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Ci-dessous, les différences entre deux révisions de la page.

--- acupuncture:evaluation:gyneco-obstetrique:03. dysmenorrhees [11 Dec 2020 18:44]
Nguyen Johan Replacement automatique de '=== Implantation de catgut ===' par '=== Catgut Embedding ==='
+++ acupuncture:evaluation:gyneco-obstetrique:03. dysmenorrhees [29 Oct 2025 14:20] (Version actuelle)
Nguyen Johan [1.2.6. Acupression]
@@ Ligne 1: / Ligne 1: @@
+/*English:Dysmenorrhoea*/
+====== dysmenorrhoea: ======
 ====== Dysménorrhées : évaluation de l'acupuncture ======
@@ Ligne 5: / Ligne 8: @@
 ===== Systematic Reviews and Meta-Analysis =====
-| ☆☆☆ | Evidence for effectiveness and a specific effect of acupuncture |
-| ☆☆ | Evidence for effectiveness of acupuncture |
-| ☆ |Limited evidence for effectiveness of acupuncture |
-| Ø |No evidence or insufficient evidence |
 ==== Generic Acupuncture ====
+=== Liu 2025 (Network Meta-Analysis) ===
+Liu J, Wang Y, Zhang J, Fan X, Chen H, Zuo G, Wang X, She Y. Efficacy and Safety of Non-Pharmacological Therapies for Primary Dysmenorrhea: A Network Meta-Analysis. J Pain Res. 2025 Feb 27;18:975-991.  https://doi.org/10.2147/JPR.S498184
+^Backgound| This network meta-analysis (NMA) aimed to explore the impact of Non-pharmacological therapies (NPT) on alleviating primary dysmenorrhea (PD) symptoms and assess the effectiveness differences among various NPT.|
+^Methods| We searched seven databases and summarized clinical trials of PD treated with NPT from inception to September 6, 2023. Randomized controlled clinical trials (RCTs) of PD treated with NPT. The outcomes were the Visual Analog Scale (VAS), the Cox menstrual symptom scale (CMSS), and response rate. Quality was assessed using the Cochrane risk of bias assessment tool. Pairwise meta-analysis and network meta-analysis (NMA) was performed by RevMan (5.4), Stata (15.0), and WinBUGS (1.4.3). The ranking probabilities for all treatment interventions were performed using the Surface Under the Cumulative Ranking curve (SUCRA).|
+^Results| A total of **16 RCTs** were finally included, involving 8 kinds of NPT. Results of pairwise meta-analyses: For the VAS score results, moxibustion (SMD: -0.591,95% CI: -0.916, -0.266) was more effective than acupuncture, acupuncture (SMD: -0.948,95% CI: -1.853, -0.044) was more effective than placebo, and yoga (SMD: 2.634,95% CI: -4.28, -0.988) was more effective than the blank control. NMA results: Compared to the blank control, acupuncture (SMD: -4.81; 95% CI: -6.63, -3.00), auricular point therapy (SMD: -4.36; 95% CI: -7.18, -1.60), yoga (SMD: -2.12; 95% CI: -3.13, -1.09), moxibustion (SMD:5.54; 95% CI: 3.33, 7.68), and placebo (SMD: 3.10; 95% CI: 1.03, 5.27) proved to be a superior reduction in VAS. The use of acupressure (SMD: 2.49; 95% CI: 0.03, 5.03), moxibustion (SMD: -2.45; 95% CI: -4.06, -0.71), and acupuncture (SMD: -1.72; 95% CI: -2.75, -0.56) demonstrated a greater decrease in VAS efficacy than placebo. The consolidated ranking outcomes indicate that moxibustion, acupuncture, and auricular acupoint therapy occupy high SUCRA positions across various outcome metrics.|
+^Conclusion| **Acupuncture, moxibustion and auricular point** may be the best treatment for PD. In the future, more trials are needed to obtain higher-quality evidence and the best protocols.|
+=== Liu 2022 ★★===
+Liu W, Wang CC, Lee KH, Ma X, Kang TL. Efficacy and Safety of Acupuncture and or Moxibustion for Managing Primary Dysmenorrhea: A Systematic Review and Meta-Analysis. Clin Nurs Res. 2022 Sep;31(7):1362-1375.  https://doi.org/10.1177/10547738221086984. Epub 2022 May 2.
+^Background| Acupuncture and moxibustion have been accepted as add-on options for primary dysmenorrhea (PD); however, the clinical evidence is still inadequate. |
+^Methods| We searched AMED, CENTRAL, EMBASE, PubMed, Web of Science, CBM, CNKI, VIP, Wangfang database, ANZCTR, ClinicalTrials.gov, and the WHO ICTRP, from their inception to February 2021. |
+^Results| The pooled analysis of **13 RCTs with 675 participants** for VAS showed that acupuncture and moxibustion were more effective in managing PD than the control group with the MD of -1.93 (95% CI [-2.80, -1.06] and -2.67 (95% CI [-4.96, -0.38]). With the CMSS, seven studies with 487 participants showed that these modalities were more effective than the control group with the MD of -7.58 (95% CI [-10.97, -4.19]) and -3.78 (95% CI [-6.90, -0.66]). |
+^Conclusions| The findings indicated that acupuncture and moxibustion could relieve pain effectively and has fewer adverse events (AEs) in managing PD. |
+=== Yang 2020 (Versus Western Medication) ☆ ===
+Yang Jun, Xiong Jun, Yuan Ting, et al. [Efficacy of Acupuncture-moxibustion Versus Western Medication for Primary Dysmenorrhea: A Meta-analysis]. Shanghai Journal of Acupuncture and Moxibustion. 2020;39(10):1339.   [214569].
