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. 2011 Sep 7;2011(9):CD007864.
doi: 10.1002/14651858.CD007864.pub2.

Acupuncture for pain in endometriosis

Xiaoshu Zhu  1 , Kindreth D Hamilton, Ewan D McNicol
Affiliations

Acupuncture for pain in endometriosis

Xiaoshu Zhu et al. Cochrane Database Syst Rev. .

Abstract

Background: 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 strategy: 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.

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Conflict of interest statement

None known

Figures

1
1
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
2
2
Forest plot of comparison: 1 Dysmenorrhoea scores, outcome: 1.1 Scores post‐therapy.
3
3
Forest plot of comparison: 1 "Cure" rates, outcome: 1.1 Subjects designated "cured" or intervention "significantly effective" according to Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis.
1.1
1.1. Analysis
Comparison 1 Dysmenorrhoea scores, Outcome 1 Scores post‐therapy.
2.1
2.1. Analysis
Comparison 2 'Cure' rates, Outcome 1 Subjects designated "cured" or intervention "markedly effective" according to Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis.
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References

References to studies included in this review

Xiang 2002 {published data only}
    1. Xiang D, Situ Y, Liang X, Cheng L, Zhang G. Ear acupuncture therapy for 37 cases of dysmenorrhoea due to endometriosis. Zhong Yi Za Zhi [Journal of Traditional Chinese Medicine] 2002;22:282‐5. - PubMed

