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ACUPUNCTURE

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ACUPUNCTURE

    ACUPUNCTURE

    WorldJ.AcuMoa?.Vo1.15,No.J,March.2005?53?

    LiteratureAnalysis

    ACUPUNCTUREFoRPRIMARYDYSMENORRHEA

    Ameta-analysis

    CHOUChin.shan(周金山)IIUBao-yan(刘保延)

    ChinaAcadentyofTraditionalChinese

    ZHANGLu(张璐)JINZhi.gao(晋志高)

    Medicine,Beijing1O0700,China

    ABSTRACTRecentliteraturesearchshowedthatupto1313wthereareatotalof9thesesaboutclinicaltreatmentofprimary

    dysmenorrheawithacupuncturetherapy,amongthem5clinicaltrialsarefromChinesejoornalsandtherest4fromforeignjo(.ir-

    nals.Majorityofthetrialshavesomemethodologicaland/orreportingshortcomings.Thefrequencyandintensityofdysmenorrhea

    aredividedintointermittentandcontinuoustypes.Resultsofquantitativerneta-analysiswithRevman4.1softwareshowedthatthe

    existingevidencesupportsthevalueofacupunctureforthetreatmentofdysmenorrhea.However,thequalityofevidenceisnotful-

    lyconvincing.Thereisanurgentneedforwell-planned,large-scaleandmultiple-centerstudiestoassesstheeffectivenessand

    cost-effectivenessofacupunctureunderreal-lifeconditions.

    KEYWORDSDysmenorrheaAcupuncturetherapyLiteratureanalysis

    Dysmenorrheaisreferredtopainfulmenstruation

    duetospasmoftheuterusintheperiodofmenstrua

    tion.Clinicalmanagementofdysmenorrheacotxli"~on

    lyconsistsofnonsteroidalantiinflammatorydrugs

    andoraladministrationofcontraceptivepills,bothof whichworkwellinreducinguterinemuscularactivi

    ty.However,thesetreatmentsareaccompaniedbya numberofsideeffects,makinganonpharmacological

    therapybepotentialvalueintreatingdysmenorrhea. Asaninterventionapproach,acupuncturetherapyhas ahistoryofover3,000yearsinChina.Thediagnosis andtreatmentdescribedinclassicalworksoftradi

    tionalChinesemedicine(TCM)aredeeplyinfluenced bythesystemsofmedicineandphilosophyofancient China.AccordingtothetheoryofFCM,animbal

    aneebetweenandrangofthetxxtypresentsase

    liesoffunctionaldisordersincludingpain,etc.. Acupuncturetreatsillnessesbyregulatingthebalance ofyinyang,andpromotingfreeflowofqi(vitalen

    ergy).Acupunctureisusuallyusedforclinicaltreat

    mentofdysmenorrhea,nevertheless,thereisstilla debateinthemedicalcycleaboutwhetheracupunc

    turehasaspecificanddefiniteeffectratherthanpsy

    chologicalactionSosystematicassessmentontheef

    ficacyofacupuncturetreatmentofdysmenorrhea seemstobeparticularlynecessary.

    Thearticlesaboutacupuncturetreatmentofdys

    menorrhealwerecollectedfromtheCochraneCon

    trolledTrialsRegister(CCRT)ontheCochraneli

    brary;ChinaInformationServiceSystemonTCM(

    国中医药信息网);ChinaNationalKnowledgeIn

    frastructure(www.cnki.net,CNKI中国期刊网);

    ChineseBiologyMedicineDisk(CBMdisk,中国生物

医学文献光盘);MEDLINE,Pubmed,EMBASE

    andBIOSISdatabases.

    Alloftherelatedjournalsandcollectionsofaca

    demicthesesofconferencesinChinafroml949to 2003weresearchedbyhand.Fhesejournalsandcol

    lectionsofacademicthesesincludedAcupunctureRe

    search,ChineseAcupunctureandMoxibustion,Jour

    nalofIntegratedTraditionalandWesternMedicine, etc.,collectionsofacademicthesisof4sessionsof nationalconferencesonacu--moxibustionandacupunc-

    tureanalgesia,etc.

    Allthepaperssearchedfromtheabovementioned journalsandliteraturewerecopiedbytwore

    searchers.Asthefirststep.wetriedtocollectallthe articlesonacupuncturetreatmentofrecurrentdys

    menorrheafromtheoriginaldataandcollectl9theses altogether.Amongthem,10wereexcludedbecause thetreatmentnotonlyinvolvedacupuncturetherapy butalsorecruitedotherremedies,Theremaining9 qualifiedtheseswereanalyzedindetailbyatleasttwo researchers(Table1).Whendi~greementsol2

?54?WorldJ.AcuMoxi.Vo1.15.No.J.March,2005

    curred.weresolvedthembydiscussion.Information aboutpatients,interventionmethods,outcomes,etc. werefilledintoapredesignedtable.Inaddition,we

    alsolistedthefirstauthorsorthecorrespondingan

    thorsoftheprimarystudiesasnecessary.Thequality ofreports/methodologicalqualityoftheincludedtrials wasassessedbyatleasttwoindependentresearchers

    usingJadad'Sscale(Jadad,etal,1996).Themain itemsofthescalewere:?randomallocation(1

    point:ifanadequatemethodtogeneratearandomse

    quencewasdescribed);?double-blindness(1point:

    iftherewasastatementthatbothpatientsandre

    searcherswereblindedandwhentheblindingproee

    durewasdescribedandadequate);?reportof

    dropouts/exclusions(1point:ifdropoutsandwith

    drawalsaswellasthereasonswerelistedindepen. dentlyineachtreatmentgroup).

