Effects of SP6 acupressure on pain and menstrual distress in young women with dysmenorrhea.
ABSTRACT This study aims to evaluate the effects of Sanyinjiao (SP6) acupressure in reducing the pain level and menstrual distress resulting from dysmenorrhea.
Forty participants with dysmenorrhea were assigned to either the acupressure group (n = 19) or the control group (n = 21). The acupressure group received 20 min of SP6 acupressure during the initial intervention session and was taught to perform the technique for them to do twice a day from the first to third days of their menstrual cycle, 3 months subsequent to the first session. In contrast, the control group was only told to rest. Outcomes were measured through (1) the Pain Visual Analogue Scale (PVAS), (2) the Short-Form McGill Pain Questionnaire (SF-MPQ), and (3) the Short-Form Menstrual Distress Questionnaire (SF-MDQ).
There was a statistically significant decrease in pain score for PVAS (p = 0.003) and SF-MPQ (p = 0.02) immediately after the 20 min of SP6 acupressure. In the self-care periods, significant reduction of PVAS (p = 0.008), SF-MPQ (p = 0.012), and SF-MDQ (p = 0.024) scores was noted in the third month of post-intervention.
SP6 acupressure has an immediate pain-relieving effect for dysmenorrhea. Moreover, acupressure applied to the SP6 acupoint for 3 consecutive months was effective in relieving both the pain and menstrual distress level resulting from dysmenorrhea.
- SourceAvailable from: Laura Otero-García
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ABSTRACT: The purpose of this study was to examine the effects of acupressure on menstrual distress and low back pain (LBP) in dysmenorrheic young adult women. In all, 129 female students, who had been experiencing dysmenorrhea with LBP during menstruation and who scored more than 4 points on the visual analog scale for pain, were randomly assigned to an experimental group and a control group. The experimental group (n = 65) received acupressure massage three times a week for 30 minutes on the sanyinjiao (SP6), ciliao (BL32), and taichong (Liver 3) acupoints. The control group (n = 64) received only a manual of menstrual health education without acupressure intervention. Data were collected at five time points: at baseline, 30 minutes, and 4, 8, and 12 months after the intervention. During the 12-month follow-up, the experimental group had significantly lower menstrual distress and LBP scores than the control group. Among 65 participants in the experimental group, 53 (82%) reported a moderate to high levels of menstrual distress, 51 (78%) reported moderate to high levels of LBP relief, and 49 (75%) reported moderate to high levels of satisfaction with acupressure. Our findings may serve as a reference for health care professionals and young women to improve self-care during menstruation and help further understand the therapeutic effects of acupressure on menstrual distress and LBP.Pain Management Nursing 08/2014; · 1.79 Impact Factor
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ABSTRACT: The use of relaxation techniques in daily life is an effective means for the self-management of stress. Acupressure is a traditional technique where pressure is applied to acupuncture points instead of puncturing the skin. Self-administered acupressure is a potential method for dealing with stress. The effect of self-administered acupressure on anxiety has been examined but whether it can reduce perceived stress over longer periods is unknown. This study aimed to examine whether a self-administered, four-week acupressure intervention would reduce perceived stress over the past month. Fifteen male and nine female college students (age, 28.9 ± 8.51 yr) majoring in acupuncture and moxibustion medicine were randomly assigned to self-acupressure (AG) and control groups (CG). AG participants were instructed to conduct five sessions of acupressure in the morning, midday, and night. Each session included pressing six acupressure points on the neck (three points on the left and right side each) for five seconds. CG participants were asked to spend their daily life as usual. The outcome was the perceived stress level during the past month, which was assessed using a reli-able and valid four-item scale. Perceived stress was measured at baseline, two weeks later, and after intervention. The stress level did not significantly differ between the two groups at baseline. In the AG, the stress level decreased from baseline to two weeks later and remained constant until the end of intervention. The stress level was significantly lower in the AG than in the CG only after intervention. These results provided initial evidence that self-administered acupres-sure reduces perceived stress over the past month.
