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Are acupuncture and related therapies beneficial for pain relief for women with primary dysmenorrhoea?
Date of publication of the systematic review: January 2011
Design
Systematic review of 10 randomized controlled trials (RCTs).
Participants
1025 women of reproductive age (15 to 49 years) with moderate to severe primary dysmenorrhoea for at least 3 consecutive menstrual cycles.
Intervention
Acupuncture (manual or electro), or acupressure with varying pattern of point selection and treatment frequency. Duration of treatment ranged between 1 to 3 menstrual cycles.
Comparator
Comparison 1: Acupuncture and related therapies versus sham acupuncture;
Comparison 2: Acupuncture and related therapies versus routine treatment;
Comparison 3: Acupuncture and related therapies versus NSAIDS;
Comparison 4: Acupressure versus sham acupuncture;
Comparison 5: Acupressure versus rest.
Comparison 2: Acupuncture and related therapies versus routine treatment;
Comparison 3: Acupuncture and related therapies versus NSAIDS;
Comparison 4: Acupressure versus sham acupuncture;
Comparison 5: Acupressure versus rest.
Major Outcomes
Outcome 1: Pain relief as measured by a visual analogue scale (VAS) or other validated scales at three months;
Outcome 2: Pain relief as measured by a VAS or other validated scales at unknown duration.
Outcome 2: Pain relief as measured by a VAS or other validated scales at unknown duration.
Settings
Among all 10 trials, 4 studies were conducted in China, 3 in Taiwan, one each in Australia and the USA. Three trials recruited college students, and two recruited from the community. The remaining studies recruited participants from gynecology clinics.
Comparison Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies did not show clear improvement on pain relief (standardized mean difference (SMD): -0.23, 95% CI: -0.64 to 0.18).
| Outcomes (units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 1 (NA) | 1 (92) | 2/46 | 2.6/46 | Not applicable as there is only 1 study. | -0.23 (-0.64 to 0.18) | Low |
Comparison Acupuncture and related therapies versus routine treatment
Main Results
Compared to routine treatment, acupuncture and related therapies significantly reduced pain (SMD: 0.59, 95% CI: 0.22 to 0.96).
| Outcomes (units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 1 (NA) | 1 (117) | 2.58/58 | 1/59 | Not applicable as there is only 1 study. | 0.59 (0.22 to 0.96) | Moderate |
Comparison Acupuncture and related therapies versus NSAIDS
Main Results
Compared to NSAIDS, acupuncture and related therapies showed significant improvement on pain relief (SMD: -0.70, 95% CI: -1.08 to -0.32).
| Outcomes (units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 1 (NA) | 1 (114) | 1.71/57 | 4.54/57 | Not applicable as there is only 1 study. | -0.70 (-1.08 to -0.32) | Moderate |
Comparison Acupressure versus sham acupuncture
Main Results
Compared to sham acupuncture, acupressure showed significant improvement on pain relief (SMD: -0.99, 95% CI: -1.48 to -0.49).
| Outcomes (Units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 2 (NA) | 1 (71) | 45.6/36 | 57/35 | Not applicable as there is only 1 study. | -0.99 (-1.48 to -0.49) | Moderate |
Comparison Acupressure versus rest
Main Results
Compared to resting alone, acupressure did not show clear improvement on pain relief (pooled SMD: -0.75, 95% CI: -2.23 to 0.74).
| Outcomes (units) | No. of studies (Total number of participants) | Mean/No. of participants | Heterogeneity test (I2) | Pooled SMD (95% CI) | Overall quality of evidence* | |
| Intervention | Comparator | |||||
| 2 (NA) | 2 (140) | Not reported /71 | Not reported/69 | 94% | -0.75 (-2.23 to 0.74) | Moderate |
Comparison Acupuncture and related therapies versus sham acupuncture
Main Results
Compared to sham acupuncture, acupuncture and related therapies did not show clear improvement on pain relief (standardized mean difference (SMD): -0.23, 95% CI: -0.64 to 0.18).