+^Objective | To systematically evaluate the clinical efficacy of acupuncture-moxibustion and Western medication in treating primary dysmenorrhea. |
+^ Method | A comprehensive retrieval was conducted through the Chinese Biomedical database (CBM), China National Knowledge Infrastructure (CNKI), VIP database (VIP), Wanfang database (WF), Pubmed, Embase and Cochrane Library by computer, assisted by manual retrieval through the relevant journals and references, to collect randomized controlled trials (RCTS) comparing acupuncture-moxibustion with Western medication in treating primary dysmenorrhea. The Jadad scale and Cochrane bias risk assessment tool were used for quality evaluation. The statistician performed meta-analysis with RevMan 5.3 software. |
+^ Result|**Forty-two studies** were included, including a total of **3179 participants**. There were 7 studies (1 6.67%) scored) 4 points by the Jadad scale. The studies were evaluated as high risk in the performance of blinding, with other potential bias, and the randomized allocation and concealment were assessed as unclear. The meta-analysis showed that there was statistical significant comparing the total effective rate between the acupuncture-moxibustion group and the Western medication group [RR=1.22, 95%CI (1.16,1.29), Z=7.86]. The funnel plot showed possible publication bias. There was statistical significance comparing the real-time efficacy between the acupuncture-moxibustion group and the Western medication group [RR=1.25, 95%CI (1.08,1.45), Z=2.95]. There was no statistical significance comparing the long-term efficacy between the acupuncture-moxibustion group and the Western medication group [RR= 1 .34, 95%CI (0.93, 1 .94), Z=1 .57]. The relapse rate in the acupuncture-moxibustion group was significantly different from that in the Westem medication group [RR=0.28, 95%CI (0. 1 5,0.5 1), Z=4. 1 3]. There was statistical significance comparing the VAS score between the acupuncture-moxibustion group and the Westem medication group [WMD= - 2.58, 95%CI (- 3.88, - 1.29), Z=3.91]. The general score of dysmenorrhea symptoms in the acupuncture-moxibustion group was significantly different from that in the Western medication group [WMD= - 2.58, 95%CI ( - 3.88, - 1.29), Z=3.91]. |
+^Conclusion | Compared with Western medication, acupuncture-moxibustion shows significant advantage in treating primary dysmenorrhea, but RCTs with large sample size, multiple centers and high quality are required for in-depth study and observation considering the included low-quality studies currently. |
 === Luo 2019 (versus NSAIDs) ☆ ===
@@ Ligne 50: / Ligne 75: @@
 ^ Conclusion |The included 6 kinds of acupunctures are superior to ibuprofen and different acupunctures have different advantages in the treatment of PD. When selecting treatment regimen, it is better to consider the clinical situation and TCM syndrome differentiation|.
-=== Xu 2017 (versus AINS) ☆☆ ===
+=== Xu 2017 (versus NSAIDs) ☆☆ ===
@@ Ligne 88: / Ligne 113: @@
-=== Jung 2015 (littérature coréenne) ===
+=== Jung 2015 (Korean Literatures) ===
@@ Ligne 210: / Ligne 235: @@
 </wrap>
 ==== Special Acupuncture Techniques ====
+=== Sham acupuncture ===
+== Sun 2023 ==
+Sun CY, Xiong ZY, Sun CY, Ma PH, Liu XY, Sun CY, Xin ZY, Liu BY, Liu CZ, Yan SY. Placebo response of sham acupuncture in patients with primary dysmenorrhea: A meta-analysis. J Integr Med. 2023 Sep;21(5):455-463.  https://doi.org/10.1016/j.joim.2023.08.005
+^Background|The placebo response of sham acupuncture in patients with primary dysmenorrhea is a substantial factor associated with analgesia. However, the magnitude of the placebo response is unclear.|
+^Objective|This meta-analysis assessed the effects of sham acupuncture in patients with primary dysmenorrhea and the factors contributing to these effects.|
+^Methods| Search strategy: PubMed, Embase, Web of Science, and Cochrane CENTRAL databases were searched from inception up to August 20, 2022. Inclusion criteria: Randomized controlled trials (RCTs) using sham acupuncture as a control for female patients of reproductive age with primary dysmenorrhea were included. Data extraction and analysis: Pain intensity, retrospective symptom scale, and health-related quality of life were outcome measures used in these trials. Placebo response was defined as the change in the outcome of interest from baseline to endpoint. We used standardized mean difference (SMD) to estimate the effect size of the placebo response.|
+^Results| **Thirteen RCTs** were included. The pooled placebo response size for pain intensity was the largest (SMD = -0.99; 95% confidence interval [CI], -1.31 to -0.68), followed by the retrospective symptom scale (Total frequency rating score: SMD = -0.20; 95% CI, -0.80 to -0.39. Average severity score: SMD = -0.35; 95% CI, -0.90 to -0.20) and physical component of SF-36 (SMD = 0.27; 95% CI, -0.17 to 0.72). Studies using blunt-tip needles, single-center trials, studies with a low risk of bias, studies in which patients had a longer disease course, studies in which clinicians had < 5 years of experience, and trials conducted outside Asia were more likely to have a lower placebo response.|
+^Conclusion| Strong placebo response and some relative factors were found in patients with primary dysmenorrhea. |
+=== Comparison of Acupuncture techniques ===
+== Chen B 2024 ==
+Chen B, Liu S, Jin F, Li T, Yang N, Xu Y, Hu J, Jiang T, Huang Y. Efficacy of acupuncture-related therapy in the treatment of primary dysmenorrhea: A network meta-analysis of randomized controlled trials. Heliyon. 2024 May 9;10(10):e30912.  https://doi.org/10.1016/j.heliyon.2024.e30912
+^Objectives| In order to compare and rank the most effective acupuncture therapy for primary dysmenorrhea and provide evidence-based medical support for clinical treatment of this disease.|