References to studies excluded from this review

Ahn 2009 {published data only}
    1. Anh AC, Schnyer R, Conboy L, Laufer M, Wayne, PM. Electrodermal measures of Jing‐well points and their clinical relevance in endometriosis‐related chronic pelvic pain. The Journal of Alternative and Complementary Medicine 2009;15:1293‐305. - PMC - PubMed
Conboy 2008 {published data only}
    1. Conboy L, Quilty MT, Kerr C, Shaw J, Wayne P. A qualitative analysis of adolescents’ experiences of active and sham Japanese‐style acupuncture protocols administered in a clinical trial. The Journal of Alternative and Complementary Medicine 2008;14(6):699‐705. - PubMed
Danielsson 2001 {published data only}
    1. Danielsson I. Dyspareunia in women with special reference to vulvar vestibulitis. Scandinavian Journal of Sexology 2001;4:235‐7.
Fu 2005 {published data only}
    1. Fu Y, Xia T. Clinical observation on the use of acupuncture and Chinese herbal medicine in combination for endometriosis. Shang Hai Zheng Jiu Za Zhi [Shang Hai Journal of Acupuncture and Moxibustion] 2005;24(3):3‐5.
Fugh‐Berman 2003 {published data only}
    1. Fugh‐Berman A, Kronenberg F. Complementary and alternative medicine (CAM) in reproductive‐age women: a review of randomised controlled trials. Reproductive Toxicology 2003;17:137‐52. - PubMed
Green 2010 {published data only}
    1. Green I, Cohen SL, Finkenzeller D, Christo PJ. Interventional therapies for controlling pelvic pain: What is the evidence?. Current Pain Headache Report 2010;14:22‐32. - PubMed
Highfield 2006 {published data only}
    1. Highfield ES, Laufer MR, Schnyer RN, Kerr C, Thomas P, Wayne PM. Adolescent endometriosis‐related pelvic pain treated with acupuncture: Two case reports. The Journal of Alternative and Complementary Medicine 2006;12(3):317‐22. - PubMed
Jin 2009 {published data only}
    1. Jin YB, Sun ZL, Jin HF. Randomised controlled study on ear‐electroacupuncture treatment of endometriosis induced dysmenorrhoea. Acupuncture Research 2009;26(3):188‐92. - PubMed
Lim 2009 {published data only}
    1. Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman BM. Acupuncture for the treatment of irritable bowel syndrome (review). Cochrane Database of Systematic Reivews 2006;18(4):CD005111. Review. - PubMed
Liu 2003 {published data only}
    1. Liu YX, Cao YX, Wang RY, MA XW, Fei L. Clinical observation on the use of herbal moxibustion with properties of warming and soothing functions for 76 cases of endometriosis. Xin Zhong Yi [New Chinese Medicine] 2003;35(5):55.
Liu 2009 {published data only}
    1. Liu YY, Ai Z, Xi YF, Lin F. Clinical observation on different acupuncture methods for endometriosis. Hu Bei Zhong Yi Za Zhi [Hu Bei Journal of Traditional Chinese Medicine] 2003;31(7):53.
Lundeberg 2008 {published data only}
    1. Lundeberg T, Lund I. Is there a role for acupuncture in endometriosis pain or 'endometrialgia'?. Acupuncture Medicine 2008;26(2):94‐110. - PubMed
Qu 2007 {published data only}
    1. Qu F, Zhou J. Acupuncture enhances the curative effect of Chinese medicinal herbs in treating infertility due to endometriosis. The Journal of Alternative and Complementary Medicine 2007;13:856.
Sanfilippo 2008 {published data only}
    1. Sanfiliippo J, Erb T. Evaluation and management of dysmenorrhoea in adolescents. Clinical Obstetrics and Gynecology 2008;51(2):257‐67. - PubMed
Schnyer 2008 {published data only}
    1. Schnyer, RN, Iuliano D, Kay J, Shields M, Wayne P. Development of protocols for randomised sham‐controlled trials of complex treatment interventions: Japanese acupuncture for endometriosis‐related pelvic pain. The Journal of Alternative and Complementary Medicine 2008;14(5):515‐22. - PMC - PubMed
Sun 2006 {published data only}
    1. Sun, YZ, Chen, HL. A control study on the use of acupuncture Shu and Mu points in combination for endometriosis. Zhong Guo Zhen Jiu [Chinese Acupuncture and Moxibustion] 2006;26:863‐5. - PubMed
Sun 2007 {published data only}
    1. Sun ZL, Jin YP. Clinical observation on the use of auricular acupuncture for 32 cases of endometriosis. Zhe Jiang Zhong Xi Yi Jie Za Zhi [Zhe Jiang Journal of Integration of Traditional Chinese and Western Medicine] 2007;17(12):738‐9.
Van Steirteghem 2009 {published data only}
    1. Steirteghem A. Editor's Choice. Human Reproduction 2009;24(5):1007.
Vercellini 2009 {published data only}
    1. Vercellini P, Crosignani PG, Abbiati A, Somiglinana E, Vigano P, Fedele L. The effect of surgery for symptomatic endometriosis: the other side of the story. Human Reproduction Update 2009;15(2):177‐88. - PubMed
Wayne 2008 {published data only}
    1. Wayne PM, Kerr CE, Schnyer RN, Legedza AT, Savetsky‐German J, Shields MH, et al. Japanese‐style acupuncture for endometriosis‐related pelvic pain in adolescents and young women: results of a randomised sham‐controlled trial. Journal of Pediatric & Adolescent Gynecology. 2008;21(5):247‐57. - PMC - PubMed
Xia 2006 {published data only}
    1. Xia T. Effect of acupuncture and Chinese medicine in treating endometriosis. Guo Ji Lin Chuang Zhen Ji [International Journal of Clinical Acupuncture] 2006;15(3):145‐50.
Yan 2008 {published data only}
    1. Yan H, Huang X, Deng, G. Observation on therapeutic effect of acupuncture and moxibustion on disorders of myometrial gland. Zhong Guo Zhen Jiu [Chinese Acupuncture and Moxibustion] 2008;28(8):579‐81. - PubMed
Zhen 2009 {published data only}
    1. Zeng R, Hong W. Clinical observation of the use of acupuncture with warming needle method for 38 cases of endometriosis. Yi Xue Li Lun Yu Shi Jian [Journal of Medical Theory & Practice] 2009;22(5):571‐2.

