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acupuncture:evaluation:gyneco-obstetrique:03. dysmenorrhees [14 Sep 2023 10:54] Nguyen Johan [1.2.1.5. Gou 2016 ☆ (Interventional Times)] |
acupuncture:evaluation:gyneco-obstetrique:03. dysmenorrhees [29 Oct 2025 14:20] (Version actuelle) Nguyen Johan [1.2.6. Acupression] |
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| ===== Systematic Reviews and Meta-Analysis ===== | ===== 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 ==== | ==== Generic Acupuncture ==== | ||
| + | === Liu 2025 (Network Meta-Analysis) === | ||
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| + | 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 2022 ★★=== | ||
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| </wrap> | </wrap> | ||
| ==== Special Acupuncture Techniques ==== | ==== Special Acupuncture Techniques ==== | ||
| + | |||
| + | === Sham acupuncture === | ||
| + | == Sun 2023 == | ||
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| + | 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 == | ||
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| + | 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 | ||
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| + | ^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.| | ||
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| === Moxibustion === | === Moxibustion === | ||
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| + | == Song 2025 == | ||
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| + | 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.| | ||
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| == Xu 2022 == | == Xu 2022 == | ||
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| === Puncture or acupression at sanyinjiao acupoint === | === Puncture or acupression at sanyinjiao acupoint === | ||
| + | == Ravi 2024 == | ||
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| + | 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 ☆ == | == Chen 2013 ☆ == | ||
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| === Acupression === | === Acupression === | ||
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| + | == Yu 2025 == | ||
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| + | 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 | ||
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| + | ^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 ☆== | == Armour 2019 ☆== | ||
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| ^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.| | ^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 acupressure === | + | |
| + | === Auricular acupuncture === | ||
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| + | |||
| + | == Cao 2023 == | ||
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| + | 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 2023 == | ||
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| + | ==== Society of Obstetricians and Gynaecologists of Canada (SOGC, Canada) 2025 ⊕ ==== | ||
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| + | 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 | ||
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| + | | 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 ⊕ ==== | ==== Australian and New Zealand College of Anaesthetists (ANZA) 2020 ⊕ ==== | ||
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| |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 | | |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 ⊕ ==== | ||
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| + | 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 ⊕ ==== | ==== Australian and New Zealand College of Anaesthetists (ANZCA, Autralia- New Zealand) 2015 ⊕ ==== | ||
