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Research concerning gynecological pain (period pain, vulvodynia)

Last updated: 11 March, 2017
by Steven Clavey, Traditional Chinese Gynaecology

Period pain

Chinese Herbal Medications for Dysmenorrhea: A Best Evidence Review

Regardless of these study limitations, Chinese herbal medications were generally effective against dysmenorrhea. Herbal medications were approximately twice as likely to improve pain compared with conventional therapy

Chinese herbal medications can also be rapidly effective against dysmenorrhea; one trial demonstrated an analgesic effect within 30 minutes. There was evidence as well that Chinese herbal medications may reduce patients’ use of other analgesic medications for dysmenorrhea.

Chinese herbal medications were superior to over-the-counter health supplements in improving dysmenorrhea. A tailored herbal regimen was more than twice as likely to improve dysmenorrhea as a routine herbal preparation available without a prescription. ”

Chinese Herbal Medications for Dysmenorrhea: A Best Evidence Review

Authors: Charles P. Vega, MD

Best Evidence Reference: Chinese Herbal Medicine for Primary Dysmenorrhea

Zhu X, Proctor M, Bensoussan A, Smith CA, Wu E

Cochrane Database of Systemic Reviews. 2007; Issue 4. Article No. CD005288

The study that this review is based on was selected from Medscape Best Evidence, which uses the McMaster Online Rating of Evidence System. Out of a possible top score of 7, this study was ranked as 7 for newsworthiness and 6 for relevance by clinicians who used this system.

Summary

Primary dysmenorrhea is a common condition that can have a significant impact on the lives of women. Although currently available treatments may be effective for dysmenorrhea, many young women may not seek treatment and are unaware of treatment options. Chinese herbal medications may be an attractive treatment alternative for many women, but there are questions regarding their efficacy. The current review highlights this issue as well as challenges in applying medical practices across different cultures.

Current Review

The current systematic review generally supports the use of Chinese herbal medicine for the treatment of primary dysmenorrhea, but it also highlights some of the difficulties in applying Western standards of evidence-based medicine to treatments used for thousands of years in the Far East. The review considered only trials of treatment of primary dysmenorrhea, and of interest, focused on trials in which women had previously received nonsteroidal anti-inflammatory medications (NSAIDs) or hormones for dysmenorrhea. The main study outcome was the reduction in pain associated with treatment; others included additional analgesia and quality of life.

Thirty-nine trials of Chinese herbal medication for dysmenorrhea were fully reviewed, but many of these trials had methodologic problems. In particular, 18 trials were not randomized, and 4 other trials failed to mention randomization.

Most research was conducted in mainland China, and the use of traditional Chinese medicine significantly affected the way the research was conducted. Chinese medicine emphasizes a different approach to patient symptoms and diagnosis compared with Western medicine, with a greater emphasis on clusters of symptoms across different organ systems. The clusters of symptoms in most of the studies examining the treatment of dysmenorrhea were consistent with the Western definitions of dysmenorrhea, but 19 studies used variations in the herbal treatment protocol based on individual participant’s diagnostic patterns.

Only 3 studies compared Chinese herbal medications with placebo; most of the other trials compared herbal treatments with:

• NSAIDs;

• Hormonal therapy; or

• Other Chinese herbal treatments.

The size of all included studies was small, with only 1 trial involving more than 100 patients. Most participants in the trials received multiple herbal treatments, although the dosage ranges of these many different therapies (19 main herbs were investigated) generally conformed to standard Chinese practice.

Results of The Cochrane Review.

Regardless of these study limitations, Chinese herbal medications were generally effective against dysmenorrhea. Herbal medications were approximately twice as likely to improve pain compared with conventional therapy. In particular, Meiguihua (Rosa rugosa Thunb) was demonstrated to reduce dysmenorrhea-associated symptoms (pain, stress, and anxiety) over a 6-month time course:

Chinese herbal medications can also be rapidly effective against dysmenorrhea; one trial demonstrated an analgesic effect within 30 minutes. There was evidence as well that Chinese herbal medications may reduce patients’ use of other analgesic medications for dysmenorrhea.

Chinese herbal medications were superior to over-the-counter health supplements in improving dysmenorrhea. A tailored herbal regimen was more than twice as likely to improve dysmenorrhea as a routine herbal preparation available without a prescription. However, the lack of standardization of herbal preparations and t that there was little confirmatory research to establish the efficacy of a specific herbal remedy precluded any recommendation for a particular treatment regimen. Chinese herbal medication was also found to be superior to acupuncture for dysmenorrhea in 2 trials.

