The Effect of 3-Liver Pressure Point on Postpartum Severity of Pain: randomized clinical trial

Document Type : Original Article


1 M.Sc. Student of Midwifery, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Acupuncturist, Iranian Acupuncture Association, Tehran, Iran.

3 PhD Student of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Assistant Professor, Department of Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Associate Professor, Department of Obstetrics & Gynecology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

6 Assistant Professor, Department of Gynecology Laparoscopy Surgery, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

7 Associate Professor, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.


Introduction: Controlling postpartum pain affects maternal care of baby and mother's return to normal life. Studies have shown the effect of pressure on the 3- liver point in reducing uterine-induced pain, such as menstrual pain. Therefore, this study was performed with aim to evaluate the effect of 3-liver pressure point on postpartum severity of pain.
Methods: This controlled randomized clinical trial study was performed on 150 mothers who had normal delivery and complained of postpartum pain in the postpartum ward of Shahid Sadoughi Hospital in Yazd in 2017-2018. Mothers were randomly divided into three groups of 3-liver pressure point (n=50), Sham group (n=50) and Ibuprofen group (n=50). All three groups received oral Ibuprofen 400 mg every 6 hours up to 24 hours if they had moderate or severe pain. In the 3-liver pressure point group (intervention group), the pressure was applied to the 3-liver point for 10 minutes on each foot, and in the Sham group, the same pressure was applied to the ectopic point. The Control group received medication only (routine care). Pain was measured every 6 hours before, 30 and 120 minutes after each intervention. Data analysis was performed using SPSS software (version 16) and tests of Chi-square, Friedman, Kruskal Wallis, Wilcoxon, and GEE)Generalized Estimation Equations (. P<0.05 was considered statistically significant.
Results: The postpartum pain severity after the intervention were statistically significantly different in each group (p <0.001). The mean of postpartum pain severity decreased as 0.34 over time. The mean pain score in the 3-liver point group was 0.8±0.23 lower than the control group (p=0.001). The mean pain score in the 3-liver point group was 0.0±64.3 lower than the sham group (p = 0.035). But there was no significant difference between the sham and control groups (p = 0.468).
Conclusion: Acupressure at 3-liver point is effective in relieving postpartum pain and it can be used like other pressure points affecting postpartum pain.


