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Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial

ABSTRACT

Introduction
Dysmenorrhea constitutes one of the most frequent disorders in women of a fertile age. The present study was conducted to evaluate the efficacy of acupuncture in the management of primary dysmenorrhea.

Materials and methods
Sixty females aged 17–23 years were randomly assigned to either a study group or a control group. The study group received acupuncture for the duration of 20 minutes/day, for 15 days/month, for the period of 90 days. The control group did not receive acupuncture for the same period. Baseline, during, and post assessments of both the groups were taken on day 1; day 30 and day 60; and day 90, respectively. Statistical analysis was performed by repeated measures of analysis of variance followed by posthoc analysis with Bonferroni adjustment for multiple comparisons, independent samples t test for visual analog scale score, and Mann–Whitney U test for rest of the variables using statistical package for the social sciences, version 16.

Results
This study showed a significant reduction in all the variables such as the visual analog scale score for pain, menstrual cramps, headache, dizziness, diarrhea, faint, mood changes, tiredness, nausea, and vomiting in the study group compared with those in the control group.

Conclusion
Acupuncture could be considered as an effective treatment modality for the management of primary dysmenorrhea.

Intervention

Study group: Participants received clinical acupuncture in Traditional Chinese Medicine style of acupuncture for symptomatic relief of dysmenorrhea. Needling was performed at 12 acupuncture points, such as KI-3, SP-8, ST-25, ST-29, ST-30, ST-36, CV-4, CV-6, BL-62, HT-7, LI-4, and PC-6 [5]. Of the 12 acupuncture points, two acupuncture points, i.e., CV-4 and CV-6, were needled using single needle for each point, whereas the rest of the 10 acupuncture points were needled bilaterally. Detailed description of these acupuncture points are provided in Table 1. Participants were informed about the procedure, sensations of needle insertion, and response sought. All needles were left undisturbed for a duration of 20 minutes without any stimulation for each session. We used 0.2 × 30 mm locally manufactured stainless steel needles. Each participant received a total of 45 sessions of acupuncture [1 session (20 minutes)/day, 15 sessions/30 days, for the period of 90 days]. Needling was started on the 6th day of menstrual cycle and was not performed during menstruations. Along with acupuncture, participants did not receive other treatments. Acupuncture was given by an institutionally qualified physician who has experience of more than 15 years in clinical acupuncture

Control group: Participants did not receive acupuncture and continued with their normal routine during the study period.

Discussion
Results of the present study showed a significant reduction in pain severity, muscle cramps, and systemic symptoms in the study group compared with the control group. Reduction in pain was also found in the previous studies on acupuncture in dysmenorrhea which supports the study findings. Improvement in the pain and other symptoms of dysmenorrhea could be possibly through the central analgesic effect of acupuncture  and its reflex effects on the tissues such as changes in blood flow substrates of acupuncture analgesia. From a biochemical perspective, it appears that acupuncture may alter the metabolism of substrates involved in the ascending facilitatory pathways, viz., N-methyl-D-aspartate receptors, substance P, and interleukin-1 and the descending inhibitory pain pathways, viz., endogenous opioids serotonin, and norepinephrine. From a neuroanatomical standpoint, several central nervous system structures are involved in acupuncture analgesia, including periaqueductal gray, nucleus raphe magnus, locus coeruleus, arcuate nucleus, amygdala, and nucleus accumbens In a previous study, stimulation of acupuncture points through needling was shown to trigger the release of enkephalins and endorphins in the periaqueductal gray, arcuate nucleus, and caudate nucleus. These structures send projections to the spinal dorsal horn via dorsal lateral funiculi. Increases in serotonin release at nucleus raphe magnus and norepinephrine release in locus ceruleus are also crucial for acupuncture-induced analgesia  in dysmenorrhea and other painful conditions.

Authors: Geetha B.Shetty1 BalakrishnaShettyA.Mooventhan3

Quelle: https://doi.org/10.1016/j.jams.2018.04.001

https://www.sciencedirect.com/science/article/pii/S2005290117302066

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