Comparison 1: Acupuncture and related therapies versus sham acupuncture for pain relief at three months in women with primary dysmenorrhoea
| Outcomes (units) | 1 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 1 (92) | |
| Mean/No. of participants | Intervention | 2/46 |
| Comparator | 2.6/46 | |
| SMD (95% CI) | -0.23 (-0.64 to 0.18) | |
| Overall quality of evidence* | Low | |
Keys: SMD = Standardized mean difference; CI = confidence interval.
Comparison Acupuncture and related therapies versus routine treatment
Main Results
Compared to routine treatment, acupuncture and related therapies significantly reduced pain (SMD: 0.59, 95% CI: 0.22 to 0.96).
Comparison 2: Acupuncture and related therapies versus routine treatment for pain relief at three months in women with primary dysmenorrhoea
| Outcomes (units) | 1 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 1 (117) | |
| Mean/No. of participants | Intervention | 2.58/58 |
| Comparator | 1/59 | |
| SMD (95% CI) | 0.59 (0.22 to 0.96) | |
| Overall quality of evidence* | Moderate | |
Keys: SMD = Standardized mean difference; CI = confidence interval.
Comparison Acupuncture and related therapies versus NSAIDS
Main Results
Compared to NSAIDS, acupuncture and related therapies showed significant improvement on pain relief (SMD: -0.70, 95% CI: -1.08 to -0.32).
Comparison 3: Acupuncture and related therapies versus NSAIDS for pain relief at three months in women with primary dysmenorrhoea
| Outcomes (units) | 1 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 1 (114) | |
| Mean/No. of participants | Intervention | 1.71/57 |
| Comparator | 4.54/57 | |
| SMD (95% CI) | -0.70 (-1.08 to -0.32) | |
| Overall quality of evidence* | Moderate | |
Keys: SMD = Standardized mean difference; CI = confidence interval.
Comparison Acupressure versus sham acupuncture
Main Results
Compared to sham acupuncture, acupressure showed significant improvement on pain relief (SMD: -0.99, 95% CI: -1.48 to -0.49).
Comparison 4: Acupressure versus sham acupuncture for pain relief at three months in women with primary dysmenorrhoea
| Outcomes (Units) | 2 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 1 (71) | |
| Mean/No. of participants | Intervention | 45.6/36 |
| Comparator | 57/35 | |
| SMD (95% CI) | -0.99 (-1.48 to -0.49) | |
| Overall quality of evidence* | Moderate | |
Keys: SMD = Standardized mean difference; CI = confidence interval.
Comparison Acupressure versus rest
Main Results
Compared to resting alone, acupressure did not show clear improvement on pain relief (pooled SMD: -0.75, 95% CI: -2.23 to 0.74).
Comparison 5: Acupressure versus rest for pain relief at three months in women with primary dysmenorrhoea
| Outcomes (units) | 2 (NA) | |
|---|---|---|
| No. of studies (Total number of participants) | 2 (140) | |
| Mean/No. of participants | Intervention | Not reported /71 |
| Comparator | Not reported/69 | |
| Pooled SMD (95% CI) | -0.75 (-2.23 to 0.74) | |
| Overall quality of evidence* | Moderate | |
Keys: SMD = Standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to sham acupuncture, acupuncture and related therapies did not show clear improvement on pain relief. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Compared to routine treatment, acupuncture and related therapies significantly reduced pain. Compared to NSAIDS, acupuncture and related therapies showed significant improvement on pain relief. Compared to sham acupuncture, acupressure showed significant improvement on pain relief. Compared to resting alone, acupressure did not show clear improvement on pain relief. For the outcome of these four comparisons, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
Among all 10 included trials, only one trial with 117 participants reported on adverse effects. Fewer side effects were found in the acupuncture group compared to usual care.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pubmed/21249697The synopsis is based on the following article:
Smith Caroline A, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd, 2011.
Smith Caroline A, Zhu X, He L, Song J. Acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd, 2011.
* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.
Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.
