Ice Massage for the Reduction of Labor Pain

Bette L. Waters, CNM, RN, Jeanne Raisler, CNM, DrPH, FACNM

Disclosures

J Midwifery Womens Health. 2003;48(5) 

In This Article

Background

Ice or cooling applied to an injured body part is used as standard treatment of trauma, bleeding, swelling, and soft tissue injuries.[8] Ice is commonly used to reduce pain of perineal lacerations or episiotomy in the postpartum period.

The early work of Denny-Brown et al.[9] showed that cold temperature effectively blocks nerve conduction in sensory fibers. Grant[10] advocated massage with ice for the treatment of musculoskeletal pain and named his technique cryokinetics. Marshall[11] published a study using ice cube massage for the relief of chronic pain of herpes of the eye.

Melzack et al.[12,13] found that intense sensory input produced by ice massage of the web between the thumb and forefinger resulted in a 50% reduction in acute dental pain. The researchers hypothesized that the efficacy of ice massage was due to engaging the gate control pain system rather than eliminating the source of the pain.[14] They hypothesized that the positive and negative effects of the different impulses counteracted each other at the "gate" level in the spine. When impulses reaching the spine pathway to the brain are stimulated by techniques such as vibration, scratching, or ice massage, the gate closes, resulting in a decrease in the sensation of pain. In addition, Melzack and his colleagues connected their work to acu-puncture relying on the correlation between trigger points used in Western medicine that corresponded to acupuncture points used in traditional Chinese medicine.[15]

The large intestine energy meridian point that Melzack used in his study on ice massage for dental pain reduction is referred to as LI4 or Hoku. The energy meridian pathway is bilateral and begins "in the surface of the skin at the root of the index fingernail. It courses on the external part of the arm. The outward end of the shoulder blade is crossed. Then the meridian leaves the skin surface to connect with the lower part of the lung and transverse colon. It then returns to the skin surface at a point under the chin. From that point, the meridian is again buried deep within the area referred to as the double chin. It follows the lower row of dental roots, passing then to the upper line of teeth roots, crossing the front of the mouth to emerge on the skin surface and the facial point next to the nostrils"[16] (Figure 1).

Large intestine energy meridian pathway.

Shiatsu practitioners[17] describe LI4 (also referred to as Hoku) as being located on the inner lateral midpoint of the first metacarpal. The area between the thumb and forefinger is within 3 to 4 mm of the location of an LI4 (Figure 2).

Large intestine energy point four, also known as LI4 and Hoku. Reprinted with permission from Massage During Pregnancy, 1st Edition, by Bette L. Waters, Research Triangle Publishing, Fuquay-Varina, NC, 1995.

A pilot study was developed on the basis of Dr. Melzack's use of ice massage of LI4 to reduce dental pain after discovering that Aleda Erskine[18] linked dental pain, childbirth pain, and myocardial infarction under the category of "acute clinical pain." Acupuncture or acupressure points used for the relief of a particular pain syndrome often lie within or near the pain area, but many are located at a distance. The large intestine pathway moves from the tip of the forefinger up to the face and circles the teeth; it bifurcates at the shoulder to move downward wrapping around the entire colon. At term pregnancy, the colon practically encircles the upper portion of the uterus. The location of LI4 is a point where the energy flow of the meridian is closest to the skin and can be easily stimulated with pressure, needles, or extreme cold and pressure.

The pilot study using ice massage for reducing labor pain was carried out by a researcher in 1992.[19] Twenty women were recruited to participate in this study on their admission to the labor and delivery unit at Humana Hospital, Dade City, FL. Ice massage of the energy meridian LI4 was performed during each contraction and was carried out over a 30-minute period. Data from the Visual Analog Scale (VAS) showed a mean reduction in pain of 25.15. The reduction of pain was statistically significant despite the small number of participants. The statistical standard was matched pairs t test. The current study expands on this previous work using a larger sample and tested efficacy of right-hand ice massage versus left-hand.

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