試験の質が低いため、確実な結論を導き出すのが困難であった。試験の大半は、筋緊張を測定する筋電図バイオフィードバックの効果の評価を実施していた。吸引・鉗子分娩、帝王切開、陣痛促進および鎮痛薬の使用に関して、バイオフィードバック群と対照群の間に有意差を認めなかった。筋電図バイオフィードバックの分娩時疼痛に対する効果を評価する十分な情報はなかった。このレビューは、分娩時疼痛を対象としたコクランレビューのシリーズの1つである。このシリーズは、女性の分娩時疼痛のシステマティック・レビューを概観する上で役立つと考えられる（準備中）。