+^Methods| A comprehensive search was conducted on China National Knowledge Infrastructure (CNKI), Wanfang Database, Information Chinese Journal Service Platform (VIP), China Biomedical Literature Service System (SinoMed), PubMed, Web of Science, Embase, and Cochrane Library databases from their inception to May 1, 2023. The Cochrane Collaboration Risk of Bias Tool was used to evaluate bias risk, and the GeMTC package of Stata 15.1 software and R 4.3.1 software was used to perform network Meta-analysis.|
+^Results| **70 studies were included, including 5772 patients** with primary dysmenorrhea, involving **25 kinds of acupuncture techniques** commonly used in clinic. The quality of the included literature was low, most of them did not mention the registration information of clinical trial centers, and the specific sample size estimation method was unclear. Some literature did not explain the specific random method, distribution concealment and blindness, so there was a certain publication bias and small sample effect. Results showed that for improving the clinical effective rate, the top three treatments were salt-separated moxibustion, massotherapy + acupoint patching, acupuncture + heat-sensitive moxibustion. In terms of reducing the visual analogue scale(VAS), the top three treatments were massotherapy + acupoint patching, acupuncture + acupoint patching and warm acupuncture. In terms of alleviating cox menstrual symptom scale (CMSS), the top three treatments were acupuncture + acupoint patching, acupoint patching and point embedding. In relieving TCM symptom score, the top three treatments were acupoint patching + heat-sensitive moxibustion, acupoint patching and moxibustion.|
+^Conclusion| Different acupuncture therapies have more advantages than oral analgesics in improving the clinical effective rate, reducing VAS score, reducing CMSS score, and alleviating TCM symptom score. Among them, massage therapy + acupoint patching, acupuncture + acupoint patching and acupoint patching may be the best solutions for the treatment of primary dysmenorrhea. However, more large-sample, multi-center and high-quality randomized controlled trials are needed to demonstrate.|
+== Chen SC 2024 ==
+Chen SC, Ruan JY, Zhang B, Pang LY, Zhong L, Lin SL, Wong KP, Ouyang HX, Yeung WF, Fu QW, Chen BQ. Traditional Chinese medicine interventions based on meridian theory for pain relief in patients with primary dysmenorrhea: a systematic review and network meta-analysis. Front Med (Lausanne). 2024 Sep 5;11:1453609.  https://doi.org/10.3389/fmed.2024.1453609
+^Objective| To determine the comparative effects and safety of traditional Chinese medicine (TCM) interventions based on meridian theory for pain relief in patients with primary dysmenorrhea (PD).|
+^Methods| This is a systematic review with network meta-analysis. Randomized controlled trials (RCTs) comparing meridian-based TCM interventions with waitlist, placebo, western medicine, and conventional therapies for PD pain. A SUCRA was used to estimate the probability ranking for the effects of interventions.|
+^Results| 57 RCTs involving 3,903 participants and 15 interventions were included. **Thirty-two RCTs** were rated as low risk of bias. A network diagram was drawn with 105 pairs of comparisons. Compared with NSAIDs and waitlist, significantly better effects were found in acupressure [SMD = -1.51, 95%CI (-2.91, -0.12)/SMD = -2.31, 95%CI (-4.61, -0.02)], warm needling [SMD = -1.43, 95%CI (-2.68, -0.18)/SMD = -2.23, 95%CI (-4.43, -0.03)], moxibustion [SMD = -1.21, 95%CI (-1.85, -0.57)/SMD = -2.10, 95%CI (-3.95, -0.07)], and acupuncture [SMD = -1.09, 95%CI (-1.62, -0.55)/SMD = -1.89, 95%CI (-3.67, -0.11)]. No adverse events were detected.|
+^Conclusion| For PD pain, the effects of acupressure, acupuncture, warm needling, and moxibustion were superior to those of NSAIDs and waitlist. Oral contraceptive pill, electro-acupuncture, acupressure, and warm needling demonstrated higher probabilities of being better interventions. More high-quality clinical trials are needed to provide more robust evidence of this network.|
 === Moxibustion  ===
+== Song 2025 ==
+Song S, Chen H. Systematic review and meta-analysis of the effectiveness of moxibustion therapy for primary dysmenorrhea. Front Med (Lausanne). 2025 Feb 19;12:1545146.  https://doi.org/10.3389/fmed.2025.1545146
+^Backgound| Primary dysmenorrhea is a common gynecological disease. Compared with traditional Chinese medicine treatment, moxibustion has advantages as a main treatment method. Therefore, we conducted a systematic review and meta-analysis to evaluate the efficacy of simple moxibustion therapy for primary dysmenorrhea.|
+^Methods| Randomized controlled trials were searched from PubMed, Web of Science, Embase, The Cochrane Library, China National Knowledge Infrastructure, Wan-fang database and VIP database. In the literature included in these databases, clinical reporters evaluated the efficacy of moxibustion as the treatment for primary dysmenorrhea. All included literature was assessed for risk bias by using Risk of Bias assessment tool 2.0, and meta-analysis was conducted using Rev. Man 5.4.|
+^Results| The findings demonstrated that the moxibustion group exhibited a statistically significant response in comparison to the control group. The improvement observed in the Cox Menstrual Symptom Scale and the visual analogue scale score between the two groups exhibited heterogeneity, with a statistically significant difference noted. In terms of Traditional Chinese Medicine symptom scores, the experimental group demonstrated superiority over the control group. Furthermore, the progesterone levels in the moxibustion treatment were found to be higher than in the control group, while the estrogen levels in the experimental group were lower than in the control group, with a statistically significant difference observed (p < 0.05). Conversely, the levels of β-EP and PGE2 in the observation group were higher than those in the control group.|
