Acupuncture found to be effective adjunctive treatment for endometriosis-related pain

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Meta-analysis of 3 studies of acupuncture for relief of endometriosis-related pain found positive results for reduction in pain intensity, according to research published in the Journal of Pain Research. This alternative and complementary therapy has been proven to be safe, with a low side-effect profile.

Swedish researchers performed a literature search for clinical trials, case reports, and observational studies with abstracts written in English using the keywords “acupuncture and endometriosis.” They retrieved 3 articles involving a total of 99 women with diagnosed endometriosis (stages I-IV) aged 13 to 40. All of the studies entailed acupuncture sessions during which 7 to 12 needles were inserted per subject and left in for 15 to 25 minutes. The needles were placed in the lower back,/pelvic area, lower abdominal area, feet, and/or hands. Depth of stimulation with the needles ranged from intracutaneous to subcutaneous to intramuscular, and the stimulation was primarily manual in nature. The number of treatments varied from 9 to 16 and occurred once or twice a week, and treatments were given in a hospital, acupuncturist’s office, or patient’s home. All of the studies reported a decrease in rated pain intensity, but differed in terms of research design, needle stimulation techniques, and the instruments used to evaluate the outcomes.

Two of the studies were prospective, randomized, single-blind, placebo/sham trials and the other was a retrospective observational case series study (n=2). The Visual Analog Scale, Numeric Rating Scale, and Verbal Rating Scale were used to measure patient-rated pain intensity. Subjects were permitted to continue using their standard analgesic in 2 studies.

The results indicated that no matter the specific technique used, acupuncture effectively and safely reduced pain intensity compared to baseline. One study found that acupuncture also reduced pain-related disability, and 2 studies found reduced analgesic intake and perceived stress. Likewise, 2 studies found that the therapy improved health-related quality of life, and social activity and attendance in school were increased after acupuncture treatment in the observational study.

Controversial Intervention

Although acupuncture has been used for many years to relieve pain and has been noted to have few serious side effects, its use remains controversial due to a lack of understanding of its mechanism of action. The authors reported that “the pain-alleviating effects induced by acupuncture have been attributed to different physiological and psychological processes such as activation of endogenous descending pain inhibitory systems, deactivation of brain areas transmitting sensations of pain-related unpleasantness, interaction between nocioceptive impulses and somato-visceral reflexes, and as a method that induces the expectation of symptom relief.” They noted that currently available therapies for pain management in endometriosis patients are often ineffective or accompanied by adverse effects, and there is need for nonpharmacological interventions such as acupuncture. They further noted that acupuncture has no impact on the environment, according it the designation of a “sustainable” therapy.

Because a variety of techniques were used in the three studies, the authors were not able to identify the type of needle stimulation most likely to be effective in women with endometriosis, and suggested a need for future studies comparing the effectiveness of different techniques.