Additional references

Allen 2005
    1. Allen C. Non‐steroid anti‐inflammatory drugs for pain in women with endometriosis. Cochrane Database of Systematic Reviews 2005, Issue 4. [DOI: 10.1002/14651858.CD004753.pub2] - DOI - PubMed
Bajaj 2003
    1. Bajaj P, Bajaj P, Madsen H, Arendt‐Nielsen L. Endometriosis is associated with central sensitization: a psychophysical controlled study. The Journal of Pain 2003;4(7):372‐80. - PubMed
Cabýoglu 2006
    1. Cabýoglu MT, Ergene N, Tan U. The mechanism of acupuncture and clinical applications. International Journal of Neurosciences 2006;116(2):115‐25. - PubMed
Cai 1997
    1. Chai X. Substitution of acupuncture for human chorionic gonadotropin in ovulation induction. Zhong Yi Za Zhi [Journal of Traditional Chinese Medicine] 1997;17:19‐21. - PubMed
Chen 2007
    1. Chen D, Chen SR, Shi XL, Guo FL, Zhu YK, Li S, et al. Clinical study on needle‐pricking therapy for treatment of polycystic ovary syndrome. Zhong Guo Zhen Jiu [Chinese Acupuncture and Moxibustion] 2007;27(2):99‐102. - PubMed
Cho 2006
    1. Cho ZH, Hwang SC, Wong EK, Son YD, Kang CK, Park TS, et al. Neural substrates, experimental evidences and functional hypothesis of acupuncture mechanisms. Acta Neurologica Scandinavica 2006;113:370‐7. - PubMed
Cook 1995
    1. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995;310:452‐4. - PMC - PubMed
Davis 2007
    1. Davis L, Kennedy SS, Moore J, Prentice A. Modern combined oral contraceptives for pain associated with endometriosis. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD001019.pub2] - DOI - PubMed
Dawood 1991
    1. Dawood MY. Dysmenorrhoea. In: Max M, Portenoy R, Laska E editor(s). The design of analgesic clinical trials. New York: Raven Press, 1991.
Dawood 2006
    1. Dawood MY. Primary dysmenorrhoea: Advances in pathogenesis and management. Obstetrics and Gynaecology 2006;108(2):428‐41. - PubMed
Denny 2004
    1. Denny E. Women's experience of endometriosis. Journal of Advanced Nursing 2004;46(6):641‐8. - PubMed
Deyo 1983
    1. Deyo R A, Inui TS, Leininger JD. Measuring functional outcomes in chronic disease: a comparison of traditional scales and a self administered health status questionnaire in patients with rheumatoid arthritis. Medical Care 1983;21:180‐92. - PubMed
Farmer 2003
    1. Farmer JE, Prentice A, Breeze A, Ahmad G, Duffy JMN, Watson A, Pick A. Gonadotrophin‐releasing hormone analogues for endometriosis: bone mineral density. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD001297] - DOI - PMC - PubMed
Farquhar 2000
    1. Farquhar C. Extracts from the "clinical evidence". Endometriosis. BMJ 2000;320(7247):1449‐52. - PMC - PubMed
Farquhar 2007
    1. Farquhar C. Endometriosis. BMJ 2007;334:249‐53. - PMC - PubMed
Frankiewicz 2000
    1. Frackiewicz E. Endometriosis: an overview of the disease and its treatment. Journal of the American Pharmacists Association 2000;40(5):645‐57. - PubMed
Gao 2006
    1. Gao X, Outley J, Botteman M, Spaulding J, Simon J, Pashos C. Economic burden of endometriosis. Fertility and Sterility 2006;86(6):1561‐72. - PubMed
Hamilton 2008
    1. Hamilton JL, Roemheld‐Hamm B, Young DM, Jalba M, DiCicco‐Bloom Y. Complementary and alternative medicine in US family medicine practices: a pilot qualitative study. Alternative Therapies in Health & Medicine 2008;14(3):22‐7. - PubMed
Harkin 2007
    1. Harkin C, Parker R. A prospective, randomised control trial of acupuncture for select common conditions within the emergency department. Journal of Chinese Medicine 2007;85:41‐8.