+^Conclusion| Moxibustion therapy shows significantly better efficacy in treating primary dysmenorrhea. However, a large sample, multi-center, high-quality RCT is still needed to evaluate its safety and efficacy.|
+== Xu 2022 ==
+Xu N, Huang Y, Huang H, Huang Y, Lai S, Zhang Z, Zhong Y. Curative Effect of Heat-sensitive Moxibustion on Primary Dysmenorrhea: A Meta-Analysis. Evid Based Complement Alternat Med. 2022 Jul 30;2022:1281336.  https://doi.org/10.1155/2022/1281336
+^Background| Primary dysmenorrhea (PD) refers to functional dysmenorrhea, typically characterized by cyclical, pronounced lower abdominal pain and seriously affects a woman's work and quality of life. Some studies have reported that heat-sensitive moxibustion (HSM) is expected to alleviate the clinical symptoms. This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of HSM on PD.|
+^Methods| 7 databases including PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wan Fang Data Knowledge Service Platform (Wan Fang Data), and China Science and Technology Journal Database (VIP) were searched for clinical randomized controlled trials. Meanwhile, Revman 5.3 software was used to evaluate the methodological quality of the included literature. The confidence interval (CI) of either relative risk or mean difference was set to 95%. Besides, the heterogeneity of the research results is tested by I2.|
+^Results| **19 studies** were ultimately included in this meta-analysis. All of them were declared as random controlled trials. 18 studies reported the total effective rate of the test group and the control group, which was significantly higher (RR: 0.92; 95% CI: 0.85,0.99; P=0.031 < 0.05) than the control group. It is demonstrated that the VAS score of the test group, totally 9 studies included, was significantly lower (SMD: -0.98; 95% CI: -1.15, -0.81; P < 0.001). The meta-analysis of 6 studies showed the symptom score of the test group was significantly lower (SMD: -0.67; 95% CI: -0.87, -0.47; P < 0.001). There were the CMSS results of 3 studies which were significantly lower (SMD: -0.88; 95% CI: -1.13, -0.62; P < 0.001). Combined with the results of subgroup analysis, compared with the control group, the test group had advantages in the VAS score, symptom score, and CMSS score.|
+^Conclusions| The result has revealed the effectiveness and feasibility of HSM in treating PD, especially in improving the total effective rate and reducing the VAS score, symptom score, and CMSS score.|
+== Wu 2021 ☆ ==
+Wu ZX, Cai MJ, Huang PD, Chen JY, Lv ZH, Huang XY. Comparative efficacy and dysmenorrhea score of 6 object-separated moxibustions for the treatment of Chinese patients with dysmenorrhea: A systematic review and network meta-analysis. Medicine (Baltimore). 2021;100(26). [219692]. [[https://doi.org/10.1097/md.0000000000026185|doi]]
+^ Background|Primary dysmenorrhea (PD), one of the most common diseases in women, is known to be effective with object-separated moxibustion. However, because there is no large sample size for comparison, it is difficult to choose the best method for the clinical treatment of these different treatments. Therefore, our aim was to compare and rank different moxibustion methods to determine the most effective treatment method for PD. |
+^ Materials and methods|A systematic search was carried out in PubMed, Cochrane Central Register of Controlled Trials, China National Knowledge Infrastructure, Wanfang Database, and Chinese Biomedical Literature, to identify the randomized controlled trials (RCTs) investigated the object-separated moxibustion is associated with dysmenorrhea, as well as we also manually checked the bibliographies of eligible studies and topic-related reviews, RCTs from their inception to May 1, 2020. Three investigators read the citations and excluded quasi-randomized trials and trials that were incomplete. We extracted data following a predefined hierarchy. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. The primary outcomes were efficacy (response rate) and dysmenorrhea scores. We estimated the summary odds ratio (OR) and mean difference (MD) using pairwise and network meta-analyses with random effects. STATA software version 16.0, ADDIS software version 1.16.5, and R software version 3.6.1 were used to statistically analyze all data. |
+^Results|**Fifty-six RCTs with 5550 patients** were included, comparing 6 object-separated moxibustion therapies with acupuncture or oral medicine. All moxibustions were more effective than ibuprofen, with OR ranging between 6.75 (95%CI: 3.58 to 13.22) for moxibustion at the navel. For relieving pain which uses dysmenorrhea score to evaluate, mild moxibustion (MD = -1.42, -4.24 to 0.85) was more effective than others. A total of 24 (42.8%) of 56 trials were rated as having a high risk of bias, 31(55.4%) as moderate, and 1(1.8%) as low, and the certainty of the evidence was moderate. |
+^Conclusions| Mild moxibustion cannot only effectively treat PD but also relieve pain in comparison with ibuprofen. Although GRADE evidence indicate low to moderate for most comparisons, mild moxibustion seems to be an advisable option for PD treatment to relieve symptoms. |
 == Li 2018 ==
@@ Ligne 234: / Ligne 320: @@
 ^Conclusion| With traditional moxibustion therapy,acupuncture and massage,Western medicine and moxibustion according to sydnrome differentiation,the curative effect of heat-sensitive moxibustion treatment of primary dysmenorrhea has certain advantages. But it still need to be confirmed by more high quality research. |
-== Gou 2016 ☆ (le moment du traitement) ==
+== Gou 2016 ☆ (Interventional Times) ==
 Gou CQ, Gao J, Wu CX, Bai DX, Mou HY, Hou XL, Zhao X. Moxibustion for Primary Dysmenorrhea at Different Interventional Times: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016. {{:medias+securises:acupuncture:evaluation:gyneco-obstetrique:gou-191063.pdf|[191063]}}.
