Women's experiences of perineal pain during the immediate postnatal period: a cross-sectional study in Brazil

Objective

to identify the severity and prevalence of perineal pain during the post partum in-patient period and associated obstetric, maternal and newborn baby factors following birth.

Design

cross-sectional study.

Setting

a postnatal ward of a hospital in São Paulo, Brazil.

Participants

303 postnatal women.

Measurements

interviews and perineal assessment were conducted to evaluate the perineal outcomes (trauma and pain). Data on maternal characteristics and infant anthropometric variables were collected.

Results

among all women, 80.5% had perineal trauma (60.7% had episiotomy) and 18.5% reported perineal pain. The mean pain intensity score was 4.8±1.9 on the visual analogue scale. Only maternal age (ORa=1.08) and performance of episiotomy (ORa=3.80) remained as independent predictors of perineal pain in the final logistic regression model.

Key conclusions

perineal pain in the immediate postnatal period was highly associated with older maternal age and use of episiotomy, although the overall reporting of perineal pain was low.

Implications for practice

perineal pain following vaginal birth is associated with interventions during labour as well as with maternal characteristics. Despite the negative impact on a woman's daily activities, perineal pain following birth is neglected by care givers and usually not reported by women who may consider it to be a normal outcome of giving birth. Care providers need to ensure all interventions during labour and birth are informed by evidence of benefit and that barriers to implementation of evidence are addressed. Further work is needed to obtain the views of women in Brazil on their health and well-being following birth.     

Does early repair of episiotomy decrease postpartum blood loss: A randomized clinical trial

Objective.?To assess whether early repair of episiotomy before expulsion of placenta affects postpartum blood loss.

Methods.?Patients who had normal vaginal delivery with episiotomy were enrolled in the study. One hundred and twenty who were randomly allocated to either episiotomy repair before (Group 1: 60) or after spontaneous placental expulsion (Group 2: 60) had mediolateral episiotomy. Postpartum blood loss was measured with calibrated collecting bags, placed under the women immediately after the birth. Amount of the blood loss 1?h after the delivery was recorded and the two groups were compared for postpartum blood loss as a primary outcome. After the normality analysis with Kolmogorov–Smirnov Test, we used Mann–Whitney U test for comparing groups. The chi-square test was used for comparing presence of postpartum hemorrhage.

Results.?Mean blood loss was slightly higher in Group 2 (259.5?±?148.9 vs. 310.6?±?195.2, P?=?0.21) but the difference was not statistically significant. There was no statistically significant differences in hemoglobin and hemotocrit levels (ΔHb and ΔHct) in both groups at admission and postpartum.

Conclusion.?Early repair of episiotomy before expulsion of placenta has a minor positive effect on postpartum blood loss.     

Effectiveness of local anaesthetics with and without vasoconstrictors for perineal repair during spontaneous delivery: double-blind randomised controlled trial

Objective

to investigate the use of local anaesthetics, in the presence or absence of vasoconstrictors, for perineal repair during spontaneous delivery.

Design

double-blind, randomised-controlled trial.

Setting

a birth centre, in the city of Sao Paulo, Brazil.

Participants

from June to December 2004, a total of 96 women were allocated into three groups (first-degree perineal lacerations, second-degree perineal lacerations or episiotomy), and treated with local anaesthesia (1% lidocaine or 1% lidocaine with epinephrine) (n=16 per treatment per group).

Interventions

an initial local infiltration of the anaesthetic solution was given so that episiotomy could be carried out (5 ml) and to suture spontaneous lacerations (1 ml), followed by repeated doses (1 ml) until pain was completely inhibited.

Measurements and findings

the main outcome measurement was the volume of anaesthetic used during episiotomy and perineal suture. Our data suggest that the concomitant use of the vasoconstrictor resulted in a significantly lower average volume used in the treatment of first-degree (1 ml, 95% confidence interval (CI) 0.4–1.6) and second-degree (3.7 ml, 95% CI 1.6–5.8) lacerations (p=0.002 and 0.001, respectively). A 0.3 ml (95% CI 1.5–2.1) average decrease in anaesthetic volume was observed with episiotomy (p=0.724). The maximum volume of anaesthetic used with and without vasoconstrictor was 1–2 ml in 95% and 3–4 ml in 50% of first-degree lacerations, respectively, and 1–6 ml in 88% and 7–15 ml in 81% of second-degree lacerations, respectively. For episiotomy, the maximum dose was 15 ml, regardless of anaesthetic solution used.

