When analgesics are not enough for postpartum perineal pain—a scoping review of the non-pharmacological, conservative therapies

Postpartum perineal pain affects up to 90% of women, with 37% reporting moderate to severe pain. Assisted delivery, episiotomy, and lacerations increase pain and medication use. Management includes pharmacological treatments like paracetamol, opioids, and non-steroidal anti-inflammatory drugs, alongside non-pharmacological methods such as thermotherapy, light therapy, electrotherapy. Many of these approaches need further research to confirm their effectiveness. This study aimed to identify and map the current evidence on the effects of non-pharmacological, conservative therapies in managing early postpartum perineal pain. Electronic databases: PubMed, EBSCO, CINAHL, Ovid, and Google Scholar were searched from May 2012 to February 2025. The PICO framework was used as recommended. The National Heart, Lung, and Blood Institute (NHLBI) Study Quality Assessment Tools were used to summarize and critically analyze the collected data. Several methodologies were embraced, including 27 randomized controlled trials, 3 randomized pilot studies, 4 pre-post studies, and 1 case-series study. Light therapy was examined in five studies on low-level laser therapy and on far-infrared radiation, most showing no superiority over placebo or no treatment. Eight studies supported cold therapy for short-term pain relief, though protocols varied. Two studies found heat therapy during labor to be effective short-term, while two low-quality observational studies examined water immersion. One study combining cold, heat, and pelvic floor muscle training showed significant benefits for up to seven days. Two randomized controlled trials on radiofrequency showed reduced perineal pain and discomfort in certain positions. Four trials on transcutaneous electrical nerve stimulation demonstrated its superiority over placebo despite varying protocols. One low-quality study on manual therapy had unclear results. Seven acupuncture and acupressure trials had poor to fair quality, with mixed findings on pain relief and medication use. One study found ultrasound with gel pads more effective than gel pads and laser therapy. No studies have explored pelvic floor muscle training for postpartum pain relief. This review highlights emerging evidence supporting conservative, non-pharmacological methods for perineal pain management, particularly cold therapy, transcutaneous electrical nerve stimulation, and radiofrequency. However, due to the limited number of robust studies, these findings should be approached cautiously. There is a clear need for standardized protocols to guide clinical recommendations.