Effects of SP6 acupressure on pain and menstrual distress
in young women with dysmenorrhea
C.L. Wonga,*, K.Y. Laib, H.M. Tseb
aRoom 621, Esther Lee Building, The Nethersole School of Nursing, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong SAR
bSchool of Nursing, The Hong Kong Polytechnic University Hong Kong SAR
a b s t r a c t
Objectives: This study aims to evaluate the effects of Sanyinjiao (SP6) acupressure in reducing the pain
level and menstrual distress resulting from dysmenorrhea.
Methods: Forty participants with dysmenorrhea were assigned to either the acupressure group (n ¼ 19)
or the control group (n ¼ 21). The acupressure group received 20 min of SP6 acupressure during the
initial intervention session and was taught to perform the technique for them to do twice a day from the
first to third days of their menstrual cycle, 3 months subsequent to the first session. In contrast, the
control group was only told to rest. Outcomes were measured through (1) the Pain Visual Analogue Scale
(PVAS), (2) the Short-Form McGill Pain Questionnaire (SF-MPQ), and (3) the Short-Form Menstrual
Distress Questionnaire (SF-MDQ).
Results: There was a statistically significant decrease in pain score for PVAS (p ¼ 0.003) and SF-MPQ
(p ¼ 0.02) immediately after the 20 min of SP6 acupressure. In the self-care periods, significant reduction
of PVAS (p ¼ 0.008), SF-MPQ (p ¼ 0.012), and SF-MDQ (p ¼ 0.024) scores was noted in the third month of
Conclusions: SP6 acupressure has an immediate pain-relieving effect for dysmenorrhea. Moreover,
acupressure applied to the SP6 acupoint for 3 consecutive months was effective in relieving both the pain
and menstrual distress level resulting from dysmenorrhea.
? 2009 Elsevier Ltd. All rights reserved.
Primary dysmenorrhea refers to painful menstruation despite
normal pelvic anatomy and ovulation within a menstrual cycle.1It
usually begins 1–3 years after menarche, and the symptoms of
dysmenorrhea start a few hours before or together with the onset
of menstrual flow.2The pain is most intense on the first or second
day, or more precisely, during the first 24–36 h of menstrual flow,
and lasts for 2–3 days.3Local symptoms of primary dysmenorrhea
include spasmodic orcramping pain in the lowerabdomen orlower
back. Some girls also experience associated systemic symptoms
such as nausea, vomiting, loose bowel movements, or dizziness.4
Apart from physical symptoms, some adolescent girls may experi-
ence bad mood, mild depression, and an inability to concentrate in
class when primary dysmenorrhea occurs.5Previous studies
suggest that the prevalence of primary dysmenorrhea ranges from
60% to 90% in countries like Canada, the United States, Turkey,
Malaysia, and Taiwan,5–9with more than 15% of adolescent girls
describing the pain as severe.10,11It is a distressing condition that
not only affects the academic, social, and sporting activities of
adolescent girls, but is also considered the leading cause of recur-
rent short-term school and work absenteeism for adolescents.6,12,13
Non-steroidal anti-inflammatory drugs (NSAIDs) are the most
common pharmacologic treatment for primary dysmenorrhea.14In
multiple studies on a variety of NSAIDs, a Cochrane review shows
that NSAIDs were significantly more effective than placebo for
menstrual pain relief.15Yet, when compared with one another, no
single NSAID is clearly superior. The common non-pharmacological
treatments for primary dysmenorrhea included transcutaneous
electrical stimulation (TENS),16,17acupuncture,18spinal manipula-
tion,19and aromatherapy.20However, the study also shows that
about 80% of the adolescents did not use prescription medication,
while 30% did not use over-the-counter drugs due to their
perceived lack of efficacy of the medications, dislike of drug
side effects, and dislike of taking medications.8Moreover, TENS
and acupuncture are inconvenient and limited to clinical use. In
contrast, Chinese medicine therapy such as acupressure is free from
such limitations, and is thus being considered as a feasible
* Corresponding author. Tel.: þ852 92157542; fax: þ852 26035296.
E-mail address: firstname.lastname@example.org (C.L. Wong).