Adverse events associated with study therapy were reported in only 8 of the 39 trials. There were no significant events found with either Chinese herbal medications or the comparator agents.

How to apply the results of this meta-analysis in Western medical practice is a difficult dilemma. First, the methodologic limitations of these studies must be considered. More practically speaking, it seems clear that some experience with Chinese herbal medications would be necessary before effectively prescribing these treatments for dysmenorrhea. Although the herbal formulas may be generally effective, they involve multiple agents in each treatment regimen, and this regimen appears to be most effective when it is individualized to each patient’s symptoms.

Conclusion

Traditional Chinese medicine has proven itself through the test of time, and it has much to offer patients around the world. However, the previous studies of the efficacy of Chinese herbal medications as well as the current review of herbal preparations for dysmenorrhea highlight the difficulty of translating medical treatment across cultures. The currently available research is not only limited regarding methodology in determining the efficacy of Chinese herbal medications, but also of importance, many of these studies do not adequately address concerns regarding tolerability and safety.

More high-quality research focused on Chinese herbal medications is forthcoming, but until that time, it appears that the most prudent approach for the incorporation of these medications in clinical practice is to partner with a practitioner who has significant experience in their use. The wealth of experience and knowledge accumulated over time is the strength of traditional Chinese medicine, and healthcare providers should build relationships and treatment teams with experienced providers to provide the most complete and effective care for a variety of patient conditions.

 

Wenjing decoction (herbal medicine) for the treatment of primary dysmenorrhea: a systematic review and meta-analysis.

The results supported the clinical use of Wenjing decoction for the treatment of primary dysmenorrhea. ”

Gao L, Jia C, Zhang H, Ma C.

Arch Gynecol Obstet. 2017 Oct: 296(4):679-689.

PURPOSE:

Wenjing decoction is a well-accepted traditional Chinese medicine for the treatment of primary dysmenorrhea in East Asia, but its clinical effectiveness and risk have not been adequately assessed. In this paper, we conducted a systematic review and meta-analysis to evaluate the efficacy of Wenjing decoction for the treatment of primary dysmenorrhea.

METHODS:

Eight databases were used in our research: the Cochrane Library, the Web of Science, PubMed, EMBASE, the Chinese Biomedical Literature Database (CBM), the Chinese National Knowledge Infrastructure (CNKI), the Chinese Scientific Journal Database, and the Wan-fang Database. The following search terms were used: (Wenjing decoction OR Wenjing formula OR Wenjing tang) AND (primary dysmenorrhea OR dysmenorrhea OR painful menstruation) AND (randomized controlled trial). No language limitation was used.

RESULTS:

A total of 18 studies, including 1736 patients, were included in the meta-analysis. Wenjing decoction was shown to be significantly better than nonsteroidal anti-inflammatory drugs for the improvement of primary dysmenorrhea according to the clinical effective rate (RR 1.41, 95% CI 1.24-1.61), the visual analogue scale (MD -1.77, 95% CI -2.69 to -0.84), and the pain scale for dysmenorrhea (MD -1.81, 95% CI -2.41 to -1.22).

CONCLUSIONS:

The results supported the clinical use of Wenjing decoction for the treatment of primary dysmenorrhea. However, the quality of the evidence for this finding was low due to a high risk of bias in the included studies. Therefore, well-designed randomized controlled trials are still needed to further evaluate the efficacy of Wenjing decoction for the treatment of primary dysmenorrhea.

 

Acupuncture has long-lasting effects on period pain

Acupuncture was found to reduce menstrual pain intensity and duration after three months of treatment, and this was sustained for up to one year after the start of the research.”

Investigators from Australia and New Zealand report that acupuncture treatment can reduce menstrual pain intensity, and that its effects can still be felt one year later. A randomised controlled trial was performed with 74 women randomly assigned to one of four treatment arms: low frequency manual acupuncture (LF-MA), high frequency manual acupuncture (HF-MA), low frequency electro-acupuncture (LF-EA) and high frequency electro-acupuncture (HF-EA). A clinical manual-based protocol was used to allow individualised treatment, with a maximum of seven points used per treatment and a total of 12 treatments performed over three menstrual cycles, either once per week (LF groups) or three times per week (HF groups), in the week prior to menstruation. All groups also received a treatment in the first 48 hours of their period. Acupuncture was found to reduce menstrual pain intensity and duration after three months of treatment, and this was sustained for up to one year after the start of the research. The mode of stimulation or frequency of treatment was not found to be significant, although the authors suggest that this may be due to a lack of statistical power. During the treatment period and nine month follow-up all groups showed statistically significant reductions in peak and average menstrual pain compared to baseline, but there were no differences between groups. Health-related quality of life increased significantly in six domains in groups with a high frequency of treatment compared to only two domains in low frequency groups. Manual acupuncture groups required less analgesic medication than electro-acupuncture groups. HF-MA was most effective in reducing secondary menstrual symptoms compared to both-EA groups.

