C20—Pain Management
A Novel Approach in the Management of Post-Episiotomy Pain
Yisroel Grabie, OMS II1; Zara Jamil, OMS II1; Joseph Schwob, OMS II1; Boris Petrikovsky, MD, PhD1; Arkady Uryash, MD, PhD1
1New York Institute of Technology College of Osteopathic Medicine
2Garden OB/GYN
3Mount Sinai Medical Center
Statement of Significance: The first tenet of osteopathic medicine states: “The body is a unit the person is a unit of body, mind, and spirit.” Given that childbirth is a traumatic event for the mother, in addition to the fact that postpartum depression rates are considerable, it seems valuable to explore novel pain management resources using the osteopathic holistic philosophy for the treatment of postepisiotomy pain. It is our belief that in treating a mother's perineal pain, we may also improve her overall mind and spirit enhancing her wellbeing.
Methods: This pilot study was conducted in an outpatient obstetrics clinic located in Miami, F.L. involving postpartum women between the ages of 18-39 years of age, who underwent vaginal delivery with episiotomy. Spray bottles with the investigational product were distributed to the patients to manage their pain freely without regulation. A survey to assess postepisiotomy pain using the Visual Analog Scale (VAS) was administered to the patients. Pain attenuation, time to pain attenuation, and quality of pain were measured
Data Analysis: Analysis of this preliminary study indicates that Relivatrol© significantly reduced postepisiotomy pain. We are currently in the process of replicating this study on a larger scale in order to address limitations inherent to the study's design.
Results: The cohort consisted of 25 postpartum women. Of note, there were 5 women who did not respond to the treatment. The investigational product attenuated pain by an average of 3.2 scale units. Additionally, in a subgroup analysis of the “responders”, pain was attenuated by 4.0 scale units. Pre-administration pain quality was reported as sharp (n=12), achy (n=6), and dull (n=5). In the participants who responded to treatment, the average time to analgesia was reported to be 9.25 Average pain ratings after treatment were compared with average pain ratings before treatment using a unidirectional paired sample t test (df=24). The average pain ratings for the entire cohort (including non-responders) after administration of Relivatrol© were significantly lower than average pain rating prior to administration t(24)=7.41, P<.0001.
Conclusion: We concluded that Relivatrol© significantly decreases postepisiotomy pain. Since this pilot study had multiple limitations, we developed a protocol for a larger investigation involving a greater number of participants, a control arm, pharmacokinetic parameters, and an analysis of quality of life impact.
Acknowledgment/Funding Source: None reported.
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