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I’m pleased to see this work.
Obviously childbirth accounts for relatively few hours of one’s life spent in pain, but I wonder if you’ve looked into it. Nitrous oxide is safe and relatively cheap and does not need an anesthetist because the patient can administer it themselves. It’s commonly used in some Western countries but only getting started in the US, and I can’t find anything about its use in middle or low income countries.
Hi Julia, thanks for drawing our attention to this! No, we didn’t look into it. From a quick review of the evidence, the effectiveness appears variable and uncertain. But as you rightly point out, it doesn’t require an anaesthetist, and it could therefore play an important role in a low resource setting.
To me “Inhaled analgesia appears to be effective in reducing pain intensity and in giving pain relief in labour” sounds like a ringing endorsement from Cochrane given that their usual bottom line seems to be “not enough evidence.” Just about anything for childbirth pain seems to be pretty hit-or-miss, so the fact that it’s not that effective for some people seems like not that big of a downside compared to other methods or no method.
Yes, good point! Based on the Cochrane review, we could confidently say nitrous oxide has an effect on pain. I should have said the evidence for the degree of pain relief appears variable and uncertain, although on a closer look, Cochrane’s estimate suggests 3.5 on a 0-10 scale vs placebo (which is pretty great).
Hi Julia, I’ve spoken to several women who said that they received absolutely no pain relief from the epidurals they were given during birth- none had ever returned to the hospital to give feedback as they had more pressing concerns. Has anyone ever systematically asked women whether their epidural worked? Any data?
Yes, there’s been a lot of research on this. Here’s an analysis of 40 trials with 11,000 women.
My guess is that epidurals are unlikely to be the most cost-effective intervention to increase access to, since it requires an anesthesiologist. I was guessing that nitrous oxide might be more promising because it’s so easy to administer.
I wrote a short blog post a little while ago on preventing low back pain with exercise. I think your problem area report might have missed several important meta-analyses on low back pain. In particular, Huang et al., 2018 and Shiri, Coggon and Hassani, 2017 seem to supersede Steffens et al., 2017, and Lin et al., 2018 seems broader and more recent than NICE, 2016. I think your assessment of the quality of evidence in favour of exercise interventions for low back pain might reasonably update with respect to these references.
Lower back pain cause is simple—we are not using our great ape bodies in the way that evolution designed them to be used. Our ancestors hunted and gathered. They moved their bodies every day and for much of the day walking, running, crouching squatting, grabbing etc. Any seats certainly didn’t have backrests. All of our ancestors cores were in great shape because they were working them out nearly every waking moment. Our desire to obtain comfort has led us to “convenience ourselves to death”.