 ^ Objectives  | Primary dysmenorrhea (PD) is one of the most common diseases in gynecology at present. Some clinical trials have reported the effects of moxibustion and confirmed temporal factors are the important elements influencing the efficacy of moxibustion. However, no systematic review has yet been conducted.  |
@@ Ligne 241: / Ligne 327: @@
 ^ Conclusions  | Based on the theory of Chinese medicine and the results of this study, **choosing 5 ± 2 days before menstruation** to start moxibustion can achieve good efficacy for PD patients. However, more high-quality RCTs are needed to confirm the conclusions.  |
+=== Chinese Medicine at Shenque (CV 8) ===
+== Yan 2023 ==
+Yan LJ, Fang M, Zhu SJ, Wang ZJ, Hu XY, Liang SB, Wang D, Yang D, Shen C, Robinson N, Liu JP. Effectiveness and Safety of Chinese Medicine at Shenque (CV 8) for Primary Dysmenorrhea: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Chin J Integr Med. 2023 Apr;29(4):341-352.  https://doi.org/10.1007/s11655-022-3319-z.|
+^Background|Primary dysmenorrhea (PD) is the most common complaint associated with menstruation and affects up to three-quarters of women at some stage of their reproductive life. In Chinese medicine, navel therapy, treatment provided at Shenque (CV 8), is used as a treatment option for PD.
+^Objective| To evaluate the effect of navel therapy on pain relief and quality of life in women with PD, compared with Western medicine (WM).|
+^Methods| China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP), SinoMed and Wanfang Database, MEDLINE, the Cochrane Library, Embase, Web of Science, and the International Clinical Trial Registry of the U.S. National Institutes of Health were searched from their inceptions to April 1, 2021. Randomized controlled trials (RCTs) assessing therapeutic effects of navel therapy on PD were eligible for inclusion. RevMan 5.4 software was used for data analyses. The certainty of the evidence was assessed using the online GRADEpro tool.|
+^Results|Totally **24 RCTs involving 2,614 participants** were identified. Interventions applied to acupuncture point CV 8 included: herbal patching, moxibustion or combined navel therapy (using at least 2 types of stimulation). Compared to placebo, there was a significant effect in favor of navel therapy on reducing overall menstrual symptom scores at the end of treatment [mean difference: -0.82, 95% confidence interval (CI): -1.00 to -0.64, n=90; 1 RCT]. As compared with Western medicine, navel therapy had a superior effect on pain intensity as assessed by Visual Analogue Scale at the end of treatment [standardized mean difference (SMD): -0.64, 95% CI: -1.22 to -0.06, I2=80%, n=262; 3 RCTs]; on symptom resolution rate at 3-month follow-up (risk ratio: 1.94, 95% CI: 1.47 to 2.56, n=1527, I2=38%; 13 RCTs); and on global menstrual symptoms score at the end of treatment (SMD: -0.67, 95% CI: -0.90 to -0.45, I2=63%, n=990; 12 RCTs). Subgroup analyses showed either a better or an equivalent effect comparing navel therapy with Western medicine. No major adverse events were reported. The methodological quality of included trials was poor overall.|
+^Conclusions|Navel therapy appears to be more effective than Western medicine in decreasing menstrual pain and improving overall symptoms of PD. However, these findings need to be confirmed by well-designed clinical trials with adequate sample size (Systematic review registration at PROSPERO, No. CRD42021240350). |
+=== Puncture or acupression at sanyinjiao acupoint ===
+== Ravi 2024 ==
-=== Puncture ou acupression au 6Rte ===
+Ravi P, Boopalan D, Vijayakumar V, Anandhan A, Vanamoorthy MK, Chidambaram Y, Kasi M, Kuppusamy M. Effect of Sanyinjiao (Spleen-6) Acupoint for Pain Management in Primary Dysmenorrhea: An Updated Systematic Review and Meta-Analysis. Med Acupunct. 2024 Aug 21;36(4):178-188.  https://doi.org/10.1089/acu.2023.0100
+^Objectives| Available literature highlights the effectiveness of Acupuncture or Acupressure on the Spleen 6 acupoint (Sanyinjiao or SP-6) for pain management in primary dysmenorrhea (PD). The objective of the current systematic review and meta-analysis is to provide an updated assessment of available randomized and non-randomized controlled trials and to compare the effectiveness of acupressure and acupuncture stimulation of Sanyinjiao among patients with PD.|
+^Methods| We conducted a comprehensive literature search on various electronic databases including Embase, PubMed, and the Cochrane Library from January 1990 to March 2023 to identify the comparative studies (randomized and non-randomized controlled trials) that assessed the effects of acupressure or acupuncture on the Sanyinjiao acupoint in patients with PD. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment. Subsequently, a fixed-effects meta-analysis was performed using the Der-Simonian and Laird method to combine intervention effects from the included studies. The primary outcome of interest was a reduction in pain.|
+^Results| We included **19 studies (9 acupressure and 10 acupuncture) with 1171 PD patients**. This meta-analysis showed a significant (Standardized Mean Difference, SMD: -0.29, 95% confidence interval -0.41 to -0.17, p < 0.001) reduction in pain, for both acupressure and acupuncture at Sanyinjiao acupoint with considerable heterogeneity. Acupressure was found to be more effective than acupuncture stimulation in reducing pain associated with PD (SMD: -0.52, 95% confidence interval -0.71 to -0.33, p < 0.001).|