Key conclusions

our data confirm the hypothesis that the use of anaesthetics in conjunction with vasoconstrictors is more effective than anaesthetics alone in the repair of perineal lacerations, but not for episiotomy.     

Reiki therapy for postoperative oral pain in pediatric patients: Pilot data from a double-blind,randomized clinical trial

PurposeTo examine the effects of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients.MethodsThis was a double-blind, randomized controlled study of children undergoing dental procedures. Participants were randomly assigned to receive either Reiki therapy or the control therapy (sham Reiki) preoperatively. Postoperative pain scores, opioid requirements, and side effects were assessed. Family members were also asked about perioperative care satisfaction. Multiple linear regressions were used for analysis.ResultsThirty-eight children participated. The blinding procedure was successful. No statistically significant difference was observed between groups on all outcome measures.ImplicationsOur study provides a successful example of a blinding procedure for Reiki therapy among children in the perioperative period. This study does not support the effectiveness of Reiki as an adjuvant therapy to opioid therapy for postoperative pain control in pediatric patients.     

The effect of traditional wet cupping on shoulder pain and neck pain: A pilot study

ObjectivesWet cupping therapy (WCT) is a traditional complementary method recommended to decrease the symptoms of a lot of diseases and used in the treatment of pain syndromes. In this pilot study, the possible effects of wet cupping therapy on nonspecific neck and upper shoulder pain were investigated.MethodsSixty one eligible volunteer participants with nonspecific neck and upper shoulder pain for at least 3 months were allocated. The Numeric Rating Scale (NRS) was used to assess pain scores. Pain scores were recorded before and after wet cupping therapy.ResultsThe mean scores of neck pain in study group were 7.02 (SD = 1.8) before and 3.70 (SD = 2.2) after cupping therapy. The decrease of pain scores between pre- and post-test was statistically significant (p < 0.05).DiscussionIt can be stated that WCT has potential therapeutic effect in nonspecific neck and upper shoulder pain. Future full-scale randomized controlled trials will be needed to provide firm evidence of the effectiveness of this intervention.     

A randomised controlled trial evaluating the effect of immersion bath on labour pain

Objective

to evaluate the effect of an immersion bath on pain magnitude during the first stage of labour.

Design

a randomised controlled trial comparing the pain scores of bathing and non-bathing nulliparous women during birth was employed.

Setting

the study was conducted at the Normal Birth Center of Amparo Maternal, São Paulo, Brazil.

Participants

108 birthing women, with 54 women randomly assigned to each group.

Interventions

when the birthing women presented at 6–7 cm of cervical dilation, they were placed in an immersion bath for 60 mins.

Outcome measures

pain scores, using a behavioural pain scale and a numeric scale, were recorded at two evaluation time points: at 6–7 cm of cervical dilation and 1 h after the first pain score evaluation.

Findings

at the first evaluation, on the behavioural scale, the means were 2.1 for both groups (p=0.914; 95% confidence intervals (CI) 1.9–2.3 for the control group and 2.0–2.2 for the experimental group). On the numeric scale, the means were 8.7 and 8.5 for the control and experimental groups, respectively (p=0.235; 95% CI 8.2–9.2 for the control group and 8.1–8.9 for the experimental group). At the second evaluation, the pain score means for both scales were statistically higher in the control group than in the experimental group. On the behavioural scale, the scores were 2.4 vs. 1.9, respectively, for the control and experimental groups (p<0.001; 95% CI 2.2–2.6 for the control group and 1.7–2.1 for the experimental group). On the numeric scale, the scores were 9.3 vs. 8.5, respectively, for the control and experimental groups (p<0.05; 95% CI 8.9–9.7 for the control group and 8.1–8.9 for the experimental group).

Conclusions

mean labour pain scores in the control group were significantly higher than those in the experimental group. The present findings suggest that use of an immersion bath is a suitable alternative form of pain relief for women during labour.     

Clinical evaluation of early postpartum pain and healing outcomes after mediolateral versus lateral episiotomy

Objective

To evaluate short-term perineal pain among primiparous women after mediolateral episiotomy (MLE) and lateral episiotomy (LE).