Contents lists available at ScienceDirect
Complementary Therapies in Clinical Practice
journal homepage: www.elsevier.com/locate/ctnm
1744-3881/$ – see front matter ? 2009 Elsevier Ltd. All rights reserved.
Complementary Therapies in Clinical Practice 16 (2010) 64–69
Acupressure is the practice of applying finger pressure to
specific acupuncture points throughout the body to balance its
internal function. It has been used in China as early as 2000 B.C.,
pre-dating the practice of acupuncture, and is a non-invasive
variation of acupuncture.21While acupressure follows the principle
of acupuncture, the use of the needles is replaced by thumb and
finger pressure, or any other device used to apply on these same
points. It is easier to perform, painless, and inexpensive. According
to Chinese medicine, the uterus is an ‘‘extraordinary’’ yang organ
connected to the heart and the kidneys through special channels,
and that the blood in the liver supplies blood to the uterus. Kidney
deficiency and ‘‘liver-qi’’ stagnation, which in turn cause blood to
stagnate in the uterus, and liver-blood deficiency are considered
major etiologic factors in the development of dysmenorrhea.22The
Sanyinjiao point (SP6) is the crossing point of the liver, spleen, and
kidney meridians (Fig.1). Based onprinciples of Traditional Chinese
Medicine (TCM), acupressure on SP6 is proposed to strengthen the
spleen, resolve and expel dampness, and restore balance to the Yin
and blood, liver, and kidney, and can therefore invigorate blood
supply and thus relieve dysmenorrhea pain.23
As there has been increasing interest in the clinical application of
TCM, it is therefore important to obtain research evidence on the
effectiveness of acupressure as a non-pharmacological and comple-
mentary nursing intervention, and to adopt it for the intervention of
primary dysmenorrhea. Similarly, little research has been conducted
in the past. Thus, this study intends to explore the use of TCM tech-
niques in managing dysmenorrhea in adolescents.
Two classes in the Nursing School were randomly selected for the
class. The criteria for choosing the participants include the following:
female students aged less than 25 years; have experienced dysmen-
orrhea with a pain score higher than five on the PVAS for at least
2 months in the past half year; and have not had any prior history of
gynecological disease, gynecological surgery, or secondary dysmen-
pills6 months prior tothe study, and who have used pain medication
them fulfilled the inclusion criteria. Eleven refused to participate.
Among the 46 participants who joined the study, 22 from one class
were randomly assigned to the acupressure group and 24 from the
other class were assigned to the control group. Subsequently, three
pain-relieving measures, such as warm pads or medications during
the study period. Three other participants in the acupressure group
were also excluded due to medication use or loss of contact despite
follow-ups. In the final sample, there were 21 participants in the
control group and 19 participants in the acupressure group.
The study received ethical approval from the School of Nursingof
the Hong Kong Polytechnic University Human Subjects Ethics Sub-
consentswere obtained. They were alsothoroughlyexplained onthe
They were informed that they could withdraw from the study at any
time without any consequences.
2.2. Outcome measures
Three measures were used to collect data in the pre-interven-
tion (T0) and immediately post-intervention (T1) stages, and the
first 3 days of the participants’ menstrual cycle within the 3-month
self-care period (T2, T3, and T4).
2.2.1. The Pain Visual Analogue Scale (PVAS)
PVAS was used for assessing the intensity of the dysmenorrhea
pain.24,25It is a reliable and valid tool and is shown to be useful in
the evaluation of menstrual pain.26,27The PVAS consists of a 10 cm
horizontal scale with verbal descriptors, such as ‘‘no pain’’ on one
end and ‘‘worst possible pain’’ on the other.
2.2.2. The Short-Form McGill Pain Questionnaire (SF-MPQ)
A Short-Form of the McGill Pain Questionnaire (SF-MPQ) was used in
this study.28The main component of the SF-MPQ consists of 15
are derived from the sum of the intensity rank values of the words
chosen for sensory, affective, and total descriptors. The SF-MPQ is
ausefultoolinsituationswhereinthe standard MPQtakes too longto
administer.29In this study, the Chinese version of SF-MPQ was used
with a Cronbach’s alpha of 0.83.