+^Conclusion| The findings of this updated systematic review and meta-analysis suggest that both acupuncture and acupressure on Sanyinjiao acupoint could effectively reduce pain associated with PD. Acupressure stimulation, in particular, was found to be more effective than acupuncture stimulation of the acupoint in reducing pain associated with PD.|
 == Chen 2013 ☆  ==
@@ Ligne 269: / Ligne 372: @@
 === Acupression ===
+== Yu 2025 ==
+Yu X, Liu B, Li J, Gao Y, Chen J, Qi R, Yuan Y, Liu Y. Efficacy and safety of acupressure for primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2025 Oct 23:103272. https://doi.org/10.1016/j.ctim.2025.103272
+^Objective| This systematic review aimed to evaluate the existing randomized controlled trials (RCTs) for evidence of the association between using acupressure and reducing pain and related symptoms of primary dysmenorrhea (PD).|
+^Methods| Six electronic databases were searched for published reports on RCTs—from database inception until May 2025—that compared the use of acupressure with that of placebo acupressure, oral medication, or usual treatment and measured the intensity of menstrual pain and related symptoms. Two independent reviewers extracted and assessed the data. Risk of bias was assessed for each article; the meta-analysis was conducted according to the type of control. Results are presented as mean differences (MDs) or standardised mean differences (SMDs) and 95% confidence intervals (CIs).|
+^Results| In total, **23 RCTs** were included in the systematic review and data from 20 RCTs were evaluated in the meta-analysis. Most studies showed a low or unclear risk of bias. We found that using acupressure was more effective in reducing menstrual pain than using placebo acupressure (MD = -1.58; 95% CI, [-1.96, -1.20]), oral medication (MD = -1.11; 95% CI, [-1.79, -0.43]), or usual treatment (MD = -1.29; 95% CI, [-1.77, -0.80]). The adverse events, reported in only two studies, were mild.|
+^Conclusion| Acupressure can effectively reduce the pain and related symptoms of PD, though the current evidence is of low quality. Future studies with rigorous designs and larger sample sizes are warranted to verify the efficacy and safety of acupressure. Subsequent findings should be incorporated into clinical practice and nursing care to refine the treatment strategies for PD.|
 == Armour 2019 ☆==
@@ Ligne 293: / Ligne 407: @@
 Cho SH, Hwang EW. Acupressure for Dysmenorrhoea: A Systematic Review. Complementary Therapies in  Medicine. 2010;18(1):49-56. {{:medias+securises:acupuncture:evaluation:gyneco-obstetrique:cho-154012.pdf|[154012].}}
-^ Objectifs | To assess the effectiveness of acupressure for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs). |
+^Objective |To assess the effectiveness of acupressure for the symptomatic treatment of primary dysmenorrhoea from randomised controlled trials (RCTs). |
-^ Méthodes | Electronic databases including English, Korean, Japanese and Chinese databases were systematically searched for RCTs investigating acupressure for primary dysmenorrhoea up to July 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Assessing risk of bias of the Cochrane Handbook edited by Higgins and Altman. |
+^Methods|Electronic databases including English, Korean, Japanese and Chinese databases were systematically searched for RCTs investigating acupressure for primary dysmenorrhoea up to July 2008 with no language restrictions. The methodological qualities of eligible studies were assessed using the criteria described in the Assessing risk of bias of the Cochrane Handbook edited by Higgins and Altman. |
-^ Résultats | **Four RCTs comprising a total of 458 participants** were systematically reviewed. Only one of the included trials described adequate methods of randomisation. All trials did not have clear descriptions of their method of allocation concealment. Two studies reported significant improvements in the severity of pain for acupressure compared with sham acupressure on non-acupoints. Acupressure reduced the pain and anxiety typical of dysmenorrhoea in a Taiwan study. The U.S. study using an acupressure device reported that the reduction of menstrual pain was significantly better in worst menstrual pain, menstrual pain symptom intensity and the consumption of pain medication, compared with conventional treatment. One study investigated adverse events and reported that there was no adverse event in acupressure treatment.|
+^Results| **Four RCTs comprising a total of 458 participants** were systematically reviewed. Only one of the included trials described adequate methods of randomisation. All trials did not have clear descriptions of their method of allocation concealment. Two studies reported significant improvements in the severity of pain for acupressure compared with sham acupressure on non-acupoints. Acupressure reduced the pain and anxiety typical of dysmenorrhoea in a Taiwan study. The U.S. study using an acupressure device reported that the reduction of menstrual pain was significantly better in worst menstrual pain, menstrual pain symptom intensity and the consumption of pain medication, compared with conventional treatment. One study investigated adverse events and reported that there was no adverse event in acupressure treatment.|
-^ Conclusion | The available data from RCTs suggest that **acupressure alleviates menstrual pain**. These results were limited by the small number of trials. Well-designed RCTs with rigorous methods of randomisation, and adequately concealed allocation, are needed.|