Higgins 2008
    1. Higgins JPT, Altman DG (editors) on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group. Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S, editors, Cochrane Handbook of Systematic Reviews of Intervention. Version 5.0.0 (updated February 2008). The Cochrane Collaboration, 2008. Available from www.cochrane‐handbook.org.
Hope‐Allan 2004
    1. Hope‐Allan N, Adams J, Sibbritt D, Tracy S. The use of acupuncture in maternity care: a pilot study evaluating the acupuncture service in an Australian hospital antenatal clinic. Complementary Therapies in Nursing & Midwifery 2004;10(4):229‐32. - PubMed
Hughes 2007
    1. Hughes E, Brown J, Collins JJ, Farquhar C, Fedorkow DM, Vandekerckhove P. Ovulation suppression for endometriosis. Cochrane Database of Systematic Reviews 2007, Issue 3. [DOI: 10.1002/14651858.CD000155.pub2] - DOI - PMC - PubMed
Hunt 1986
    1. Hunt SM, McEwan J, McKenna SP. Measuring Health Status. Beckenham: Croom Helm, 1986.
Jackson 2006
    1. Jackson B, Telner DE. Managing the misplaced. Canadian Family Physician 2006;52:1420‐4. - PMC - PubMed
Kaptchuk 2006
    1. Kaptchuk TJ, Stason WB, Davis RB, Legedza ATR, Schnyer RN, Kerr CE, et al. Sham device vs inert pill: randomised controlled trial of two placebo treatments. BMJ 2006;332:391‐7. - PMC - PubMed
Kennedy 2005
    1. Kennedy S, Bergqvist A, Chapron C, D'Hooghe T, Dunselman G, Greb R, et al. ESHRE Special Interest Group for Endometriosis and Endometrium Guideline Development Group. ESHRE guideline for the diagnosis and treatment of endometriosis. Human Reproduction 2005;20(10):2698‐704. - PubMed
Lan 1997
    1. Lan FL, Li D. The development of study on acupuncture for uterine fibroids. Zhong Guo Zhen Jiu [Journal of Clinical Acupuncture and Moxibustion] 1997;13(10):51‐3.
Li 2001
    1. Li X. Exploration of the use of TCM for the diagnosis and treatment of endometriosis. Shang Hai Zhong Yi Yao Da Xue Xue Bao [ACTA Universitatis of Traditions Medicalis Sinensis Pharmacologiaeque Shanghai] 2001;15(3):33‐4.
Liao 2008
    1. Liao XH, Zhang GM, Qi QY, Zhang YY. Overview of TCM research on endometriosis. Zhong Yi Yao Xin Xi [Information on Traditional Chinese Medicine] 2008;25(1):24‐5.
Lin 2008 a
    1. Lin J, Chen W. Acupuncture analgesia: a review of its mechanisms of actions. American Journal of Chinese Medicine 2008;36(4):635‐45. - PubMed
Lin 2008 b
    1. Lin LL, Liu C, ZHuang BY. Clinical observation on treatment of primary dysmenorrhoea with acupuncture and massage. Zhong Guo Zhong Xi Yi Jie He Za Zhi [China Journal of Integrated Traditional and Western Medicine] 2008;28(5):418‐20. - PubMed
Linde 2010
    1. Linde K, Niemanna K, Meissner K. Are sham acupuncture interventions more effective than (other) placebos? A re‐analysis of data from the Cochrane Review on Placebo Effects. Fortschritte der Komplementmedizin 2010;17:259‐64. - PubMed
Maciocia 1998
    1. Maciocia G. The foundations of Chinese medicine: a comprehensive text for acupuncturists and herbalists. Edinburgh: Churchill Livingstone, 1998.
MacPherson 2007
    1. MacPherson H, White A, Bensoussan A. Chapter 5: The Safety of Acupuncture. In: MacPherson H, Hummerschlag, R, Lewith G, Schyer R editor(s). Acupuncture Research: Strategies for Establishing an Evidence Base. Churchill Livingstone, 2007:57‐76.
McQuay 1998
    1. McQuay H, Moore R. Summary measures. In: McQuay H, Moore R editor(s). An evidence‐based resource for pain relief. 1st Edition. Oxford: Oxford University Press, 1998:14‐8.