The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: An exploratory randomised controlled trial. PLoS One. 2017 Jul 12;12(7):e0180177.

 

Moxibustion as effective as ibuprofen for period pain

Three months after the end of treatment, the effectiveness of moxibustion was sustained and superior to the effect of the drug.”

A Chinese study suggests that moxibustion may be as effective as drugs for alleviating menstrual pain. In a pragmatic randomised trial, 152 participants received either moxibustion or ibuprofen over a three month period. Moxibustion was carried out at Guanyuan REN-4, Shenque REN-8 and Sanyinjiao SP-6, once a day for seven days leading up to the beginning of the period for three menstrual cycles. The results showed that menstrual pain intensity in both the experimental and control groups was significantly reduced after treatment. Pain reduction was not significantly different between the two groups. Three months after the end of treatment, the effectiveness of moxibustion was sustained and superior to the effect of the drug. Serum levels of pain mediators, including prostaglandins, were found to have significantly improved after treatment in both groups.

Moxibustion for pain relief in patients with primary dysmenorrhea: A randomized controlled trial. PLoS One. 2017 Feb 7;12(2):e0170952.

 

Vulvodynia

Acupuncture may help with vulvodynia

Reports of vulvar pain and dyspareunia were significantly reduced, while changes in scores on the Female Sexual Function Index suggested significant improvement in sexual function, in those receiving acupuncture compared with those who did not. “

A small study carried out by investigators in the USA has found that acupuncture appears to reduce pain and dyspareunia, while increasing sexual function, for women with vulvodynia (a chronic pain syndrome affecting the vulvar area without an identifiable cause). Thirty-six women with vulvodynia were randomly assigned either to an acupuncture group or a wait-list control group. Subjects assigned to the acupuncture group received acupuncture twice a week for five weeks. Reports of vulvar pain and dyspareunia were significantly reduced, while changes in scores on the Female Sexual Function Index suggested significant improvement in sexual function, in those receiving acupuncture compared with those who did not. However, acupuncture did not significantly increase sexual desire, sexual arousal, lubrication, ability to orgasm or sexual satisfaction in women with vulvodynia.

Acupuncture for the treatment of vulvodynia: a randomized wait-list controlled pilot study. J Sex Med. 2015 Apr;12(4):1019-27.

 

 Pain in pregnancy

Treating Pain in Pregnancy with Acupuncture: Observational Study Results from a Free Clinic in New Zealand

“Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting.”

(also saved as pdf in website materials)

Elizabeth Soliday, Debra Betts DOI: https://doi.org/10.1016/j.jams.2017.11.005 |

Highlights

  •   Observational studies of acupuncture outcomes and descriptions of specific acupuncture approaches for treating pregnancy conditions are needed to strengthen the existing evidence base to guide professionals who use acupuncture in their practice.
  •   Our observational study results from women’s reports after acupuncture treatment for lumbopelvic pain in pregnancy indicated clinically meaningful pain reduction following treatment.
  •   Treatment was based on published guidelines for acupuncture in pregnancy and was effective despite excluding so-called “forbidden points” that have been used in clinical trials.

Abstract

Introduction: Clinic-based acupuncturists, midwives, and physiotherapists have reported using acupuncture to treat lumbopelvic pain in pregnancy, a common condition that may affect functioning and quality of life. To contribute to the emerging evidence on treatment outcomes, we collected patient-reported pain reduction data from women treated during pregnancy in a no-pay, hospital-based acupuncture service in New Zealand.

Methods: Observational study of patient-reported symptom reduction.The main outcome measure was the MYMOP (Measure Your Medical Outcome Profile), a brief, validated self-report instrument. Open-ended questions on treatment experiences and adverse events were included.

Results: Of the 81 women on whom we had complete treatment data, the majority (N = 72, 89%) reported clinically meaningful symptom reduction. Patient-reported adverse events were infrequent and mild.

Discussion: Patient-reported and treatment-related lumbopelvic pain symptom reduction findings provide further evidence that acupuncture in pregnancy is safe and beneficial in a field setting. We discuss this study’s unique contributions in providing guidance for clinicians who practice acupuncture in pregnancy, including midwives, physiotherapists, and physicians.

 

 

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