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RCT confirms efficacy of acupuncture for endometriosis-associated pain

Background


Endometriosis is a gynecological disease in which endometrial tissue grows outside the uterine cavity. This disease is common in women of childbearing age, with a prevalence of about 10%. About 176 million women of reproductive age worldwide suffer from endometriosis. It is difficult to treat, and patients with endometriosis are prone to relapse. This chronic and intractable disease consumes a lot of social resources. In 2017, endometriosis was the highest economic burden of gynecological diseases worldwide. The main symptoms of endometriosis are pain, infertility and pelvic mass. Approximately 70-90% of women with endometriosis experience chronic pain, which seriously affects their physical health, mental health and quality of life. However, the mechanisms by which endometriosis causes pain are still not fully understood. Surgical removal of the lesion can relieve pain associated with endometriosis, but pain does not improve after surgery in about 20% of women, and pain often recurs after surgery. Medications for pain in endometriosis include NSAIDs, progestins, oral contraceptives, androgen derivatives, and gonadotropin-releasing hormone agonists, and while drug therapy is useful, there is a considerable Women stop taking the medicine because the treatment doesn't work well or because of side effects.


Acupuncture, a part of Traditional Chinese Medicine (TCM), has been used for thousands of years. Acupuncture has become increasingly popular in pain management in many countries in recent decades. A systematic review of acupuncture for pain associated with endometriosis suggests that acupuncture is safe and effective. However, there is still a lack of rigorous randomized controlled studies to prove its effectiveness and safety.


Intervention: It is a randomized clinical trial (RCT). Subjects were randomly assigned to receive either acupuncture or sham acupuncture treatment for 12 weeks, starting one week before each expected menstruation and administered as a 30-min session once per day, 3 times a week. During the menstruation period, acupuncture was administered daily when pelvic pain associated with endometriosis occurred. After acupuncture or sham acupuncture treatment, the subjects were followed for another 12 weeks. Point selection: Guanyuan (CV4), bilateral Sanyinjiao (SP6), Taichong (LR3), Zhaohai (KI6), and Qichong (ST30), a total of 9 acupoints.


Main outcomes: Changes in maximum pain as assessed with the visual analog scale (VAS) for various pelvic pain, duration of dysmenorrhea, and scores on the Multidimensional Pain Inventory (MPI), Beck Depression Inventory (BDI), Profile of Mood States (POMS), and Endometriosis Health Profile (EHP) from baseline to week 12 and week 24


Results: A total of 106 women were randomly assigned to the acupuncture and sham groups. In the acupuncture group, the reduction in the dysmenorrhea VAS score was significantly greater after treatment, but not at the end of the trial, compared to the sham group. The duration of pain was significantly shorter in the acupuncture group. MPI, BDI, POMS, and EHP scores were improved to a significantly greater extent in the acupuncture group than in the sham group at week 12 but not at week 24. Changes in nonmenstrual pelvic pain and dyspareunia VAS scores were not different between the groups. No severe adverse events or differences in adverse events were recorded.


Conclusion: Acupuncture is an effective and safe method of relieving dysmenorrhea, shortening the pain duration, and improving wellbeing and quality of life in women with endometriosis-associated pain, although its efficacy fades after treatment is discontinued.


Keywords: acupuncture; endometriosis; pain; quality of life.


My comments:

This is the result of a multicenter, randomized, single-blind, placebo-controlled trial, the highest level of evidence for evidence-based medicine.


Reference

Efficacy of acupuncture for endometriosis-associated pain: A multicenter randomized single-blind placebo-controlled trial. Fertil Steril. 2023 Jan 27;S0015-0282(23)00072-9. doi: 10.1016/j.fertnstert.2023.01.034.

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