2.2.3. The Short-Form Menstrual Distress Questionnaire (SF-MDQ)
The Menstrual Distress Questionnaire (MDQ) contains 47
symptoms grouped into eight categories. This includes pain (six
items), impaired concentration (eight items), behavior changes
(five items), autonomic reactions (four items), water retention (four
items), negative affect (eight items), arousal positive experiences
(five items), and control symptoms (six items).30The MDQ reflects
the general tendency of patient complaints on a variety of symp-
toms during menstruation. Participants were asked to report the
symptoms experienced during their menstrual period using
a rating scale, the responses of which range from 1 (no experience
of the symptom) to 4 (severe or partially disabling symptoms). The
MDQ Short-Form was translated into a full-scale Chinese version
with 16 or 19 items, and is used for the Chinese population.31In this
study, the 19-item MDQ Short-Form is used, and its validity and
reliability had a Cronbach’s alpha of 0.8.
During the first 24 h of their initial menstrual cycle, each subject
was requiredto siton a chair with pillowsupport and restin a room
Fig. 1. SP6 acupoint.
C.L. Wong et al. / Complementary Therapies in Clinical Practice 16 (2010) 64–69 65
for 5 min. They were asked to complete a brief menstrual history
questionnaire to assess their PVAS, SF-MPQ, and SF-MDQ before
and after the intervention. Participants in the acupressure group
were asked to sit cross-legged for easy access of the SP6. The
researcher located the SP6 site by asking the subject to place their
3 cun (unit equivalent to four fingerbreadths) above the inner
malleolus, and then by placing her own thumb on that of the
participants to mark the point (Fig. 2).32The location of SP6 was
further validated using the ‘‘Point Locator’’ to show the change of
color from red to green at the acupoint, which had a lower electric
resistance than the surrounding skin. The highest reading of the
point locator was than recorded. They next received a 20-min
acupressure from the researcher, alternating between each leg at
the SP6 acupoint. The SP6 acupoint was pressed using the thumb,
and gently and vertically applied to one leg for 15 s each time and
then allowed to rest for 15 s. This was repeated 10 times to satisfy
a 5-min intervention. It was then repeated on the other leg and
pressed for another 5 min. This completed a 10-min cycle, and was
repeated twice on both legs until the 20-min period of intervention
was completed. As the efficacy of acupressure is related to the
magnitude of the pressingforce,with the force controlled at around
3 kg, a pressure-sensing device (Fig. 3) was used to ensure that the
amount of pressure applied by the researcher would remain
constant throughout the intervention.33
to the participants in the acupressure group and they were taught to
practice SP6 acupressure at home in order for them to use the tech-
the Teaching Booklet. The pressure-sensing device was also used to
train the participants in the acupressure group. It recorded the inter-
face pressure between the participants’ SP6 acupoint and the thumb
that pressed on it. The pressure and time can be observed visually on
a computer screen. The participants in the acupressure group were
required to press successively for at least 15 s each time, but the
pressure readings could not be seen by the participants until they
achieved the correct pressing force 10 times.
Participants in the acupressure group were required to perform
SP6 acupressure for 20 min upon waking and at bedtime during
their first 3 days (average duration of menstrual pain) of their next
three menstrual cycles.
For the control group, they were allowed to rest for 20 min
accompanied by the researcher in the room with no acupressure
intervention. During the first 3 days of their next three menstrual
cycles, they were required to rest for 20 min upon waking and at
bedtime. The dependent variables for PVAS, SF-MPQ, and SF-MDQ
were self-administered in the daily log and collected after each
menstrual cycle by the researcher.
2.4. Data analysis
Descriptive statistics was used to describe the group’s charac-
teristics. As the datawere notnormallydistributed, non-parametric
tests such as Mann–Whitney U were used to determine whether
any statistically significant difference was found between groups
for each outcome variable at each time point. T1 was not included
in the repeated measures analysis because it involved the training
of the participants to locate SP6 and to apply the correct amount of
2.5. Characteristics of participants
The participant characteristics between two groups were
compared for age; age of menarche; menstruation cycle; menstrua-
time, ending time, and frequency of dysmenorrhea; limitations in
daily activities; and number of self-care methods used when experi-
encing dysmenorrhea. Results showed that there were no significant
differences between the groups (Table 1).
