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Effects of Auricular Acupressure on Menstrual Symptoms and Nitric Oxide for Women with Primary Dysmenorrhea

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The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide (NO) for women with primary dysmenorrhea. This was a randomized clinical trial comparing the effects of auricular acupressure by seed-pressure method and placebo adhesive patch. Settings included colleges in northern and central Taiwan. Serum CA-125 testing was used as a screening test for primary dysmenorrhea (<35 mg/dL). The study included 36 college females randomized to acupressure group, 35 to control group. The acupressure group received auricular acupressure by seed-pressure method on liver (CO12), kidney (CO10), and endocrine (CO18) acupoints. The control group had a plain adhesive patch placed on the same acupoints with no seed attached. Acupressure protocol included massaging 15 times on each acupoint, 3 times a day, for a total of 20 days. Primary: Short-form Menstrual Distress Questionnaire (MDQs). Secondary: blood sample of NO. Assessments of MDQs and NO were performed at baseline and within the first 2 days of their next menses (after completion of 20 days of acupressure). In the acupressure group, the overall menstrual symptoms (95% confidence interval [CI] = -49.8 to -6.5, effect size [ES] = 0.43, p = 0.01) and two subscales, menstrual pain (95% CI = -16.4 -to -2.2, ES = 0.45, p = 0.01) and negative affects (95% CI = -11.9-2.0, ES = 0.38, p = 0.04), revealed that menstrual symptoms decreased significantly after auricular acupressure by the seed-pressure method. The ES for the MDQs were in favor of the auricular acupressure by seed-pressure method. NO level increased in the acupressure group, although this difference did not achieve statistical significance (p > 0.05). This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual symptoms, and offers a noninvasive complementary therapy for women with primary dysmenorrhea.
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THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE
Volume 15, Number 3, 2009, pp. 235–242
© Mary Ann Liebert, Inc.
DOI: 10.1089/acm.2008.0164
Effects of Auricular Acupressure on Menstrual Symptoms
and Nitric Oxide for Women with Primary Dysmenorrhea
Mei-Chuan Wang, M.N., R.N.,
1
Mei-Chi Hsu, Ph.D., R.N.,
2
Li-Wei Chien, M.D., Ph.D.,
3
Chien-Huei Kao, Ph.D.,
4
and Chi-Feng Liu, Ph.D.
5
Abstract
Objectives: The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual
symptoms and decreasing nitric oxide (NO) for women with primary dysmenorrhea.
Design: This was a randomized clinical trial comparing the effects of auricular acupressure by seed-pressure
method and placebo adhesive patch.
Setting: Settings included colleges in northern and central Taiwan.
Subjects: Serum CA-125 testing was used as a screening test for primary dysmenorrhea (35 mg/dL). The
study included 36 college females randomized to acupressure group, 35 to control group.
Interventions: The acupressure group received auricular acupressure by seed-pressure method on liver (CO12),
kidney (CO10), and endocrine (CO18) acupoints. The control group had a plain adhesive patch placed on the
same acupoints with no seed attached. Acupressure protocol included massaging 15 times on each acupoint, 3
times a day, for a total of 20 days.
Outcome measures: Primary: Short-form Menstrual Distress Questionnaire (MDQs). Secondary: blood sample of
NO. Assessments of MDQs and NO were performed at baseline and within the first 2 days of their next menses
(after completion of 20 days of acupressure).
Results: In the acupressure group, the overall menstrual symptoms (95% confidence interval [CI] 49.8 to
6.5, effect size [ES] 0.43, p0.01) and two subscales, menstrual pain (95% CI 16.4 to 2.2, ES 0.45,
p0.01) and negative affects (95% CI 11.9–2.0, ES 0.38, p0.04), revealed that menstrual symptoms de-
creased significantly after auricular acupressure by the seed-pressure method. The ES for the MDQs were in
favor of the auricular acupressure by seed-pressure method. NO level increased in the acupressure group, al-
though this difference did not achieve statistical significance (p0.05).
Conclusions: This study supports the effects of auricular acupressure by seed-pressure method in improving
menstrual symptoms, and offers a noninvasive complementary therapy for women with primary dysmenor-
rhea.