    Table1Generalinformationabouttheincludedstudies Da?dPainalleviated

    RelatedclinicaIRCT2.1-0TENS(100HZ)/ShamTENS+analg~c. MY32P>O,0528.5scale(15),men5unkfxM

    ,

    criteriaDoublebliIldP0(400ms,t.i.d)( t990)symptonmquestkmnaite

    Note:Noonereportedside-effects.LiYe'trials(1998)includedsimpleprimarydy~aenorrhe

    a(excludedothergynecologicdiseases)

    Gr=group

    I'hemaximumscorewas5points.Studiesscor

    ing3ormorewereconsideredtobehighquality.The pointsachievedforeachoftheabovethreeitemswere listedinorderforeachstudyinthetabledescribing the"characteristicsoftheincludedstudies"(e.g.for atrialgettingfullpointsoneachitem,thesCOre wouldbe221).Asummaryofthescoresforallthe includedtrialsisalsoprovidedinTable1(Jadad'S scale).

    Atotalof880patientsofthe9studiesmetthe

includedcriteriaofmeta-analysis.Twostudiescol

    lectedfromChinesejournalsadoptedcriteriaofTCM (1994)toclassifydysmenorrhea,threeusedthelat

    estChinesenationalcriteria,andfourusedself-made criteria.Ofallthetrials,fivewerechemicaldrug- controlled.twowereherbalmedieine-controlledand twoused"Sham''acupunctureforwhichtheneedled pointswerebesidetherealacupointsorthesuperficial

    WorM.,.AcuMoxi.Vo1.15,No.j,M(drch,2005?55? non.acupoints.Theacupunctureinterventionsused variedconsiderably.Fivetrialsadoptedtraditional acupuncture,threeusedSham-TENS(transcuta

    neouselectricnervestimulation)andoneusedelec

    troacupuncture(EA).Symmetrybetweentreatment andcontrolgroupswasgoodinallthestudiesinclud

    ei.Insixstudies.thetheorybehindthechoiceof acupointswastraditionalChinesemedicine,three gaveotherreasons.Fiveusedbodyacupoints.two usedauricularpointsandtheotheroneusedperipher

    aldermatomes."Deqi",anirradiationfeelingsaidto indicatetheeffectivenessofneedling,wasreportedin mostofthestudiesespeciallybyChineseclinicalre

    searches.Alloftheninetrials.threeattemptedto blindpatients,andonlyoneblindedbothpatientsand theresearcherssuccessfully.Whilethestudies searchedfromChinesejournalsdidnotdescribethe concreteblindmethod.

    Themeandurationoftreatmentwas4months

    (rangingfrom3to12months).In8trialsthatafter

    completionofthetreatment,amean10months'(7 to12months)follow.upwasconducted.

    Themostcommonlyreportedoutcomeswere

    painintensity,durationandremission.Butinmany studiestheresultswerenotreportedindetail.Sub. jectivemood,qualityoflife,medicationuse,anddis

    abilitywerereportedinminorityofthetrials.Criteria madeinChinesestudieslaidenoughemphasisonthe acupoints.Majorityofthetrialshadmethodological and/orreportingshortcomings.Allocationconceal

    mentwasdescribedinonlyonetrailwhichuseda centraltelephonecallrandomizationscheme.Theme

    dianJadad's8corewas1.5(rangingfrom1to5) fromapossiblemaximumscoreof5(seeTable1). Reportofdropoutsandwithdrawalswassatisfactory inonlythreetrials.

    2RESULTS

    Thetrialswerehomogeneousinacupuncturever

    SUScontrolledgroup,buthighlyheterogeneousbe

    tweenacupunctureandmedicationgroupsregarding theinterventions;typesandtimingofoutcomemea

    sures.Inaddition,dataoftheseclinicalreportswere oftenpresentedinaninsufficientdetail.Weper. formedquantitativemeta?-analysisofacupuncturever.. SUScontrol(9studies)andacupunctureversusmedi. cation(9studies).Bothofthemobtainedpositivere. suits.ThefiguresandgraphsinCochraneReviews displaytheOddsRatioandtheWeightedMeanDif

    ferencebydefault(Fig1,2).

    Compllrison:02Acupunctumforprimarydysmenorrhca

    Outcoll~:OIAcupunctureVscontrol q?tI-reCO10R-.-_OR

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