2.6. Immediate effects of acupressure on SP6
There were no significant differences between groups in the
report for PVAS, SF-MPQ, and SF-MDQ at baseline T0 (p ¼ 0.727,
0.693 and 0.341). However, there were significant differences
between the groups with the PVAS score (p ¼ 0.003) and SF-MPQ
score (p ¼ 0.02) at T1. No significant differences were noted in the
SF-MDQ scores (p ¼ 0.146) (Table 2).
2.7. Effects of acupressure on SP6 in the 3-month self-care period
The mean scores obtained from day 1, day 2, and day 3 of the
menstrual cycle of the first (T2), second (T3), and third month
Fig. 2. Location of SP6 acupoint.
Fig. 3. A pressure-sensing device.
C.L. Wong et al. / Complementary Therapies in Clinical Practice 16 (2010) 64–6966
(T4) of self-care periods were used for analysis. Although no
significant differences were observed at T2 and T3 (PVAS:
p ¼ 0.616 and p ¼ 0.054; SF-MPQ: p ¼ 0.233 and p ¼ 0.045; SF-
MDQ: p ¼ 0.296 and p ¼ 0.113), a comparison between the
acupressure and control group for the 3-month self-care period
showed that the level of significance increased over time. Statis-
tically significant differences were noted between the acupressure
group and control group in the three outcome variables of PVAS
(p ¼ 0.008), SF-MPQ (p ¼ 0.012), and SF-MDQ (p ¼ 0.024) at T4
Characteristics of participants.
Experimental (n ¼ 19)
Control (n ¼ 21)
Mean (SD) 220.882 21.57 0.7460.089a
Age of menarche (years)
Menstruation cycle (days)
Menstruation duration (days)
Mean (SD)5.260.872 5.48 0.9280.584a
Color of menstruation
Amount of menstruation
The first time of dysmenorrhea
Happens in the first menarche
Happens in the 1/2 year to 1 year after menarche
Happens in the 1–2 years after first menarche
Happens in the 2 years after first menarche
Onset time of dysmenorrhea (days)
Mean (SD)1.210.419 1.1 0.3010.314a
Ending time of dysmenorrhea (days)
Mean (SD)2.89 0.9942.62 0.865 0.358a
Frequency of dysmenorrhea (months)
Mean (SD) 51.7324.62 1.5960.356a
Limited of daily activities
No. of self-care methods used when dysmenorrhea
Mean (SD) 0.840.3751.71 1.460.099a
cFisher’s exact test.
Change of the PVAS, SF-MPQ and SF-MDQ immediate post-intervention.
Acupressure (n ¼ 19)
Control (n ¼ 21)
Mean (SD)Mean (SD)
Immediate post-test (T1)
Immediate post-test (T1)
Immediate post-test (T1)
C.L. Wong et al. / Complementary Therapies in Clinical Practice 16 (2010) 64–6967
This study investigated the effectiveness of SP6 acupressure in
relieving dysmenorrhea. The target participants in this study were
university nursing students in their early 20s because dysmenor-
rhea is most severe in the second and third decades of life among
females of conceivable age.3
Our findings suggest that the
acupressure group had an immediate and significant reduction of
menstrual pain severity on the PVAS and SF-MPQ scores but not in
the SF-MDQ in both groups. The reported effects of our study were
in agreement with previous literature showing a reduction in PVAS
after the initial application of 20-min acupressure on SP6.31
However, significant reduction of SF-MPQ scores was only found in
our study. The difference in outcomes may be due to the differences
in the time of the intervention administration and the duration of
the pressing time of SP6. In our study, acupressure was givenwithin
24 h of the participants’ menstrual cycle when dysmenorrhea pain
was most intense.3As had been suggested, the pressing time for an
effective acupressure treatment needs to exceed 15 s; our study
adopted a pressing cycle of 15 s of acupressure and 15 s of rest,
while a previous study used a 6 s of acupressure and 2s of rest
The results of this present study also corroborate the findings of
previous literature wherein there was statistically significant reduc-
tion in the intensity of dysmenorrhea after a 20-min acupressure
having an immediate effect in relieving menstrual distress and
symptoms (e.g., breast tenderness, weight gain, and constipation)
because the scores on SF-MDQ did not achieve significant differences
between the acupressure and control groups.
