Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis – 2017
Acupuncture can alleviate the pain of dysmenorrhoea and reduce peripheral blood CA-125. As a result, the therapy could be applied as a complementary treatment for endometriosis-related pain.
However, few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature consistently finds that acupuncture yields better reductions in pain and serum CA-125 levels than do control treatments, regardless of the control intervention used.
To confirm this finding, additional studies with proper controls, blinding methods, and adequate sample sizes are needed.
Chinese herbal medicine for endometriosis (Review 2012)
Two Chinese RCTs involving 158 women were included in this review. Although both these trials described adequate methodology they were of limited quality. Neither trial compared CHM with
placebo treatment. There was no evidence of a significant difference in rates of symptomatic relief between CHM and gestrinone administered subsequent to laparoscopic surgery (RR 1.04, 95% CI 0.91 to 1.18). There was no significant difference between the CHM and gestrinone groups with regard to the total pregnancy rate (69.6% versus 59.1%; RR 1.18, 95% CI 0.87 to 1.59, one RCT).
CHM administered orally and then in conjunction with a herbal enema resulted in a greater proportion of women obtaining symptomatic relief than with danazol (RR 5.06, 95% CI 1.28 to 20.05; RR 5.63
, 95% CI 1.47 to 21.54, respectively). Oral plus enema administration of CHM resulted in a greater reduction in average dysmenorrhoea pain scores than did danazol (mean difference (MD) -2.90, 95%
CI -4.55 to -1.25). For lumbosacral pain, rectal discomfort, or vaginal nodules tenderness, there was no significant difference between CHM and danazol. Overall, 100% of women in both studies showed some improvement in their symptoms. Women taking CHM had fewer side effects than those taking either gestrinone or danazol.
Post-surgical administration of CHM may have comparable benefits to gestrinone. Oral CHM may have a better overall treatment effect than danazol and it may be more effective in relieving dysmenorrhoea when used in conjunction with a CHM enema. CHM appears to have fewer side effects than either gestrinone or danazol. However, more rigorous research is required to accurately assess the potential role of CHM in treating endometriosis.
P L A I N L A N G U A G E S U M M A R Y
Chinese herbs for endometriosis
Endometriosis is a common gynaecological condition causing menstrual and pelvic pain. Treatment involves surgery and hormonal drugs, with potentially unpleasant side effects and high rates of reoccurrence of endometriosis. The two small studies in this review suggest that Chinese herbal medicine (CHM) may be as effective as gestrinone and may be more effective than danazol in relieving
endometriosis-related pain, with fewer side effects than experienced with conventional treatment. However, the two trials included in this review were small and of limited quality so these findings must be interpreted cautiously. Better quality randomised controlled trials are needed to investigate apossible role for CHM in the treatment of endometriosis.
Twenty-four studies were identified that involved acupuncture for endometriosis; however only one trial, enrolling 67 participants, met all the inclusion criteria. The single included trial defined pain scores and cure rates according to the Guideline for Clinical Research on New Chinese Medicine. Dysmenorrhoea scores were lower in the acupuncture group (mean difference -4.81 points, 95% confidence interval -6.25 to -3.37, P < 0.00001) using the 15-point Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis scale. The total effective rate (’cured’, ’significantly effective’ or ’effective’) for auricular acupuncture and Chinese herbal medicine was 91.9% and 60%, respectively (risk ratio 3.04, 95% confidence interval 1.65 to 5.62, P = 0.0004).
The improvement rate did not differ significantly between auricular acupuncture and Chinese herbal medicine for cases of mild to moderate dysmenorrhoea, whereas auricular acupuncture did significantly reduce pain in cases of severe dysmenorrhoea. Data were not available for secondary outcomes measures.
The evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review. This review highlights the necessity for developing future studies that are well-designed, double-blinded, randomised controlled trials that assess various types of acupuncture in comparison to conventional therapies.
P L A I N L A N G U A G E S U M M A R Y
Acupuncture for pain in endometriosis
Endometriosis is a gynaecological disease that causes chronic pelvic pain, most notably painful menstruation, as the most common complaint. Acupuncture is frequently used to treat both pain and various gynaecological conditions. This review examined the effectiveness of acupuncture for reducing pain in endometriosis; however only one study met our inclusion criteria.
