Effects of Acupoint-Stimulation in the Treatment of Primary Dysmenorrhoea Compared with NSAIDs: A Systematic Review and Meta-analysis
Acupoint-stimulation is an effective measure in relieving pain associated with primary dysmenorrhoea (PD) and also offers additional benefits in increasing the overall effectiveness.
Dysmennorhoea is a prevalent gynecological complaint among adolescent and young adult females. The global prevalence of the condition differs among various countries and ranges from 80% in Western Australia, to 60% in Canada, 48.4% in Mexico, and 79.9% in Iran. Among 50% of females of reproductive age with painful menstruation, 10% suffers from severe dysmenorrhoea.
Dysmennorhoea is a prevalent gynecological complaint among adolescent and young adult females. The global prevalence of the condition differs among various countries and ranges from 80% in Western Australia, to 60% in Canada, 48.4% in Mexico, and 79.9% in Iran. Among 50% of females of reproductive age with painful menstruation, 10% suffers from severe dysmenorrhoea. It starts few hours before the onset of menstruation and continues for 48–72 h. It causes cramps in lower abdomen that radiates towards the inner side of the thighs and systematic symptoms such as nausea, vomiting, diarrhea, fatigue, irritability and dizziness. The patients suffering from mild to moderate pain does not need medical treatment, but those with severe pain need some drugs for pain management. Dysmennorhoea occurring in adolescents and young adults is defined as primary with normal pelvic anatomy, while in severe cases, pelvic abnormalities such as endometriosis or uterine anomalies may occur which is considered to as secondary dysmenorrhoea.
Pathogenesis of primary dysmenorrhoea (PD) has been a focus for researchers in the recent years. The pathogenesis of PD is related to two factors including abnormal uterine contraction, and endocrine and metabolic factors, in addition to factors relating to the body’s nerve, genetic and immune systems, and psychological/social factors. The condition of uterine ischemia and hypoxia leads to contraction in muscles that in turn rises intrauterine tension, ultimately causing abdominal pain. Various types of molecular endocrine factors seem to play an integral role in pathogenesis of PD, such as prostaglandins (PGs), oxytocin (OT) and vasopressin (VP), β-EPs, nitric oxide (NO), noradrenaline (NE), endothelins, and magnesium and calcium ions. Among these molecular factors, prostaglandin F2α (PGF2α), cyclooxygenase (COX) metabolite of arachidonic acid, causes potent vasoconstriction and myometrial contractions, leading to uterine ischemia and pain.
A variety of pharmacological and non-pharmacological treatments including Non-Steroidal Anti-Inflammatory Drugs (NASIDs) and oral contraceptives are available for the management of dysmenorrhoea. Among these therapeutic modalities, NSAIDs are widely used, but these are associated with various side effects like stomach ache, diarrhoea, nausea, and liver or kidney damage. Therefore, patients are seeking complementary and alternative techniques such as acupoint-stimulation to treat the symptoms of PD. Acupuncture stimulates the acupoint(s) to enhance the body’s endogenetic regulated function in order to preventing and treating diseases by controlling the meridian system.
Rationale behind the research
- There are various publications available in history reporting the use of acupuncture in PD, but still there evidences are of low quality and of small sample size. So there is a need of further research of high methodoligical quality in this context.
To evaluate the efficacy and safety of acupoint-stimulation compared with NASIDs in the treatment of PD.
Note: This was a systematic review and meta-analysis
- Study outcome measures
- Clinical effectiveness rate, Symptom score, Visual analogue score (VAS), Peripheral blood PGF2α, and side effects
- The clinical efficacy of intervention group was better than control group (odds ratio = 5.57; 95% confidence interval (95% CI) = 3.96, 7.83; p<0.00001)
- The effect of intervention was positive in relieving the severity of PD symptoms as comparted to control group (mean difference (MD) = 2.99; 95%CI = 2.49, 3.49; p<0.00001)
- There was no statistical difference existed between two groups in terms of a reduction in the VAS (MD = 1.24; 95%CI = −3.37, 5.85; P=0.60)
- There was a positive effect seen on the variation in peripheral blood PGF2α between two groups was positive (MD = 7.55; 95%CI = 4.29,10.82; p<0.00001)
- There were increase in side effects associated with control groups as compared to acupoint-stimulation group: OR = 0.03; 95%CI =0.00,0.22; P= 0.0005.
The systematic review included 19 RCTs and their meta analysis determined that acupoint stimulation in PD was clinically superior to NSAIDs in terms of efficacy, improvement in symptoms and reducing the concentration of PGF2α in peripheral blood. Most of the RCTs included in this review utilize a self -reported index of treatment effects as the outcome measure and different treatments methods such as acupuncture, moxibustion, ear acupressure, electroacupuncture and acupoint application were used in intervention group for the prrpose of acupoint stimulation.
The main approach, NSAIDs work by suppressing the conversion of arachidonic acid to cyclic endoperoxides, namely COX, which disrupts the production of prostaglandins (PGs) and are considered as a drug of positive control. The lower levels of PGs results in vigorous contraction of uterus and less pain. They are helpful in alleviation of discomfort and pain, but they suffers from various limitations like adverse reactions of gastrointestinal and central nervous system
It was concluded that the comparison between the effect of acupoint-stimulation and NSADIs in the treatment of PD presents new evidences and horizons which shows effectiveness of acupoint-stimulation in pain relief for the treatment of PD and offers advantages in increasing the overall effectiveness.