+^Conclusions | The available data from RCTs suggest that **acupressure alleviates menstrual pain**. These results were limited by the small number of trials. Well-designed RCTs with rigorous methods of randomisation, and adequately concealed allocation, are needed.|
+=== Auricular acupuncture ===
+== Cao 2023 ==
+Cao M, Ye F, Xie W, Yan X, Ho MH, Cheung DST, Lee JJ. Effectiveness of auricular acupoint therapy targeting menstrual pain for primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs. 2023 Dec;20(6):621-633.  https://doi.org/10.1111/wvn.12636
+^Background| Primary dysmenorrhea (PD) is a global public health concern affecting women's health and quality of life, leading to productivity loss and increased medical expenses. As a non-pharmacological intervention, auricular acupoint therapy (AAT) has been increasingly applied to treat PD, but the overall effectiveness remains unclear. |
+^Aims| The aim of this review was to synthesize the effects of AAT targeting menstrual pain among females with PD. |
+^Methods| Eight databases (PubMed, EMBASE, AMED, CINAHL Plus, Cochrane Library, Web of Science, China National Knowledge Infrastructure and Wanfang Data) and three registries (ClinicalTrials.gov, ISRCTN Registry and the Chinese Clinical Trial Registry) were searched to identify existing randomized controlled trials (RCTs) from inception to 21 August 2022. Two reviewers independently screened, extracted the data, and appraised the methodological quality and the evidence strength using the Cochrane risk-of-bias tool for randomized trials (RoB 2) and the GRADE approach. |
+^Results| A total of **793 participants from 11 RCTs** were included. Despite substantial heterogeneity, AAT was more effective in reducing menstrual pain and related symptoms than placebo and nonsteroidal anti-inflammatory medications (NSAIDs). No significant subgroup differences were found between study locations as well as invasiveness, duration, type, acupoints number, ear selection and provider of AAT. Only minor adverse effects of AAT were reported. |
+^Linking evidence to action|AAT can help women with PD, particularly those who are refrained from pharmaceuticals. Primary healthcare professionals, including nurses, can be well-equipped to provide evidence-based and effective AAT for people with PD. AAT can be used in a broader global clinical community. To provide an optimal effect and have wider usability, a unified practice standard is required, which would necessitate further adaptation of clinical care of people with PD. AAT effectively decreased menstrual pain and other accompanying symptoms of PD. More research is needed to identify effective AAT features and explore optimal therapy regimes for PD. |
+== Kong 2023 ==
+Kong X, Fang H, Li X, Zhang Y, Guo Y. Effects of auricular acupressure on dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials. Front Endocrinol (Lausanne). 2023 Jan 5;13:1016222.  https://doi.org/10.3389/fendo.2022.1016222
+^Background|Auricular acupressure (AA) is widely used in treatment of dysmenorrhea, but the safety and efficacy of auricular acupressure on dysmenorrhoea are still lack of evidence-based basis.|
+^Objective|The purpose of meta-analysis was to evaluate the effects of auricular acupressure on dysmenorrhea.|
+^Methods| Data sources: A systematic search was conducted in six electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CINAHL), Weipu (CQVIP), China National Knowledge Infrastructure (CNKI), and Wanfang databases, to retrieve studies published from the inception dates to June 10, 2022. Study selection: Randomized controlled trials (RCTs) that investigated the effectiveness of AA on dysmenorrhea were identified. Data extraction and synthesis: The data extraction and quality assessment of the included studies were performed by two reviewers independently. Outcomes were abstracted to determine the effect measure by using mean differences (MD), standardized mean differences (SMD), or odds ratio (OR) from a random effects model. Main outcomes and measures: Cure rate, total effective rate, and visual analogue scale (VAS) were described as primary outcomes; Short-form Menstrual Distress Questionnaire (MDQs), symptom scores, serum nitric oxide (NO) level, and adverse events were recorded as secondary outcomes.|
+^Results|**Thirty-five RCTs involving 3960 participants** were included in this study. Our findings indicated that, overall, AA was associated with a significant benefit in cured rate (OR = 1.95, 95%CI: [1.34, 2.83], P=0.0004, I2 = 75%), total effective rate (OR = 3.58, 95%CI: [2.92, 4.39], P<0.00001, I2 = 67%), VAS score (MD = -1.45, 95%CI: [-1.73, -1.17], P<0.00001, I2 = 67%), and symptom scores compared to the control group (SMD = -0.85, 95%CI: [-1.28, -0.43], P<0.0001, I2 = 91%). However, no difference in serum NO (SMD = 0.77, 95%CI: [-0.39, 1.92], P = 0.19, I2 = 89%) and MDQs (SMD = -0.58, 95%CI: [-1.26, 0.10], P = 0.10, I2 = 79%) was found between the two groups. Furthermore, subgroup analysis results indicated that AA showed significant superiorities in increasing cured rate and total effective rate, and reducing VAS score and symptom scores when compared to analgesics and non-intervention. Moreover, AA presented the same superiorities when used as an adjunctive strategy to other therapy. However, these benefits were not detected in AA used alone when compared to the therapies, including Chinese herbs, acupuncture, external application of Chineseherbal medicine, moxibustion, auricular needle, and health education.|