Methods

The prospective randomized study was conducted in the Czech Republic during 2010–2012. Consecutive primiparous women who gave birth at or after 37 weeks of pregnancy and had indications for an episiotomy were enrolled and randomly assigned to undergo MLE or LE. Patients were unaware of the episiotomy type performed. The primary outcomes were pain at 24 hours, 72 hours, and 10 days post partum, measured by a visual analog scale, verbal rating scale, interference with activities of daily living, and amount of analgesic use.

Results

The analysis included 266 women who underwent MLE and 297 women who underwent LE. Complete relief of pain was observed in 6 (2.3%) of 266 women after 24 hours, 21 (8.0%) of 264 after 72 hours, and 77 (29.1%) of 265 after 10 days in the MLE group, and in 11 (3.9%) of 285, 23 (7.7%) of 297, and 78 (26.4%) of 295 in the LE group, respectively (P = 0.36). There were no significant differences in overall pain scores from any rating system or in the amount of analgesics used.

Conclusion

Incidence and extent of pain in the first 10 days after LE correspond to those after adequately performed MLE.     

Continuous versus interrupted sutures for repair of episiotomy or second-degree perineal tears: a randomised controlled trial

Objective  To evaluate the repair techniques of continuous and interrupted methods for episiotomy or perineal tears.
Design  A randomised controlled trial.
Setting  The Hospital Universitario Principe de Asturias, a state hospital belonging to the community of Madrid.
Sample  Four hundred forty-five women who had undergone vaginal deliveries with episiotomies or second-grade tearing of the perineum between September 2005 and July 2007.
Methods  One group was repaired with continuous, nonlocking sutures involving the vagina, perineum, and subcutaneous tissues. The other group had continuous, locking sutures of the vagina, interrupted sutures in the perineal muscles, and interrupted transcutaneous sutures. The threads used for stitching were identical in both groups.
Main outcome measures  The participants were questioned regarding the sensation of pain and the use of painkillers on the second and the tenth days, and 3 months postpartum.
Results  When comparing the group with continuous suture to the group with interrupted sutures, the differences included less repair time (1 minute; P = 0.017) and less suture material used (relative risk [RR], 3.2, 95% CI: 2.6–4.0). The comparison of pain on the second and tenth days, and 3 months postpartum were not statistically different between the two techniques (RR, 1.08, 95% CI: 0.74–1.57; RR, 0.96, 95% CI: 0.59–1.55; and RR, 0.68, 95% CI: 0.19–2.46, respectively).
Conclusions  Although we did not demonstrate that one technique was better than the other in the incidence of pain in the short or long term, we showed that episiotomy and perineal tear repairs with continuous suturing were quicker and used less suture material without an increase in complication than interrupted suturing.     

Massage as adjuvant therapy in the management of post-cesarean pain and anxiety: A randomized clinical trial

ObjectiveThe present study was conducted to determine the effect of massage on post-cesarean pain and anxiety.MethodsThe present single-blind clinical trial was conducted on 156 primiparous women undergone elective cesarean section. The participants were randomly divided into three groups, including a hand and foot massage group, a foot massage group and a control group (n = 52 per group). The patients' intensity of pain, vital signs and anxiety level were measured before, immediately after and 90 min after the massage.ResultsA significant reduction was observed in the intensity of pain immediately and 90 min after massage (P < 0.001). Moreover, changes in some of the physiological parameters, including blood pressure and respiration rate, were significant after massage (P < 0.001); however, this change was not significant for pulse rate. A significant reduction was also observed in the level of anxiety (P < 0.001) and a significant increase in the frequency of breastfeeding (P < 0.001) after massage.ConclusionAs an effective nursing intervention presenting no side-effects, hand and foot massage can be helpful in the management of postoperative pain and stress.     