A previous study showed that the reduction of pain intensity
was extended to 30 min after, 1 h after, and 2 h after the SP6
acupressure intervention.35From a clinical point of view, short-
term effects are of less significance compared to long-term effects.
In our study, a majority of the participants experienced moderate
to severe pain in each menstrual cycle with primary dysmenor-
rhea occurring more than 4 months in the past half year during
the baseline assessment, thus showing primary dysmenorrhea not
only happens in a single occasion but persists for months. In
relation, our study not only examined the immediate effect of
acupressure in relieving pain, but further investigated the effect of
acupressure for a longer period (up to 3 months) and its
applicability as a self-care measure for adolescents in relieving
It was shown that the participants applying SP6 acupressure,
those who were able to learn from the nurse and administer self-
care for the first 3 days of their menstrual cycle during the three-
month self-care periods after the initial intervention session, had
a significant reduction in their PVAS, SF-MDQ, and SF-MPQ scores
in the third month. The reduction of pain score may be due to
the SP6 acupoint stimulation, which causes the activation of an
endogenous opioid system and facilitates the release of specific
neuropeptides (e.g., endorphin) in the central nervous system; in
effect, achieving pain relief.36While a previous study applied
acupressure at various points to relieve menstrual pain,23we
found that the participants have difficulty identifying various
acupoints for self-treatment. Our study therefore focused on
a single acupoint, which was easily applied by the adolescent girls
themselves, and which can achieve a fairly long-term effect of
reducing not only menstrual pain severity, but also the symptoms
of menstrual distress in cases of primary dysmenorrhea. The
effectiveness of acupressure was shown to increase across time
wherein the level of significance had achieved the greatest results
during the third month of post-intervention, showing an accu-
However, there were several potential limitations in this study.
First, it was limited in terms of the random assignment into groups
of the subjects. Since the nursing students in the same class know
each other, it was difficult to rule out the possibility of a control
group member learning from the acupressure technique from the
acupressure group during the post-3-month self-care period.
Therefore, participants were recruited periodically and from
different classes to prevent any cross-contamination.
Second, this study lacked the use of shame acupressure groups
to eliminate placebo effects. However, adding a shame acupressure
group in this study might raise ethical considerations because it
involves teaching the subjects fake acupressure points or applying
a wrong pressure to an acupoint.
This study conveniently sampled only university nursing
students, the results of which may have limited generalizability to
other populations such as adolescents or young womenwith lower
which is not limited to university nursing students, and a longer
follow-up period (i.e., more than 3 months) are recommended.
Change of PVAS, SF-MPQ, SF-MDQ in post-3-month self-care periods.
Median [Range]Mean (SD)Mean (SD)
C.L. Wong et al. / Complementary Therapies in Clinical Practice 16 (2010) 64–6968
This study supports the SP6 acupressure as being able to
produce an immediate analgesic effect and can be adopted as a self-
care measure for adolescent girls who are suffering from primary
dysmenorrhea. The use of acupressure is simple, convenient, and
non-invasive, unlike other alternative therapies such as acupunc-
ture or TENS that are restricted to clinical application. In the
post-3-month self-care period wherein adolescents self-adminis-
tered the SP6 acupressure theylearned from the nurse, it was found
that both pain severity and menstrual distress decreased gradually
across each month, thus achieving a significant reduction in the
third month. These indicate that acupressure has a long-term and
accumulative effect in relieving primary dysmenorrhea. Given
proper training, this intervention can be easily integrated into the
current nursing practice in order to offer a cheap and effective
non-pharmacological intervention for adolescents with primary
Conflict of interest
The manuscript is the original work of the authors and has not been
submitted for publication before. No commercial party having
a direct financial interest in the results of the research supporting
this article has or will confer a benefit upon the authors or authors
upon any organization with which the authors are associated.
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