Effectiveness and Safety of Moxibustion Robots on Primary Dysmenorrhea: A Randomized Controlled Pilot Trial

Efficacy and Safety of Non-Pharmacological Therapies for Primary Dysmenorrhea: A Network Meta-Analysis

Background

This network meta-analysis (NMA) aimed to explore the impact of Non-pharmacological therapies (NPT) on alleviating primary dysmenorrhea (PD) symptoms and assess the effectiveness differences among various NPT.

Methods

We searched seven databases and summarized clinical trials of PD treated with NPT from inception to September 6, 2023. Randomized controlled clinical trials (RCTs) of PD treated with NPT. The outcomes were the Visual Analog Scale (VAS), the Cox menstrual symptom scale (CMSS), and response rate. Quality was assessed using the Cochrane risk of bias assessment tool. Pairwise meta-analysis and network meta-analysis (NMA) was performed by RevMan (5.4), Stata (15.0), and WinBUGS (1.4.3). The ranking probabilities for all treatment interventions were performed using the Surface Under the Cumulative Ranking curve (SUCRA).

Results

A total of 16 RCTs were finally included, involving 8 kinds of NPT. Results of pairwise meta-analyses: For the VAS score results, moxibustion (SMD: -0.591,95% CI: -0.916, -0.266) was more effective than acupuncture, acupuncture (SMD: -0.948,95% CI: -1.853, -0.044) was more effective than placebo, and yoga (SMD: 2.634,95% CI: -4.28, -0.988) was more effective than the blank control. NMA results: Compared to the blank control, acupuncture (SMD: -4.81; 95% CI: -6.63, -3.00), auricular point therapy (SMD: -4.36; 95% CI: -7.18, -1.60), yoga (SMD: -2.12; 95% CI: -3.13, -1.09), moxibustion (SMD:5.54; 95% CI: 3.33, 7.68), and placebo (SMD: 3.10; 95% CI: 1.03, 5.27) proved to be a superior reduction in VAS. The use of acupressure (SMD: 2.49; 95% CI: 0.03, 5.03), moxibustion (SMD: -2.45; 95% CI: -4.06, -0.71), and acupuncture (SMD: -1.72; 95% CI: -2.75, -0.56) demonstrated a greater decrease in VAS efficacy than placebo. The consolidated ranking outcomes indicate that moxibustion, acupuncture, and auricular acupoint therapy occupy high SUCRA positions across various outcome metrics.

Conclusion

Acupuncture, moxibustion and auricular point may be the best treatment for PD. In the future, more trials are needed to obtain higher-quality evidence and the best protocols.

Effects of Ethnic Medicinal Plant Extracts Versus Nonsteroidal Anti-Inflammatory Drugs on Menstrual Pain in Women With Primary Dysmenorrhea: A Systematic Review and Meta-Analysis Study

BACKGROUND

This study aimed to compare the pain reduction effects of ethnic medicinal plant extracts and nonsteroidal anti-inflammatory drugs (NSAIDs) in women with primary dysmenorrhea.

METHODS

The following databases were searched: CNKI, Wanfang Data Knowledge Service Platform (Wanfang), VIP Chinese Journal Service Platform (VIP), SinoMed, PubMed, and Web of Science. The retrieval period was from the time of database construction to December 2023.Randomized controlled trials (RCTs) that compared the treatment of pain in women with primary dysmenorrhea using NSAIDs in the control group and plant extracts in the intervention group were identified. The literature was independently screened by two researchers, and the quality of the literature were evaluated using Cochrane's RCT Risk Assessment Manual for Bias. The evaluation includes several aspects including random sequence generation, assignment hiding, blind method and result data reporting. Meta-analysis was conducted using RevMan 5.4 software.

RESULTS

A total of 12 literature were included. Meta-analysis showed that there was no significant difference between ethnic medicinal plant extracts and NSAIDs in reducing the Visual Analog Scale (VAS) pain scores for primary dysmenorrhea (SMD = 0.32, 95% CI (-0.14, 0.78), p = .17). However, ethnic medicinal plant extracts were more effective than NSAIDs in reducing the proportion of people with pain, with a slight difference (OR = 1.75, 95% CI (1.02, 3.02), p < .05).

CONCLUSION

Ethnic medicinal plant extracts can effectively reduce the VAS pain scores in women with primary dysmenorrhea and the proportion of people with pain. The effect is comparable to or even better than that of NSAIDs, with fewer side effects. Therefore, ethnic medicinal plant extracts can be considered as a clinical option to alleviate menstrual pain.

Research methodology in acupuncture and moxibustion for managing primary dysmenorrhea: A scoping review

BACKGROUND

Acupuncture and moxibustion have promising effects in managing primary dysmenorrhea. However, some evidence from clinical trials remains controversial due to methodological flaws in study designs that involve acupuncture and its related modalities and require urgent attention and dialogue.

METHODS

Allied and Complementary Medicine Database (AMED), Cochrane Library, Excerpta Medica database (EMBASE), PubMed, Web of Sciences, Chinese Biological Medicine (CBM), China National Knowledge Infrastructure (CNKI), VIP Database for Chinese Technical Periodicals (VIP), and Wanfang database were searched from their inception to July 2021. Data were extracted based on the types of study design, primary outcome measures, adverse events (AEs), and participants' subjective views.

RESULTS

Most studies (n = 282, 93 %) were published in Chinese and 21 (7 %) in English. Among these, there were 209 (69 %) randomized controlled trials (RCTs), 39 (13 %) non-randomized controlled trials (nRCTs), 30 (10 %) case-series reports, 15 (5 %) cohort studies, and 10 (3 %) case reports. The most frequent reported outcome was pain, followed by emotion, sleeping quality, quality of life, skin temperature, changes in brain function, uterine and ovarian blood flow, and reproductive endocrine level. AEs were reported in 37 studies with mild events, and all recovered without actions taken; 31 trials reported no AEs; 235 failed to report any AEs. One RCT found that the satisfaction rate of the intervention group was statistically significantly higher than the control group.

CONCLUSION

Clinical studies on acupuncture and its related modalities face methodological challenges and require urgent attention. RCT with blinding and sham control might be the gold standard trial design. However, it may not be the most suitable research method for these modalities. We recommend using pragmatic RCTs in this field, where trial protocol registration on the trial registry platforms and detailed safety reporting should be mandatory.

Anxiety, Depression, Chronic Pain, and Quality of Life Among Older Adults in Rural China: An Observational, Cross-Sectional, Multi-Center Study

PURPOSE

To determine the incidence of anxiety and depression and examine their cross-sectional associations with chronic pain and quality of life among older adults in rural China.

DESIGN

Observational, multi-center, cross-sectional study.

METHODS

A structured, self-report questionnaire was administered. Descriptive statistics analysis and stepwise multiple linear regression analysis were performed.

FINDINGS

244 participants (female: 47.1%) filled out the questionnaires. 87 (35.7%) had symptoms of anxiety and 123 (50.4%) had symptoms of depression. The sensory pain descriptor, affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of anxiety while affective pain descriptor, physical component summary, and mental component summary significantly influenced symptoms of depression.

CONCLUSION

Subjective pain experiences and QoL, including physical and mental domains, are strongly related to symptoms of anxiety and depression among older adults in rural China.

CLINICAL EVIDENCE

Interventions that highlight subjective pain experiences and QoL may help to relieve symptoms of anxiety and depression in older adults.