Rectal analgesia for the relief of perineal pain after childbirth: a randomised controlled trial of diclofenac suppositories

OBJECTIVE: To evaluate rectal diclofenac in the relief of perineal pain after trauma during childbirth. DESIGN: A randomised, double-blind trial. SETTING: Delivery Suite, Women's and Children's Hospital, South Australia. POPULATION: Women with a second-degree (or greater) perineal tear or episiotomy. METHODS: Women were randomly allocated to either diclofenac or placebo suppositories (Anusol), using a computer-generated randomisation schedule with stratification for parity and mode of birth. Treatment packs contained two x 100 mg diclofenac or two placebo suppositories, the first being inserted when suturing was complete, and the second 12-24 hours after birth. Women were asked to complete questionnaires at 24 and 48 hours after birth relating to their degree of perineal pain using the validated Short Form McGill Pain Questionnaire. MAIN OUTCOME MEASURES: Pain scores at 24 and 48 hours after birth. RESULTS: A total of 133 women were recruited, with 67 randomised to diclofenac suppositories and 66 to placebo. Women in the diclofenac group were significantly less likely to experience pain at 24 hours while walking (RR 0.8; 95% CI 0.6 to 1.0), sitting (RR 0.8; 95% CI 0.6 to 1.0), passing urine (RR 0.6; 95% CI 0.4 to 1.0) and on opening their bowels (RR 0.6; 95% CI 0.2 to 0.9) compared with those women who received placebo. These differences were not sustained 48 hours after birth. CONCLUSIONS: The use of rectal non-steroidal anti-inflammatory drug suppositories is a simple, effective and safe method of reducing the pain experienced by women following perineal trauma within the first 24 hours after childbirth.     

Comparison of the efficacy of diclofenac and indomethacin suppositories in treating perineal pain after episiotomy or laceration: a prospective,randomized, double-blind clinical trial

Purpose  

To compare the results in terms of effectiveness, side effects, and patient satisfaction when diclofenac and indomethacin suppositories were used for the relief of perineal pain after episiotomy or tearing during childbirth.     

A randomised controlled trial of yoga for the treatment of chronic low back pain: results of a pilot study

ObjectiveTo conduct a pilot trial of yoga for the treatment of chronic low back pain (LBP) to inform the feasibility and practicality of conducting a full-scale trial in the UK; and to assess the efficacy of yoga for the treatment of chronic low back pain.DesignA pragmatic randomised controlled trial was undertaken comparing yoga to usual care.ParticipantsTwenty participants who had presented to their GP with chronic low back pain in the previous 18 months were recruited via GP records from one practice in York, UK.InterventionsTwenty patients were randomised to either 12 weekly 75-min sessions of specialised yoga plus written advice, or usual care plus written advice. Allocation was 50/50.Main outcome measuresRecruitment rate, levels of intervention attendance, and loss to follow-up were the main non-clinical outcomes. Change as measured by the Roland and Morris disability questionnaire was the primary clinical outcome. Changes in the Aberdeen back pain scale, SF-12, EQ-5D, and pain self-efficacy were secondary clinical outcomes. Data were collected via postal questionnaire at baseline, 4 weeks, and 12 weeks follow-up.ResultsOf the 286 patients identified from the GP database, 52 (18%) consented and returned the eligibility questionnaire, out of these 20 (6.9%) were eligible and randomised. The total percentage of patients randomised from the GP practice population was 0.28%. Ten patients were randomised to yoga, receiving an average of 1.7 sessions (range 0–5), and 10 were randomised to usual care. At 12 weeks follow-up data was received from 60% of patients in the yoga group and 90% of patients in the usual care group (75% overall). No significant differences were seen between groups in clinical outcomes apart from on the Aberdeen back pain scale at four weeks follow-up where the yoga group reported significantly less pain.ConclusionThis pilot study provided useful data and information to inform the design and development of a full-scale trial of yoga for CLBP in the UK. A key finding is the calculation of GP practice total list size required for patient recruitment in a full-scale trial, and the need to implement methods to increase class attendance.     

The effect of transcutaneous electrical nerve stimulation on the severity of labor pain among nulliparous women: A clinical trial

IntroductionThis study aimed to investigate the effect of transcutaneous electrical nerve stimulation on labor pain among nulliparous women referred to a hospital in an urban area of Iran.Materials and methodsSamples were consisted of 90 nulliparous women. They were randomly assigned into three groups with equal number in each groups: experiment group, placebo group and control. Pain was measured using the visual pain severity scale.FindingsThe mean of the severity of labor pain indicated a statistically significant difference after the intervention. The severity of pain indicated a statistically significant difference in the second stage of labor, and 4 h after the labor in the groups. The duration of the first stage of labor was significantly different between the groups.ConclusionThe application of transcutaneous electrical nerve stimulation affected pain relief in the first and second stages of labor and 4 h after labor.     

