A clinical trial of acupuncture about time-varying treatment and points selection in primary dysmenorrhea

Abstract

Objective

To observe the clinical therapeutic effects of acupuncture at single point Shiqizhui (EX-B8) and multi-points in time-varying treatment for primary dysmenorrhea.

Methods

600 patients with primary dysmenorrhea were randomly assigned to the single point group (n=200) including group A (treating before the menstruation, n=100) and group B (immediately treating as soon as pain occurrence, n=100), the multi-points group (n=200) including group C (treating before the menstruation, n=100) and group D (immediately treating as soon as pain occurrence, n=100), or the control group, group E (n=200, no treatment). The therapeutic effects were analyzed after treatment for three menstrual cycles and interviewed for three follow-up periods.

Results

Acupuncture could effectively relieve menstrual pain for primary dysmenorrhea compared with the control group (P<0.05, P<0.01). Immediate pain relief occurred following acupuncture within 5 min in group B (P<0.01) and group D (P<0.01), and the two groups obviously relieved menstrual pain for VAS scores. Both group A and group C obviously relieved menstrual pain (P<0.01), and group C was better than group A (P<0.05). Compared with group D, Group C was much better for CMSS scores in cycle 1.

Conclusion

Treating before the menstruation is better than immediately treating as soon as pain occurrence at the improvement in symptoms of dysmenorrheal at multi-points. And single point is better than multi-points when immediately treating as soon as pain occurrence. The present trial suggest Shiqizhui (EX-B8) should be chosen as a convenient point.

Introduction

Dysmenorrhea is a painful uterine contraction during menstruation and is one of the most common disorders in women (Shah-Hosseini et al., 2005). It affects almost half of them, with symptoms becoming too severe in 10% of the half women to disturb their routine activities (Daniels et al., 2005, Holtzman et al., 2008). Primary dysmenorrhea (PD), which is defined as painful menses in women with normal pelvic anatomy, usually begins during adolescence. Depending on the measurement used, 20% to 90% of young girls report primary dysmenorrheal (Harel, 2006, Latthe et al., 2006, Patel et al., 2006).

Evidence of efficacy supports use of pharmacological agents such as NSAIDs (Wong et al., 2009), and the use of oral contraceptives (Sundell et al., 1990) to alleviate menstrual pain. However, side effects may not be well tolerated or pain relief may be inadequate for some women. Acupuncture has been proven by a great number of randomized controlled trials (RCTs) that it is effective in treatment of chronic low back pain (Witt et al., 2006), knee osteoarthritis (Witt et al., 2005), migraine (Li et al., 2009), chronic neck pain (Willich et al., 2006), and other conditions. Acupuncture has been used to treat dysmenorrhea for over 2000 years in China. Recent developments of acupuncture in Australia indicate that through adequate and appropriate evaluation, it is being integrated into mainstream health care in Australia (Changli Xue et al., 2009). A clinical study showed both acupuncture and western medication are effective for primary dysmenorrhea and acupuncture treatment is better than Ibuprofen (Bing and Xiaohua 2011).

Acupuncture on treatment of primary dysmenorrhea is usually started before the menstruation in clinical. Several studies have used different time sequences of acupressure in dysmenorrheal (Wayne et al., 2008, Cho and Hwang, 2010, Lin et al., 2010). There are short of the evidence-based medicine about the point selection and time of intervention in primary dysmenorrhea. The aim of our study was to examine the effectiveness of acupuncture in time-varying treatment with single point and multi-points, and to screen out the best therapeutic regimen for primary dysmenorrhea. The program is registered with its own identifier (ChiCTR-TRC-09000471) by Chinese Clinical Trial Register in China.