Acupuncture for Pain and Pain-related Disability in Deep Infiltrating Endometriosis

Overview

Journal Front Pain Res (Lausanne)

Date 2024 Mar 25

PMID 38524269

Authors

Giulia Chiarle

Gianni Allais

Silvia Sinigaglia

Gisella Airola

Sara Rolando

Fabiola Bergandi

Salvatore Micalef

Chiara Benedetto

Affiliations

Soon will be listed here.

Abstract

Objectives: To evaluate the efficacy of acupuncture in relieving symptoms (dysmenorrhea, dyspareunia, pelvic pain and dyschezia) intensity, improving functional disability, reducing the number of days per months of dysmenorrhea, the frequency and the efficacy of analgesic use in deep infiltrating endometriosis (DIE). The safety profile was also evaluated.

Methods: The study sample was 34 patients with DIE; for 2 months (T-2, T-1) the women recorded diary notes on the numbers of days of menstruation, the presence, intensity, and disability related to dysmenorrhea, dyspareunia, pelvic pain, and dyschezia. They then received a total of 15 acupuncture treatments over 6 months (T1-T6; once a week for 12 weeks, then once a month for 3 months).

Results: Dysmenorrhea intensity was decreased during treatment. A decrease of at least 50% in number of days of dysmenorrhea, and a decrease in moderate-to-severe disability starting from T1 to T6 was recorded for 58.6% of patients. Dyspareunia intensity steadily decreased starting at T2; the percentage of women with moderate-to-severe disability declined from 73.3% at T-2, to 36.9% at T3, T4, and T5. A decrease in pelvic pain score was noted starting at T1; the percentage of disability decreased from 83.3% at T-2 to 33.3% at T3 and T6. The intensity of dyschezia decreased from T-2 to T3 and T4 and then increased slightly. Analgesic drug use was lower during treatment and its efficacy appeared to be greater.

Conclusions: The limitations notwithstanding our study-findings show that acupuncture was safe and effective in reducing pain intensity and symptoms-related disability. Larger-scale studies are needed to compare acupuncture and pharmacotherapy for endometriosis-related pain.

References

Koninckx P, Martin D . Deep endometriosis: a consequence of infiltration or retraction or possibly adenomyosis externa?. Fertil Steril. 1992; 58(5):924-8. DOI: 10.1016/s0015-0282(16)55436-3. View

Biberoglu K, BEHRMAN S . Dosage aspects of danazol therapy in endometriosis: short-term and long-term effectiveness. Am J Obstet Gynecol. 1981; 139(6):645-54. DOI: 10.1016/0002-9378(81)90478-6. View

Ma J, Yun-guang H, Zhang D . [Effects of acupuncture on bone metabolism and serum estradiol level in ovariectomy-induced osteoporosis rats]. Zhen Ci Yan Jiu. 2008; 33(4):235-9. View

Rubi-Klein K, Kucera-Sliutz E, Nissel H, Bijak M, Stockenhuber D, Fink M . Is acupuncture in addition to conventional medicine effective as pain treatment for endometriosis? A randomised controlled cross-over trial. Eur J Obstet Gynecol Reprod Biol. 2010; 153(1):90-3. DOI: 10.1016/j.ejogrb.2010.06.023. View

Ahn S, Khalaj K, Young S, Lessey B, Koti M, Tayade C . Immune-inflammation gene signatures in endometriosis patients. Fertil Steril. 2016; 106(6):1420-1431.e7. PMC: 5683404. DOI: 10.1016/j.fertnstert.2016.07.005. View

Nirgianakis K, Ma L, McKinnon B, Mueller M . Recurrence Patterns after Surgery in Patients with Different Endometriosis Subtypes: A Long-Term Hospital-Based Cohort Study. J Clin Med. 2020; 9(2). PMC: 7073694. DOI: 10.3390/jcm9020496. View

Zhu X, Hamilton K, McNicol E . Acupuncture for pain in endometriosis. Cochrane Database Syst Rev. 2011; (9):CD007864. PMC: 10010596. DOI: 10.1002/14651858.CD007864.pub2. View

Bausell R, Lao L, Bergman S, Lee W, Berman B . Is acupuncture analgesia an expectancy effect? Preliminary evidence based on participants' perceived assignments in two placebo-controlled trials. Eval Health Prof. 2005; 28(1):9-26. DOI: 10.1177/0163278704273081. View

Streitberger K, Kleinhenz J . Introducing a placebo needle into acupuncture research. Lancet. 1998; 352(9125):364-5. DOI: 10.1016/S0140-6736(97)10471-8. View

10.

Chae Y . The dilemma of placebo needles in acupuncture research. Acupunct Med. 2017; 35(5):382-383. DOI: 10.1136/acupmed-2017-011394. View

11.

Ouchi N, Akira S, Mine K, Ichikawa M, Takeshita T . Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention. J Obstet Gynaecol Res. 2013; 40(1):230-6. DOI: 10.1111/jog.12164. View

12.

Ernst E, Lee M, Choi T . Acupuncture in obstetrics and gynecology: an overview of systematic reviews. Am J Chin Med. 2011; 39(3):423-31. DOI: 10.1142/S0192415X11008920. View

13.

Soliman A, Du E, Yang H, Wu E, Haley J . Retreatment Rates Among Endometriosis Patients Undergoing Hysterectomy or Laparoscopy. J Womens Health (Larchmt). 2017; 26(6):644-654. DOI: 10.1089/jwh.2016.6043. View

14.

Witt C, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S . Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009; 16(2):91-7. DOI: 10.1159/000209315. View

15.

Park J, White A, Stevinson C, Ernst E, James M . Validating a new non-penetrating sham acupuncture device: two randomised controlled trials. Acupunct Med. 2003; 20(4):168-74. DOI: 10.1136/aim.20.4.168. View

16.

Brown J, Farquhar C . Endometriosis: an overview of Cochrane Reviews. Cochrane Database Syst Rev. 2014; (3):CD009590. PMC: 6984415. DOI: 10.1002/14651858.CD009590.pub2. View

17.

Tobiume T, Kotani Y, Takaya H, Nakai H, Tsuji I, Suzuki A . Determinant factors of postoperative recurrence of endometriosis: difference between endometrioma and pain. Eur J Obstet Gynecol Reprod Biol. 2016; 205:54-9. DOI: 10.1016/j.ejogrb.2016.07.516. View

18.

Xu Y, Zhao W, Li T, Zhao Y, Bu H, Song S . Effects of acupuncture for the treatment of endometriosis-related pain: A systematic review and meta-analysis. PLoS One. 2017; 12(10):e0186616. PMC: 5659600. DOI: 10.1371/journal.pone.0186616. View

19.

Wang Y, Coyle M, Hong M, He S, Zhang A, Guo X . Acupuncture and moxibustion for endometriosis: A systematic review and analysis. Complement Ther Med. 2023; 76:102963. DOI: 10.1016/j.ctim.2023.102963. View

20.

Brown J, Crawford T, Allen C, Hopewell S, Prentice A . Nonsteroidal anti-inflammatory drugs for pain in women with endometriosis. Cochrane Database Syst Rev. 2017; 1:CD004753. PMC: 6464974. DOI: 10.1002/14651858.CD004753.pub4. View