Medical Outcomes Trust 1994
    1. Medical Outcomes Trust. SF‐36 Health Survey scoring manual language adaptations: Australia/New Zealand, Canada, United Kingdom. Boston: Medical Outcomes Trust, 1994.
Ministry of Public Health 1993
    1. Ministry of Public Health, P.R. China. Guideline for clinical research on new Chinese medicine for the treatment of pelvic endometriosis. Guideline for Clinical Research on New Chinese Medicine 1993;1:267.
Moore 1998
    1. Moore RA, Gavaghan D, Tramer MR, Collins SL, McQuay HJ. Size is everything – large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998;78:209‐16. - PubMed
Olive 2008
    1. Olive DL. Gonadotropin‐releasing hormone agonists for endometriosis. New England Journal of Medicine 2008;359:1136‐42. - PubMed
Prentice 2001
    1. Prentice A. Endometriosis. BMJ 2001;323(14):93‐5. - PMC - PubMed
Proctor 2002
    1. Proctor ML, Smith CA, Farquhar CM, Stones RW. Transcutaneous electrical nerve stimulation and acupuncture for primary dysmenorrhoea. Cochrane Database of Systematic Reviews 2002, Issue 1. [DOI: 10.1002/14651858.CD002123] - DOI - PMC - PubMed
Qiu 1993
    1. Qiu ML, Li LY. Chinese Acupuncture and Moxibustion. Singapore: Churchill Livingstone, 1993.
Schmineke 2008
    1. Schmincke C, Torres‐Londoño P, Seiling M, Gaus W. Evaluating traditional Chinese medicine as applied in the Clinic at Steigerwald. Part 1: Methods of assessment. Fortschritte der Komplementmedizin 2008;Apr;15(2):89‐95. - PubMed
Selak 2007
    1. Selak V, Farquhar C, Prentice A, Singla A. Danazol for pelvic pain associated with endometriosis. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD000068.pub2] - DOI - PubMed
Shakiba 2008
    1. Shakiba K, Bena JF, McGill KM, Minger J, Falcone T. Treatment of endometriosis: a 7‐year follow‐up on the requirement for further surgery. Obstetrics and Gynecology 2008;111(6):1285‐92. - PubMed
Stratton 2006
    1. Stratton P. The tangled web of reasons for the delay in diagnosis of endometriosis in women with chronic pelvic pain: will the suffering end?. Fertility and Sterility 2006;86(5):1302‐4. - PubMed
Streitberger 1998
    1. Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 1998;352(9125):364‐5. - PubMed
White 2001
    1. White AR, Filshie J, Cummings TM. Clinical trials of acupuncture: consensus recommendations for optimal treatment, sham controls and blinding. Complementary Therapies in Medicine 2001;9:237‐45. - PubMed
Wu 2007
    1. Wu M, Shoji Y, Chuang P, Tsai S. Endometriosis: disease pathophysiology and the role of prostaglandins. Expert Reviews in Molecular Medicine 2007;9(2):1‐20. - PubMed
Xia 2000
    1. Xia GC. Chinese medicine diagnosis and treatment in the management of menstrual disorders. Beijing: People's Press, 2000.
Xiang 2005
    1. Xiang DF, Si DY. Laboratory study on influence of auricular acupuncture in regulating β‐endorphin and uterine activity on animal model of endometriosis. Guo Yi Lun Tan [Forum on Traditional Chinese Medicine] 2005;20(4):46‐7.
Yu 1998
    1. Yu J. Handbook of Obstetrics and Gynaecology in Chinese Medicine: an integrated approach. Seattle: Eastland Press, 1998.
Zhang 2008
    1. Zhang Y, Clarke J, Feng H, Liu Z, Weina P. Acupuncture for uterine fibroids. Cochrane Database of Systematic Reviews 2008, Issue 3. [DOI: 10.1002/14651858.CD007221] - DOI - PMC - PubMed

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