'Soothing the ring of fire': Australian women's and midwives' experiences of using perineal warm packs in the second stage of labour

Objective

to determine women's and midwives’ experiences of using perineal warm packs in the second stage of labour.

Design

as part of a randomised controlled trial (Warm Pack Trial), women and midwives were asked to complete questionnaires about the effects of the warm packs on pain, perineal trauma, comfort, feelings of control, satisfaction and intentions for use during future births.

Setting

two hospitals in Sydney, Australia.

Participants

a randomised controlled trial was undertaken. In the late second stage of labour, nulliparous women (n=717) giving birth were randomly allocated to having warm packs (n=360) applied to their perineum or standard care (n=357). Standard care was defined as any second stage practice carried out by midwives that did not include the application of warm packs to the perineum. Three hundred and two nulliparous women randomised to receive warm packs (84%) received the treatment. Questionnaires were completed by 266 (88%) women who received warm packs, and 270 (89%) midwives who applied warm packs to these women.

Intervention

warm, moist packs were applied to the perineum in the late second stage of labour.

Findings

warm packs were highly acceptable to both women and midwives as a means of relieving pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both midwives and women were positive about using warm packs in the future. The majority of women (85.7%) said that they would like to use perineal warm packs again for their next birth and would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of routine care in the second stage of labour.

Key conclusions

responses to questionnaires, eliciting experiences of women and midwives involved in the Warm Pack Trial, demonstrated that the practice of applying perineal warm packs in the late second stage of labour was highly acceptable and effective in helping to relieve perineal pain and increase comfort.

Implications for practice

perineal warm packs should be incorporated into second stage pain relief options available to women during childbirth.     

Effects of low-power laser auriculotherapy on chronic spinal pain: Randomized clinical trial

Aims and objectivesTo evaluate the effect of laser auriculotherapy on chronic spinal pain. It is a randomized controlled clinical trial. Methods: Volunteers with chronic spinal pain underwent three evaluations: an initial evaluation, a final evaluation immediately after the last intervention session, and a 15-day follow-up. Pain intensity, nociceptive threshold in relation to mechanical stimulus, and degree of pain (the greatest and least pain) in the last seven days were the assessed variables. The experimental group (EG, n = 24) underwent 10 sessions of laser auriculotherapy twice a week, while the control group (CG, n = 23) did not receive any intervention.ResultsThe EG showed great clinical improvement in relation to the variable pain intensity between pre- and post-interventions (65.2%) and pre-intervention and follow-up (58.62%) compared to the CG. There was a significant increase in the nociceptive threshold for the EG. In contrast, the CG showed a significant reduction in the nociceptive threshold. The intergroup analysis indicated an improvement in pain intensity for the EG (0.006). This result remained at the follow-up (0.012). The nociceptive threshold increased over time for the EG (0.016). In contrast, the CG showed a reduction in this variable with a significant difference over time (<0.001).ConclusionThe results of this clinical trial suggest that the proposed intervention may be effective in reducing pain intensity and increasing the nociceptive threshold. The effect of the intervention remained 15 days after the end of the treatment, when the volunteers were re-evaluated.     

The effect of acupressure applied to points LV4 and LI4 on perceived acute postpartum perineal pain after vaginal birth with episiotomy: a randomized controlled study

Archives of Gynecology and Obstetrics - Acupressure can be used for alleviating perineal pain sustained after a vaginal birth with episiotomy. To evaluate if a 10-min acupressure application...     

Effects of birth ball exercise on pain and self-efficacy during childbirth: a randomised controlled trial in Taiwan