235
Introduction
Dysmenorrhea is categorized as primary or secondary
based on the presence of known etiology or pelvic
pathology. Medically defined, primary dysmenorrhea is di-
agnosed by exclusion when painful menstruation occurs in
the absence of pathology such as endometriosis.
1
Secondary
dysmenorrhea involves an underlying pathology acting di-
rectly or indirectly on pelvic anatomy to cause the pain
symptoms during menstrual flow. Primary dysmenorrhea is
1
Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan, Republic of China.
2
Department of Nursing, I-Shou University, Taiwan, Republic of China.
3
Department of Obstetrics and Gynecology, Taipei Medical University and Hospital, Taipei, Taiwan.
4
National Taipei College of Nursing, Taipei, Taiwan, Republic of China.
5
Graduate Institute of Integration of Traditional Chinese Medicine with Western Nursing, National Taipei College of Nursing, Taipei,
Taiwan, Republic of China.
a common women’s health condition and health-related ex-
perience among women worldwide. Primary dysmenorrhea
includes cramping pain in the lower abdomen
2
and associ-
ated discomfort symptoms such as fatigue, mood swing,
headache, backache, and irritability.
2,3
These symptoms are
either psychologic or physical in nature and most are rou-
tinely considered in a medical model differential diagnosis
of premenstrual syndrome or dysmenorrhea.
4
Prevalence of
primary dysmenorrhea ranged from 41% to 95%.
1
Many
women report experiencing cyclic pelvic pain (CPP) that sig-
nificantly impacts their quality of life. Another form of CPP
is mittelschmerz, a term used to denote midcycle pain often
associated with ovulation. This type of CPP is far less com-
mon than dysmenorrhea. The incidence of CPP is as high as
80% for women in their teens and early 20s, with half of these
women experiencing loss of time from school or work.
3,5–7
For 10%–20% of women, CPP is severe.
8,9
Young women in
their teens and early 20s experience menstrual pain most of-
ten, with the onset occurring within 3 years of menarche.
10
This leads to expenses for self-care, over-the-counter treat-
ments, and visits to health care professionals.
4
The cause of primary dysmenorrhea is unknown, but a num-
ber of influencing factors, for example, uterine hyperactiv-
ity, prostaglandins, leukotrienes, and antidiuretic hormone,
11
have been implicated. Combined oral contraceptives and non-
steroidal anti-inflammatory drugs (NSAIDs) or NSAIDs used
alone are widely used for prevention or treatment of peri-
menstrual pain. Both medications are effective in about 70%–
90% women with primary dysmenorrhea.
5,11
Western medi-
cine may not be entirely effective and has side-effects for some
cases.
2,12
Nonresponse to drug treatment is estimated to occur
in about 10% of patients with primary dysmenorrhea.
2
How-
ever, women and girls with primary dysmenorrhea may not
wish to take medications and show resistance or unwillingness
to take any treatment. Thus, there is a need to develop easy
and effective methods to ease many forms of their discomfort,
so their quality of life can be improved.
Acupressure is a long-standing treatment in Traditional
Chinese Medicine technique and may be a valuable treat-
ment in improving menstrual symptoms.
13,14
The effects of
acupressure have been demonstrated to be comparable to
ibuprofen (a type of NSAID) in treating dysmenorrhea.
15
The
use of acupressure as a complementary therapy for more se-
vere cases of dysmenorrhea is also supported.
13
In Chinese medicine, menstrual symptoms are caused by
either the lack of blood in the body or stagnant qi or Blood.
The general treatment principles of Chinese medicine for
dysmenorrhea are to tonify the Kidney Deficiency, clear the
accumulation of Liver Fire, dissipate Cold, expel Wind, and
move qi and Blood. Acupressure involves the stimulation of
acupuncture points and meridians without the use of nee-
dles. Moreover, acupressure has been found to be safe and
effective for improving anxiety and stress-related ail-
ments,
16–21
reducing tension, promoting wellness, maintain-
ing the normal bodily functions, and providing comfort.