The data from the included study, involving 67 women, indicated that ear acupuncture is more effective compared to Chinese herbal medicine for reducing menstrual pain. The study did not report whether participants suffered any side effects from their treatments. Lager, well-designed studies comparing acupuncture with conventional therapies are necessary to confirm these results.
Chinese herbal medicines (CHM) are often used in managing cancer related symptoms but their effectiveness and safety is controversial.
We conducted this overview of meta-analyses to summarize evidence on CHM for cancer palliative care. We included systematic reviews (SRs) with meta-analyses of CHM clinical trials on patients diagnosed with any type of cancer.
Methodological quality of included meta-analyses was assessed with the Methodological Quality of Systematic Reviews (AMSTAR) Instrument. Fifty-one SRs with meta-analyses were included. They covered patients with lung (20 SRs), gastric (8 SRs), colorectal (6 SRs), liver (6 SRs), breast (2 SRs), cervical (1 SR), esophageal (1 SR), and nasopharyngeal (1 SR) cancers. Six SRs summarized evidence on various types of cancer. Methodological quality of included meta-analyses was not satisfactory.
Overall, favorable therapeutic effects in improving quality of life among cancer patients have been reported. Conflicting evidence exists for the effectiveness of CHM in prolonging survival and in reducing chemotherapy and/or radiotherapy related toxicities. No serious adverse effects were reported in all included studies. Evidence indicated that CHM could be considered as an option for improving quality of life among patients receiving palliative care. It is unclear if CHM may increase survival, or reduce therapy related toxicities.
Evidence showed that the combination of CHM and chemotherapy significantly reduced leucopenia, nausea and vomiting, thrombocytopenia and anemia in NSCLC, gastric cancer patients. It also significantly reduced nausea and vomiting in liver cancer patients. In general, CHM appears to be useful in improving leucopenia, thrombocytopenia and anemia among various types of cancer.
Base on the evidence we identified, CHM may be considered as an adjuvant option to improve QoL among cancer patients.
Chung, V. C.H. et al. Effectiveness of Chinese herbal medicine for cancer palliative care: overview of systematic reviews with meta-analyses. Sci. Rep.5, 18111; doi: 10.1038/srep18111 (2015).
Hye Lin Woo, KMD,a Hae Ri Ji, KMD,e Yeon Kyoung Pak, KMD,e Hojung Lee,c Su Jeong Heo, KMD, PhD,dJin Moo Lee, KMD, PhD,b and Kyoung Sun Park, KMD, PhDb,∗
Medicine (Baltimore). 2018 Jun; 97(23): e11007.
This systematic review aimed to evaluate the current evidence regarding the efficacy and safety of acupuncture on primary dysmenorrhea.
Ten electronic databases were searched for relevant articles published before December 2017. This study included randomized controlled trials (RCTs) of women with primary dysmenorrhea; these RCTs compared acupuncture to no treatment, placebo, or medications, and measured menstrual pain intensity and its associated symptoms. Three independent reviewers participated in data extraction and assessment. The risk of bias in each article was assessed, and a meta-analysis was conducted according to the types of acupuncture. The results were expressed as mean difference (MD) or standardized mean difference (SMD) with 95% confidence intervals (CIs).
This review included 60 RCTs; the meta-analysis included 49 RCTs. Most studies showed a low or unclear risk of bias. We found that compared to no treatment, manual acupuncture (MA) (SMD = −1.59, 95% CI [−2.12, −1.06]) and electro-acupuncture (EA) was more effective at reducing menstrual pain, and compared to nonsteroidal anti-inflammatory drugs (NSAIDs), MA (SMD = −0.63, 95% CI [−0.88, −0.37]) and warm acupuncture (WA) (SMD = −1.12, 95% CI [−1.81, −0.43]) were more effective at reducing menstrual pain. Some studies showed that the efficacy of acupuncture was maintained after a short-term follow-up.
The results of this study suggest that acupuncture might reduce menstrual pain and associated symptoms more effectively compared to no treatment or NSAIDs, and the efficacy could be maintained during a short-term follow-up period. Despite limitations due to the low quality and methodological restrictions of the included studies, acupuncture might be used as an effective and safe treatment for females with primary dysmenorrhea.
