Acupuncture for pain in endometriosis: Cochrane systematic review
Assessed as up to date: 2010/07/26
Endometriosis is a prevalent gynaecological condition, significantly affecting women's lives. Clinical presentations may vary from absence of symptoms to complaints of chronic pelvic pain, most notably dysmenorrhoea. The management of pain in endometriosis is currently inadequate. Acupuncture has been studied in gynaecological disorders but its effectiveness for pain in endometriosis is uncertain.Objectives
To determine the effectiveness and safety of acupuncture for pain in endometriosis.Search methods
We searched the Cochrane Menstrual Disorders and Subfertility Group (MSDG) Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI and TCMDS (from inception to 2010) and reference lists of retrieved articles.Selection criteria
Randomised single or double-blind controlled trials enrolling women of reproductive age with a laparoscopically confirmed diagnosis of endometriosis and comparing acupuncture (body, scalp or auricular) to either placebo or sham, no treatment, conventional therapies or Chinese herbal medicine.Data collection and analysis
Three authors independently assessed risk of bias and extracted data; we contacted study authors for additional information. Meta-analyses were not performed as only one study was included. The primary outcome measure was decrease in pain from endometriosis. Secondary outcome measures included improvement in quality of life scores, pregnancy rate, adverse effects and rate of endometriosis recurrence.Main results
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.Authors' conclusions
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.
Zhu Xiaoshu, Hamilton Kindreth D, McNicol Ewan D
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. Larger, well-designed studies comparing acupuncture with conventional therapies are necessary to confirm these results.
Implications for practice
There is not enough evidence to support the effectiveness of acupuncture for pain in endometriosis based on the results of the single RCT included in this review. While the results of this trial did show that auricular acupuncture decreased pain from endometriosis in comparison to Chinese herbal medicine, the overall low-quality of methodology makes broad implications for practice difficult to determine.
Auricular acupuncture is but one facet of acupuncture therapy and the effectiveness of body acupuncture, most commonly used in practice, has not been evaluated. There is currently a lack of high quality trials to determine the effectiveness of acupuncture versus conventional therapies or placebo.
Implications for research
The trial included in this review indicated the effectiveness of acupuncture in treating pain from endometriosis in comparison to Chinese herbal medicine ; however no conclusive recommendation can be drawn from one small study. There is a need for more high quality trials, enrolling large numbers of women, before a definitive conclusion can be made. This review highlights the necessity of developing future studies that are well-designed, double-blinded, randomised controlled trials that assess various types of acupuncture in comparison to conventional treatments and placebo.Get full text at The Cochrane Library
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