16,21
Particularly, in Chinese medicine theory, auricular acupres-
sure can activate and regulate the flow of qi and Blood. It
brings relief of symptoms by rebalancing Yin and Yang sta-
tus of internal organs and qi. Stimulating acupoints with
pressure triggers the production of a morphine-like natural
painkiller in the body called endorphins.
22
Such acupressure
promotes the secretion of neurotransmitters that lead to pain
relief.
22
Dysmenorrhea may be related to nitric oxide (NO). Nitric
oxide is a potent vasodilator produced by endothelial and
other cells, which helps to control blood pressure, platelet
aggregation, and cytotoxicity.
23,24
The uterine muscle stabil-
ity is associated with a higher concentration of serum NO
level. NO activity has influences in the severity of dysmen-
orrhea symptoms and affects the homocysteine metabolic
pathway in dysmenorrhea symptoms.
25
Decreased serum
NO level caused more frequent muscular and vascular con-
tractibility of the uterus.
25,26–29
There has been little evidence-based research to support
the effects of auricular acupressure for the management of
primary dysmenorrhea. Moreover, most of existing studies
does not include any physiologic indices to confirm the ef-
fect of acupressure in their research. Reports regarding the
role of auricular acupressure on NO changes in reducing
menstrual symptoms are scanty. No studies compared the
differences of auricular acupressure by seed-pressure
method and placebo adhesive patch for primary dysmenor-
rhea. Therefore, the present study was undertaken to evalu-
ate the effects of auricular acupressure on menstrual symp-
toms and serum level of NO in women with primary
dysmenorrhea.
Materials and Methods
Sample
This double-blinded, randomized clinical trial was con-
ducted in Taiwan. All participants met the following crite-
ria: (1) they were between 18 and 28 years old; (2) they had
no prior internal and gynecologic diseases, or secondary dys-
menorrhea affecting the progress of their menstrual period,
or underlying medical illness that causes primary dysmen-
orrhea; (3) a serum CA-125 level less than 35mg/dL was con-
firmed; (4) the initial onset of primary dysmenorrhea oc-
curred shortly after 6 months following menarche; (5) they
had complains of menstrual pain at least three times in the
past 6 months; (6) they had no smoking or drinking history;
(7) they were not taking over-the-counter analgesics (e.g.,
NSAIDs or other painkillers) during the study period; and
(8) they were able to speak Chinese or Taiwanese.
Power analysis by using SSize software (version 2.0; for
Windows; ECHIP, Inc.) was used to calculate the sample size.
A significance level of 0.05, power of the test of 0.8, propor-
tion of group 1 of 0.9, and proportion of group 2 of 0.6
showed that 32 women were needed in each group.
Procedures
The pilot study. A convenience sample of 32 eligible par-
ticipants was sought for the pilot study. An issue arose from
this pilot study was that the adhesive acupressure patch
could not consistently stick well on acupoints after shower-
ing. However, this problem was solved after the provision
of education related to protection in the area of the acu-
pressure patches.
The recruitment of the participants. A total of 90 college
women were recruited. A team staff not involved in the trial
organized and held the randomization list and numbered en-
velopes. The team staff passed envelopes to one of the two
researchers after demonstrating that the college student was
eligible and had consented to the trial. The researcher opened
WANG ET AL.236
envelopes to reveal study treatment allocation and then ad-
ministered the acupressure protocol. Another researcher was
only responsible for evaluating outcome measures.
All potential participants were screened using the Health
Examination Survey for any internal and gynecologic dis-
eases. No health problems listed were found. They also com-
pleted Short-form Menstrual Distress Questionnaire (MDQs)
and collection of CA-125 blood samples. CA-125 is a bio-
AURICULAR ACUPRESSURE ON PRIMARY DYSMENORRHEA 237
FIG. 1. Flow diagram of the progress of all data collection procedures. MDQs, Menstrual Distress Questionnaires.
chemical marker that was used to monitor benign disease
such as endometriosis and ovarian disease. Thus, CA-125 as-
say was selected as a screening test for determination of pri-
mary or secondary dysmenorrhea. Six (6) participants in the
experimental and control groups, respectively, were identi-
fied and excluded from the study as having CA-125 test re-
sults of greater than 35mg/dL. The blood sample was then
collected from the other 74 eligible participants in order to
determine their serum NO levels prior to acupressure ther-
apy just 0–2 days before menstrual period. The progress of
all procedures is outlined in Figure 1.