  1. Deussen AR, Ashwood P, Martis R. Analgesia for relief of pain due to uterine cramping/involution after birth.  Cochrane Database Syst Rev 2011; (5):CD004908.
  2. Dennis CL, Jackson K, Watson J. Interventions for treating painful nipples among breastfeeding women. Cochrane Database Syst Rev 2014.
  3. Petrenko N. Postpartum Physiology. Nursing care of the Postpartum Woman. Transition to parenthood [online] 2012; [Cited 2016 June 6]; Available at: URL:
  4. Doumouchtsis SK, Arulkumaran SS. Emergencies in Obstetrics and Gynaecology. 2nd ed. London, UK: Oxford Univ Press; 2016.
  5. Wen L, Hilton G, Carvalho B. The impact of breastfeeding on postpartum pain after Vaginal and cesarean delivery. J Clin Anesth 2015; 27(1):33-8.
  6. Holdcroft A, Snidvongs S, Cason A, Doré CJ, Berkley KJ. Pain and uterine contractions during breast feeding in the immediate post-partum period increase with parity. Pain 2003; 104(3):589-96.
  7. ACOG Committee Opinion No. 742: Postpartum Pain Management. Obstet Gynecol 2018; 132(1):e35-e43.
  8. Jangsten E, Bergh I, Mattsson LÅ, Hellström AL, Berg M. Afterpains: a comparison between active and expectant management of the third stage of labor. Birth 2011; 38(4):294-301.
  9. Karlström A, Nystedt A, Hildingsson I. The meaning of a very positive birth experience: focus groups discussions with women. BMC Pregnancy Childbirth 2015; 15(1):251.
  10. Cunningham FG, Leveno KJ, Bloom SL, Spong CY, Dashe JS. Williams obstetrics. 24nd ed. New York: McGraw-Hill; 2014.
  11. Golalipour MJ, Ghafari S. Purkinje cells loss in off spring due to maternal morphine sulfate exposure: a morphometric study. Anatomy & cell biology 2012; 45(2):121-7.
  12. Eisenach JC, Pan PH, Smiley R, Lavand’homme P, Landau R, Houle TT. Severity of acut pain after childbirth, but not type of delivery, predicts persistent pain and postpartum depression. Pain 2008; 140(1):87-94.
  13. Petersen MR. Review of interventions to relieve postpartum pain from perineal trauma. MCN Am J Matern Child Nurs 2011; 36(4):241-5.
  14. Dijkers M. Comparing quantification of pain severity by verbal rating and numeric rating scales. J Spinal Cord Med 2010; 33(3): 232-42.
  15. Ogunfowokan AA, Babatunde OA. Management of primary dysmenorrhea by school adolescents in ILE-IFE, Nigeria. J Sch Nurs 2010; 26(2):131-6.
  16. Bar-Oz B, Bulkowstein M, Benyamini L, Greenberg R, Soriano I, Zimmerman D, et al. Use of antibiotic and analgesic drugs during lactation. Drug Saf 2003; 26(13):925-35.
  17. Sutton CD, Carvalho B. Optimal pain management after cesarean delivery. Anesthesiol Clin 2017; 35(1):107-124.
  18. Valentine AR, Carvalho B, Lazo TA, Riley ET. Scheduled acetaminophen with as-needed opioids compared to as-needed acetaminophen plus opioids for post-cesarean pain management. Int J Obstet Anesth 2015; 24(3):210-6.
  19. Ellfolk M, Hultzsch S, Merlob P, Weber-Schoendorfer C, Padberg S, Lawrence RA, et al. Specific drug therapies during lactation. Drugs during pregnancy and lactation: treatment options and risk assessment. 3nd ed. Academic Press; 2015. p. 651-861.
  20. Spigset O, Hägg S. Analgesics and breast-feeding: safety considerations. Paediatr Drugs 2000; 2(3):223-38.
  21. Sachs HC, Committee On Drugs. The transfer of drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics 2013; 132(3):e796-809.
  22. Drugs and Lactation Database (LactMed) [Internet]. Bethesda (MD): National Library of Medicine (US); 2006-. Brompheniramine. [Updated 2018 Oct 31]. Available from:
  23. Conrad P, Adams C. The effects of clinical aromatherapy for anxiety and depression in the high risk postpartum woman - a pilot study. Complement Ther Clin Pract 2012; 18(3):164-8.
  24. Maa SH, Tsou TS, Wang KY, Wang CH, Lin HC, Huang YH. Self‐administered acupressure reduces the symptoms that limit daily activities in bronchiectasis patients: pilot study findings. J Clin Nurs 2007; 16(4):794-804.
  25. Demir Y. Non-Pharmacological Therapies in Pain Management, Pain Management - Current Issues and Opinions, Gabor B. Racz and Carl E. Noe, IntechOpen. DOI: 10.5772/30050. Available from:; 2012.
  26. Carotenuto M, Esposito M. Nutraceuticals safety and efficacy in migraine without aura in a population of children affected by neurofibromatosis type I. Neurol Sci 2013; 34(11):1905-9.