Objectives: to examine the effectiveness of a birth ball exercise programme during childbirth by measuring childbirth self-efficacy and childbirth pain. In addition, it tested the mediating effects of childbirth self-efficacy on the relationship between the birth ball exercise programme and childbirth pain.Design: randomised controlled trial.Participants and setting: the study was conducted from December 2008 to November 2009, at two birth units, one at a regional hospital and one at a medical centre, with 600 and 1022 annual births, respectively. One hundred and eighty-eight expectant mothers were recruited (recruitment rate: 47%) and were allocated by block randomisation into the two arms of the study, but only 48 intervention and 39 control group participants completing the trial.Interventions: the birth ball exercise programme consisted of a 26-page booklet and a 19-minute videotape, with periodic follow-ups during prenatal checks. All members of the experimental group were asked to practise the exercises and positions at home for at least 20 minutes three times a week for a period of 6–8 weeks. Each woman in the experimental group was given a birth ball for use during labour and encouraged every hour to choose the most comfortable positions, movements, and exercises. Both the experimental and control groups received standard nursing and midwifery care from hospital staff nurses in all aspects of pregnancy and childbirth.Measurement and findings: when cervical dilations were four centimetres and eight centimetres, the women completed demographic and obstetrics information, the Childbirth Self-efficacy Inventory (CBSEI), and the short form of the McGill Pain Questionnaire (SF-MPQ). Our study revealed that birth ball exercises provided statistically significant improvements in childbirth self-efficacy and pain. Specifically, self-efficacy had a 30–40% mediating effect on relationships between birth ball exercises and childbirth pain. Mothers in the experimental group had shorter first-stage labour duration, less epidural analgesia, and fewer caesarean deliveries than the control group.Conclusions and implications for practice: clinical implementation of the birth ball exercise programme could be an effective adjunctive tool to improve childbirth self-efficacy and reduce pain among women in labour. On the basis of our mediating model, the results further suggest that confidence is greater after prenatal preparation powerfully related to decreased pain perception and decreased medication/analgesia use during labour.     

Topical lidocaine-prilocaine cream versus lidocaine infiltration for pain relief during repair of perineal tears after vaginal delivery: randomized clinical trial

Objective: The current study aims to compare the analgesic effect of lidocaine-prilocaine (LP) cream with lidocaine infiltration during repair of perineal tears after vaginal delivery.

Materials and methods: A single center open-labeled randomized clinical trial was carried out in a tertiary University Hospital between October 2016 and May 2017 (Clinical Trials.Gov: NCT02883179). We included parous women, who delivered at gestational age >37 weeks with first- or second-degree perineal tears. The participants were randomized in a 1:1 ratio to either lidocaine infiltration (Group I); or application of LP cream (Group II) for pain relief during perineal repair. The primary outcome was the difference in mean pain score during perineal repair. Secondary outcomes included the participants’ satisfaction, the need for additional anesthesia, the duration of perineal repair, and the rate of adverse effects of both medications.

Results: The study included 144 participants randomized to both groups. The mean pain score during perineal repair was significantly lower in the LP cream group (3.86?±?1.59) than the lidocaine infiltration group (5.99?±?1.47) [p?=?.001]. The duration of repair was significantly shorter in the LP group than the lidocaine infiltration group (6.37?±?3.68 versus 8.17?±?2.75?min, respectively, p?=?.001). The need for additional anesthesia was quite similar in both groups (p?=?.371). More women in the LP cream group were satisfied than the other group with statistical significant difference (76.4 versus 30.6%, p?=?.000). No difference between side effects in both groups (p?=?.171)

Conclusions: Topical application of lidocaine-prilocaine cream is an effective analgesic during repair of perineal tears with no harmful side effects.     

The effect of Swedish massage on pain in rheumatoid arthritis patients: A randomized controlled trial

Background and PurposeJoint pain is one of the most common symptoms in rheumatoid arthritis patients and require medical attention. The purpose of this study was to assess the effects of Swedish massage on pain and painkiller consumption in rheumatoid arthritis patients.Materials and methodsA total of 60 patients participated in the experiment, with half assigned to the control group (n = 30) and half to the experimental (n = 30) group using the block randomization method. On patients in the experimental group, a 30-min Swedish massage was performed regularly for eight weeks: twice a week for the first four weeks, and three times a week for the last four weeks. The control group received routine care. The visual analogue scale-pain was used to measure pain in the two groups at three points of time: before the beginning of the experiment, immediately after the last session, and one month after the last session of the intervention.ResultsThe analysis of covariance showed that there were significant differences between the two groups’ mean scores of pain and painkiller consumption immediately after and one month after the last session of the intervention (p = 0.01). Furthermore, in the experimental group, the mean scores of pain and painkiller consumption decreased over the three points of time (p < 0.05).ConclusionSwedish massage can be effective in reducing pain and the need to use painkillers in rheumatoid arthritis patients.