New research demonstrates a consensus amongst acupuncture experts on best practice treatment protocols for acupuncture enhancement of assisted reproductive technology (ART) fertility treatments. ART includes all fertility treatments in which both the eggs and sperm are handled. ART includes in vitro fertilization (IVF) and intrauterine insemination (IUI).
In this study, researchers set out to determine if a consensus exists on high priority acupuncture points for the enhancement of ART. Acupuncture IVF and IUI ART has been used in the USA since 1981 to help women become pregnant. Although acupuncture and Chinese medicine for the treatment of infertility is a time honored practice, the combination of acupuncture with ART has emerged in recent years as an effective approach for improving pregnancy and live birth rates.
In this study, researchers administered three rounds of questionnaires to fifteen international acupuncture fertility experts to determine if a consensus exists on best practice protocols. The investigation revealed that several key components are central to acupuncture in combination with ART.
The timing of an acupuncture treatment in relation to the menstrual cycle is of great importance. An acupuncture treatment administered between day 6 and 8 of the “stimulated ART cycle” is optimal. In addition, it is ideal to have two acupuncture treatments “on the day of embryo transfer.”
Pre-transfer acupuncture points of high priority are
SP8, SP10, Liv3, ST29 and CV4.
Post-transfer points include
GV20, K3, SP6, P6 and K3.
Auricular acupuncture points Shenmen and Zigong were also determined to be of high priority.
About the Healthcare Medicine Institute: HealthCMi provides online acupuncture CEU credit to licensed acupuncturists and publishes current events related to acupuncture, herbal medicine and important innovations in healthcare technology.
BMC Complementary and Alternative Medicine 2012, 12:88 doi 10.1186/1472-6882-12-88. 7 July 2012.
Development of an acupuncture treatment protocol by consensus for women undergoing Assisted Reproductive Technology (ART) treatment. Caroline A Smith, Suzanne Grant, Jane Lyttleton and Suzanne Cochrane. ?Zhongguo Zhen Jiu. 2012 Feb;32(2):113-6.
Effects of electroacupuncture on embryo implanted potential for patients with infertility of different symptom complex]. Kong FY, Zhang QY, Guan Q, Jian FQ, Sun W, Wang Y. Department of Reproduction, The Second Affiliated Hospital of Shandong University of TCM, Jinan, China. Fertil Steril. 2005 Jan;83(1):30-6.
Secretion of human leukocyte antigen-G by human embryos is associated with a higher in vitro fertilization pregnancy rate. Yie SM, Balakier H, Motamedi G, Librach CL.
Declaration: Support provided by NIH/NCCAM grant R25 AT002879 (Suppl) and 1K23AT006392. LHR owned the acupuncture practice. The authors report no financial or commercial conflicts of interest.
Whole Systems Traditional Chinese Medicine (WS-TCM) added to IVF may be beneficial.
WS-TCM and IVF was associated with more live births compared with acupuncture and IVF.
WS-TCM and IVF was associated with more live births compared with IVF alone.
WS-TCM is individualized and includes acupuncture and other TCM interventions.
Patients undergoing IVF may receive either acupuncture or whole-systems traditional Chinese medicine (WS-TCM) as an adjuvant IVF treatment. WS-TCM is a complex intervention that can include acupuncture, Chinese herbal medicine, dietary, lifestyle recommendations.
In this retrospective cohort study, 1231 IVF patient records were reviewed to assess the effect of adjuvant WS-TCM on IVF outcomes compared among three groups:
IVF with no additional treatment;
IVF and elective acupuncture on day of embryo transfer; or
IVF and elective WS-TCM.
The primary outcome was live birth.
Of 1069 non-donor cycles, WS-TCM was associated with greater odds of live birth compared with IVF alone (adjusted odds ratio [AOR] 2.09; 95% confidence interval [CI] 1.36 to 3.21), or embryo transfer with acupuncture only (AOR 1.62; 95% CI 1.04 to 2.52). Of 162 donor cycles, WS-TCM was associated with increased live births compared with all groups (odds Ratio [OR] 3.72; 95% CI 1.05 to 13.24, unadjusted) or embryo transfer with acupuncture only (OR 4.09; 95% CI: 1.02 to 16.38, unadjusted).
Overall, IVF with adjuvant WS-TCM was associated with greater odds of live birth in donor and non-donor cycles. These results should be taken cautiously as more rigorous research is needed.