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Acupuncture ‘is better than drugs’ for period pain

By Lilian Anekwe

A systematic review of acupuncture for the treatment of primary dysmenorrhoea has concluded that there is ‘promising evidence' for its use.

South Korean researchers evaluated 27 randomised controlled trials of 3,000 women who were treated with a variety of different forms of acupuncture. It concludes that - compared with pharmacological treatment or herbal medicine - acupuncture was associated with a significant reduction in pain.

Overall 12 trials concluded that acupuncture was more effective than pharmacological treatment, and three trials that used pain severity scales showed that traditional acupuncture was significantly better than pharmacological treatment.

One comparison between acupuncture and herbal medicine found a significant mean difference of 2.21 points on a symptom severity scale. But comparisons of acupuncture with sham acupuncture were less clear. While some trials reported an improvement in pain relief in women given acupuncture compared with sham acupuncture, one reported no significant difference in menstrual pain score.

Physical exercise has also been suggested as a non-medical approach to the management of primary dysmenorrhoea, but earlier this month a Cochrane review by researchers from New Zealand found there is a lack of available evidence from randomised controlled trials to support the use of exercise in the alleviation of symptoms associated with dysmenorrhoea.

Four potential trials were identified of which one found some evidence that exercise reduced the Moos' Menstrual Distress Questionnaire (MDQ) score during the menstrual phase and resulted in a sustained decrease in symptoms over the three observed cycles, but warned that the data ‘should be interpreted with caution.'

The team behind last week's acupuncture review - from the Kyung Hee medical centre in Seoul - concluded in the British Journal of Obstetrics and Gynaecology: 'There is convincing evidence that acupuncture stimulates the production of endorphins, serotonin and acetylcholine within the central nervous system, thus enhancing analgesia. [But] the evidence for the effectiveness of acupuncture compared with sham acupuncture for the treatment of primary dysmenorrhoea is not convincing.'

Professor Philip Steer, professor of obstetrics at Imperial College London, said: ‘Women with primary dysmenorrhoea should consult their GPs or gynaecologists on the best treatment available to them. Complementary therapies should not be used exclusively, at the expense of conventional treatment, unless significant improvements have been made and your doctor tells you otherwise.'

The study found acupuncture was 'better than drugs' for treating period pain How do I manage primary dysmenorrhoea?

• Offer a nonsteroidal anti-inflammatory drug (NSAID) first line unless NSAIDs are contraindicated. Ibuprofen, naproxen, and mefenamic acid are the NSAIDs of choice

• Offer paracetamol first line if NSAIDs are contraindicated or not tolerated, or in addition to an NSAID if the response is insufficient

• Codeine may be added to paracetamol or an NSAID if the response is insufficient

• If the woman does not wish to conceive, consider hormonal contraception as alternative first-line treatment. Monophasic combined oral contraceptive (COC) preparations containing 30–35 micrograms of ethinylestradiol, and norethisterone, norgestimate, or levonorgestrel, are usually first choice

• Refer the woman if her symptoms are severe and not responding to initial treatment, or if there is doubt about the diagnosis

• Non-drug measures that may help to reduce pain include local application of heat and transcutaneous electrical nerve stimulation (TENS)

Source: NHS clinical knowledge summary June 2009