Discussion Five-Element Music Combined With Electroacupuncture Produce Analgesic Effects On Labor Pain Based On MAPK/ERK Signaling Pathway

Objective:To investigate mechanism through which five-element music combined with electroacupuncture(EA)produce analgesic effects on labor pain based on MAPK/ERK signaling pathway by molecular biology,and provide a scientific basis for labor analgesia in five-element music combined with electroacupuncture.Methods:A total of 240 primiparous women in the start of first stage of labor was assigned to four experimental groups randomly and equally,60 cases in each group.Effects of labor pain management,labor time,blood loss within 2 hours post-partum,neonatal Apgar score and umbilical cord blood gas analysis were evaluated.In addition,mRNA and protein levels of C-Raf,P-ERK,P-CREB and dynorphin(DYN)in placenta were tested by real-time PCR and western blotting.Before any treatment and when the cervical dilatation is 3 and 10 cm,blood samples were collected in ulnar vein and serum concentration of DYN were examined by ELISA.All the experimental data were processed by SPSS20.0 statistical analysis software.Results:(1)In first-stage of labor,time of EA group,five-element music+EA group and drug analgesia group are all shorter than control group(P<0.01).With respect to second and third-stage of labor,control group and drug analgesia group took longest time,followed by EA group and five-element music+EA group(P<0.01).(2)In the comparison of effective rate among groups at one hour after treatment,drug analgesia group is the highest,followed by five-element music+EA group,EA group and control group.Nevertheless,when cervical os dilated to 8cm,five-element music+EA group is the highest,followed by EA group,control group and drug analgesia group.(3)Compared with control group and drug analgesia group,EA group and five-element music+EA group suffered less sever blood loss within 2 hours post-partum(P<0.01).(4)Before treatment,serum concentration of DYN between groups show no difference.After treatment,serum concentration of DYN are significantly different between groups(P<0.01),sorted by concentration in descending order: drug analgesia group and five-element music+EA group,EA group,control group.(5)The m RNA levels of C-Raf,phosphorylated ERK and CREB in placenta were significantly reduced in EA group,five-element music+EA group and drug analgesia group than those in control group(P<0.01).mRNA levels of DYN of placenta were remarkably increased in EA group than that of control group(P<0.01),sorted by expression level in descending order: drug analgesia group and five-element music+EA group,EA group,control group.(6)The protein levels of C-Raf,phosphorylated ERK and CREB in placenta were significantly reduced in EA group,five-element music+EA group and drug analgesia group than those in control group(P<0.01).mRNA levels of DYN of placenta were remarkably increased in EA group than that of control group(P<0.01)(7)Apgar scores of 1 and 5min after birth significantly differed between groups(P<0.01).Groups were sorted by Apgar score in ascending order: control group/drug analgesia group,EA group,five-element music+EA group.Apgar scores of 10 min after birth showed no difference between groups.(8)Umbilical cord blood gas analysis revealed that,in EA group and five-element music+EA group,PH and PO2 increased markedly while PCO2 decreased dramatically,compared with control group(P<0.01).However,there is no difference between drug analgesia group and control group in PH,PO2 and PCO2.Conclusions:Five-element music combined with EA may have analgesic effects on labor pain,reduce labor time and blood loss within 2 hours post-partum,increase Apgar scores of 1 and 5min,and raise blood oxygen level of infant.Additionally,five-element music combined with EA could attenuate phosphorylation of C-Raf,ERK and CREB,and thus increase mRNA and protein levels of DYN in placenta and mRNA level of DYN in serum,indicating negative correlation between activation of ERK signaling and DYN.In summary,five-element music combined with EA may produce analgesic effects on labor pain by regulating ERK-mediated DYN secretion.