Auricular acupressure protocol
All participants were given a detailed description of the
auricular acupressure protocol. To control the reliability and
validity of auricular acupressure, the protocol was devel-
oped and set up as follows:
1. The acupressure protocol was developed based on the lit-
erature and the consultation with 3 physicians and experts
in Chinese medicine. Three (3) auricular acupressure
points—Liver (CO12), Kidney (CO10), and Endocrine
(CO18) —were selected for the study.
2. In the acupressure group (n37), auricular acupressure
was performed by using acupressure seeds named Semen
vaccariae. The seeds were kept in place by a piece of
opaque adhesive patch and fixed onto the three acupoints
selected.
3. Members of the control group (n37) had a plain adhe-
sive patch placed on the same points with no seed at-
tached. Both groups had acupressure.
4. Participants were instructed by one of the researchers on
(1) how to apply auricular acupressure, for example, the
procedure, duration, and intensity of auricular acupres-
sure by manually pressing lightly on every acupressure
point; (2) how to check and keep acupressure patches in
the right place and how to protect them; and (3) how to
record the time of application of acupressure and any pos-
sible side-effects in a diary after each session.
5. The next step in the application of acupressure included
massaging 15 times on each point of a sequence of three
acupressure meridian points, three times a day, for a to-
tal of 20 days.
6. To both enhance and ascertain the accuracy of timing for
a follow-up test, the anticipated time of the next menstrual
period was monitored.
7. For optimal treatment outcome and better hygiene, the
adhesive patch with/without the ear seed was renewed
and recorded every 5 days by the researcher.
8. Assessments of MDQs and NO level were performed
again starting within the first 2 days of their next menses.
However, 1 participant in the acupressure group and 2 in
the control group were dropped from the study because of
prolonged time between two menstrual periods and time
management problems.
Measures
Short-form MDQs. The primary outcome measure was
Moos MDQs.
30
The MDQs were used comprehensively to
screen women and identify those suffering from premen-
strual or menstrual distress on both psychologic and physi-
cal aspects. The original questionnaire has been shown pre-
viously to have split half reliabilities of 0.74–0.98,
30
and good
internal consistency (Cronbach 0.83–0.84). The MDQs
were composed of 22 items from the full MDQ scale, which
were grouped into 4 categories, namely, pain, water reten-
tion, autonomic reactions, and negative affect. Participants
were asked to rate the presence of menstrual symptoms ex-
perienced during their most recent menstrual period on a 4-
point Likert-type scale, ranging from 1 (no experience of the
symptom) to 4 (severe or partially disabling symptoms).
Higher scores are indicative of increasing symptom distress.
Serum NO level. The secondary outcome was assays of
serum NO level. It was performed by utilizing the enzyme-
liked immunosorbent assay (ELISA) kit (Cayman Chemical
Company, Ann Arbor, MI) and ELISA reader (Immuno Bi-
ological Laboratories, IBL, Minneapolis, MN) according to
the manufacturer’s instructions for measurement. The incu-
bation time of the substrate reaction in the laboratory was
carefully controlled and ensured. Absorbance was deter-
mined by ELISA reader at 540 nm in a micro ELISA reader.
Statistical analysis
Values were presented as mean standard deviation
(SD). Mann-Whitney Utests and independent t-tests were
used for the analysis of menstrual symptoms. The 95% con-
fidence interval (95% CI) for the difference in the outcome
measures between groups was calculated. An effect size (ES)
analysis was computed to compare the mean of the acu-
pressure group with the mean of the control group. ES was
measured as the standardized difference between two post-
test means.