+^Conclusions|Overall, AA, as a potential safety therapy, is effective for the management of dysmenorrhea, such as increasing cured rate, total effective rate, VAS, and symptom scores. Nevertheless, AA showed no significant improvement in serum NO and MDQs. It is furtherly found that AA used alone is superior to analgesics and non-intervention regarding cured rate, total effective rate, VAS, and symptom scores. Furthermore, the same superiorities are observed when AA serves as an adjunctive strategy to other therapy. However, AA alone has little effect on them compared to other therapies, and there is no definite conclusion on the benefits of AA compared to placebo for patients with dysmenorrhea. Rigorous RCTs with blind method and placebo control are warranted to confirm these findings.|
@@ Ligne 340: / Ligne 478: @@
 ^ Conclusions  | High frequency TENS was found to be effective for the treatment of dysmenorrhoea by a number of small trials. The minor adverse effects reported in one trial requires further investigation. There is insufficient evidence to determine the effectiveness of low frequency TENS in reducing dysmenorrhoea. There is also **insufficient evidence to determine the effectiveness of acupuncture in reducing dysmenorrhoea, however a single small but methodologically sound trial of acupuncture suggests benefit for this modality**.  |
-==== Specific outcome ===='évaluation particuliers ====
+==== Specific outcome ====
-=== Lin 2020 (Acupuncture vs MTC) ===
+=== Lin 2020 (Acupuncture vs TCM) ===
@@ Ligne 355: / Ligne 493: @@
-==== Qualité méthodologique des essais ====
+==== Methodological quality of studies ====
@@ Ligne 366: / Ligne 504: @@
 ^ Conclusions  | Acupuncture and moxibustion treat clinical random controlled studies (RCT) of menstruation quality take, wait for, raise, should follow the clinical research characteristics that acupuncture and moxibustion treat menstruation, explore that sets up the best healing solution, in order to improve clinical curative effect.  |
-===== Revues de revues sytématiques =====
+===== Overviews of Systematic Reviews =====
 ==== Yang 2020 ====
@@ Ligne 378: / Ligne 516: @@
 ^ Results                | A total of **28 SRs and MAs**, 281 original studies, reporting on 26,459 female patients were analyzed. The majority of the SRs were of moderate reporting quality and poor methodological quality. Moderate-quality evidence suggested that acupuncture and moxibustion were more effective compared to indomethacin or Fenbid in treating PD. Low-quality evidence suggested that, compared to NSAIDs, acupuncture and moxibustion could relieve pain with less adverse effects.            |
 ^ Conclusion             | Acupuncture and moxibustion seem to be effective and safe approaches in treatment of PD; yet, the methodological quality of most of the studies and the quality of evidence were low. Thus, additional studies are required to further confirm these results.                                                                                                                                                                                                                                 |
@@ Ligne 383: / Ligne 522: @@
 | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) |
+==== Society of Obstetricians and Gynaecologists of Canada (SOGC, Canada) 2025 ⊕  ====
+Burnett M. Guideline No. 345: Primary Dysmenorrhea. J Obstet Gynaecol Can. 2025 May;47(5):102840.  https://doi.org/10.1016/j.jogc.2025.102840
+| 12. High-frequency transcutaneous electrical nerve stimulation (TENS), local heat therapy (heated pads/patches), **acupoint stimulation** and ginger supplementation may be considered as complementary treatments for dysmenorrhea, especially for women who cannot or choose not to use conventional therapy, though evidence varies in strength and certainty (conditional, low).|
+==== Australian and New Zealand College of Anaesthetists  (ANZA) 2020 ⊕ ====
+Acute Pain Management: Scientific Evidence Australian and New Zealand College of Anaesthetists  (ANZA). 2020:1317P.  {{:medias securises:acupuncture:evaluation:algologie-anesthesie par acupuncture:anza-205268.pdf|[205268]}} . [[https://www.anzca.edu.au/news/top-news/acute-pain-management-scientific-evidence-5th-edit|URL]].
+| Acupuncture or acupressure may be effective in the treatment of primary dysmenorrhoea (S) (Level I [Cochrane Review]).  |
 ==== American College of Obstetricians and Gynecologists 2018 ⊕ ====
@@ Ligne 406: / Ligne 559: @@
 |Members with the Medicare Dual-Eligible benefit are eligible for acupuncture when performed by an individual licensed by New York State to perform acupuncture and when performed for the following diagnoses: 1. Adult postoperative nausea and vomiting 2. Chemotherapy related nausea and vomiting 3. Pregnancy related nausea and vomiting 4. Carpal tunnel syndrome 5. Epicondylitis (tennis elbow) 6. Headache 7. Low back pain 8. **Menstrual pain** 9. Myofascial pain 10. Osteoarthritis |
+==== Society of Obstetricians and Gynaecologists of Canada (SOGC, Canada) 2017 ⊕ ====
+Burnett M, Lemyre M. No. 345-Primary Dysmenorrhea Consensus Guideline. J Obstet Gynaecol Can. 2017 Jul;39(7):585-595.  https://doi.org/10.1016/j.jogc.2016.12.023. PMID: 28625286.
+| 11. Acupoint stimulation should be considered for women wishing to use complementary or alternative therapies (II-1B).|
 ==== Australian and New Zealand College of Anaesthetists (ANZCA, Autralia- New Zealand) 2015 ⊕ ====

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