  27. Deng SZ, Zhao XF, Huang LH, He S, Wen Y, Zhang C, et al. The quantity-effect relationship and physiological mechanisms of different acupuncture manipulations on posterior circulation ischemia with vertigo: study protocol for a randomized controlled trial. Trials 2015; 16(1):152.
  28. Bernardo-Filho M, de Sá-Caputo Dda C, Marin PJ, Chang S. The mechanism of auriculotherapy: a case report based on the fractal structure of meridian system. Afr J Tradit Complement Altern Med 2014; 11(3):30-7.
  29. Ezadi H, Geranmay M, Taebi NS. Effect of acupressure of Xue Hai point on severity of pain in primary dysmenorrhea. Horizon Med Sci 2016; 22(4):359-63. )Persian(.
  30. Bazarganipour F, Taghavi SA, Allan H, Hosseini N, Khosravi A, Asadi R, et al. A randomized controlled clinical trial evaluating quality of life when using a simple acupressure protocol in women with primary dysmenorrhea. Complement Ther Med 2017; 34:10-15. )Persian(.
  31. Soltani M, Azhari S, Khorsand Vakilzadeh A, Tara F, Mazloum SR. The effect of acupressure on uterine tone and pain after delivery. Iran J Obstet Gynecol Infertil 2017; 20(9):91-100. )Persian(.
  32. Afravi S, Abbaspoor Z, Montazeri S, Cheraghian B. The effect of Hugo point pressure on postpartum pain in multiparous women. Fam Med Prim Care Rev 2019; 21(1):7-11. )Persian(.
  33. Rostami U, Heshmat R. Acupuncture & moxibustion in family fertility health & infertility treatment. 2nd ed. Tehran: Teimourzadeh; 2008. p. 69-115. (Persian).
  34. Mansouri E, Kordi M, Badiee Aval Sh, Shakeri MT, Mirteimouri M. Comparison of the effect of pressure on bladder-GV20 and gallbladder-GV20 points on the ability to cope with labor pain among the primiparous women: A randomized clinical trial. Iran J Obstet Gynecol Infertil 2018; 21(10):38-47. )Persian.(
  35. Ganji Gh, Keramat A, Ahmad Shiravani M. Effect of acupressure on labor pain relief: a systematic review of clinical trials. Iran J Obstet Gynecol Infertil 2014; 17(119):8-17. )Persian).
  36. Gharloghi Sh, Tork Zahrani Sh, Heshmat R, Akbarzade A. The effects of acupressure points in SP6 and SP8 on primary dysmenorrhea. J Kermanshah Univ Med Sci 2011; 15(4):245-250.)Persian.(
  37. Ghiasi A, Keramat A, Mollaahmadi L, Hashemzadeah M, Bagheri L. The effect of acupressure at the Sanyinjiao (SP6) point on relief of primary dysmenorrhea: a systematic review of clinical trials. Iran J Obstet Gynecol Infertil 2017; 19(40):55-68. )Persian.(
  38. Yaghobinejad A, Amir Ali Akbari S, Alavimajd H, Heshmat R. The effect of SP6 moxibustion and acupressure on the severity of systemic symptoms associated with dysmenorrhea. Iran J Obstet Gynecol Infertil 2017; 20(3):57-67. )Persian(.
  39. Kafaei-Atrian M, Mirbagher-Ajorpaz N, Sarvieh M, Sadat Z, Asghari-Jafarabadi M, Solhi M. The effect of acupressure at third liver point on the anxiety level in patients with primary dysmenorrhea. Iran J Nurs Midwifery Res 2016; 21(2):142-6. (Persian).
  40. Akhavan Amjadi M, Shahbazzadegan S, Shakiba M. Comparison of acupressure effect on two points, Sanyinjiao versus Tai Chong, on primary Dysmenorrhea. J Ardabil Univ Med Sci 2015; 15(1):97-106. (Persian).
  41. Chen HM, Chen CH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs 2004; 48(4): 380-7.
  42. Bazarganipour F, Lamyian M, Heshmat R, Abadi MAJ, Taghavi A. A randomized clinical trial of the efficacy of applying a simple acupressure protocol to the Taichong point in relieving dysmenorrhea. Int J Gynaecol Obstet 2010; 111(2):105-9. )Persian(.
  43. Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken) 2011; 63(S11):S240-52.
  44. McCaffery M, Beebe A. Managing your patients' adverse reactions to narcotics. Nursing 1989; 19(10):166-8.
  45. Sadeghi SM, Bozorgzad P, Ghafourian AR, Ebadi A, Razmjouei N, Afzali M, et al. Effect of foot reflexology on sternotomy pain after coronary artery bypass graft surgery. Iranian journal of critical care nursing 2009; 2(2):51-54.
  46. Lin JA, Wong CS, Lee MS, Ko SC, Chan SM, Chen JJ, et al. Successful treatment of primary dysmenorrhea by collateral meridian acupressure therapy. J Manipulative Physiol Ther 2010; 33(1):70-5.
  47. Habek D, Habek JČ, Barbir A. Using acupuncture to treat premenstrual syndrome. Arch Gynecol Obstet 2002; 267(1): 23-6.
  48. Kim SY, Park HJ, Lee H, Lee H. Acupuncture for premenstrual syndrome: a systematic review and meta‐analysis of randomised controlled trials. BJOG 2011; 118(8): 899-915.