Results
Participants
The mean age of the participants was 22.4 years (range:
19–28 years; Table 1). The average age of menarche was 12.5
years (range: 10–15 years). The average menstrual cycle was
29.2 days. More than half the participants (52%, n37) had
their initial onset of menstrual pain 6 months to 2 years fol-
lowing menarche. At baseline, mean serum CA-125 level for
all participants was 13.4 0.9 mg/dL (range: 0.5–33.2). No
baseline differences existed for demographics or assessments
between acupressure/control groups.
Primary outcome measure
Pain (61.9 14.6) and water retention (69.2 18.7) were
commonly reported categories for menstrual symptoms dur-
ing the menstrual period. Figure 2 presents the differences
at baseline and after application of acupressure among
groups. The 10 most frequently reported symptoms experi-
enced during participants’ most recent menstrual period are
presented in Table 2.
The global score of the MDQs showed that the mean post-
test scores of both the experimental and control groups de-
creased compared with that of the pretest scores. This indi-
cated that improvements in menstrual symptoms were
observed in both groups (Table 3). Moreover, the overall
menstrual symptoms (95% CI 49.8 to 6.5, ES 0.43, p
WANG ET AL.238
0.01) and the categories of pain (95% CI 16.4 to 2.2, ES
0.45, p0.01), and negative affect (95% CI 11.9–2.0, ES
0.38, p0.04) of the acupressure group revealed that men-
strual symptoms of the acupressure group decreased signif-
icantly after auricular acupressure by the seed-pressure
method, in comparison with that of the control group. How-
ever, the ES for the four categories of the MDQs were in fa-
vor of the auricular acupressure by the seed-pressure
AURICULAR ACUPRESSURE ON PRIMARY DYSMENORRHEA 239
T
ABLE
1. C
HARACTERISTICS OF
S
AMPLE
Acupressure group Control group
(n36) (n35)
Mean (SD) n(%) Mean (SD) n(%) p value
Age 22.3 (2.4) 22.6 (2.6) 0.82
Age at menarche (years) 12.6 (1.2) 12.4 (1.1) 0.77
Menstrual cycle (days) 28.8 (3.6) 29.7 (3.5) 0.20
The initial onset of 0.30
menstrual pain
Within 6–24 months 22 (61.1) 15 (42.9)
after menarche
After 24 months of 9 (25) 12 (34.3)
menarche
Cannot remember 5 (13.9) 8 (22.9)
Times of menstrual 4.9 (1.5) 5.3 (1.2) 0.39
pain/half year
MDQs
Pain 60.9 (11.1) 62.9 (17.5) 0.57
Water retention 68.5 (18.2) 69.9 (19.4) 0.60
Autonomic reactions 58.7 (18.3) 58.7 (19.9) 0.73
Negative affect 54.9 (13.2) 58.6 (18.8) 0.54
Total scores 242.97 (44.9) 250.1 (57.4) 0.56
CA-125 11.7 (6.8) 15.3 (8.8) 0.07
Nitric oxide 0.353 (0.12) 0.340 (0.16) 0.72
MDQs, Menstrual Distress Questionnaires, SD, standard deviation.
45.64 ± 1.53**
60.86 ± 1.85 62.89 ± 2.97
57.00 ± 2.25**
52.97 ± 2.13**
68.50 ± 3.03 69.94 ± 3.27
60.69 ± 2.34*
47.28 ± 1.58**
58.67 ± 3.04
58.69 ± 3.37
55.14 ± 2.43
42.19 ± 1.37*
54.94 ± 2.20 58.63 ± 3.18
50.83 ± 2.04*
0
10
20
30
40
50
60
70
80
90
100
At baseline
Acupressure group
Post-test
Acupressure group
At baseline
Control group
Post-test
Control group
0
10
20
30
40
50
60
70
80
90
100
Pain
Water retention
Autonomic reactions
Negative affect
FIG. 2. Comparisons of Menstral Distress Questionaires in acupressure and control groups at baseline and after applica-
tion of acupressure. * p0.05; ** p0.01
method. This suggested that overall menstrual symptoms in
the acupressure group significantly improved more than in
the control group (Table 3).
Secondary outcome measure
Mean serum NO level at baseline for the acupressure
group was 0.353 (SD 0.12) and 0.340 (SD 0.16) for the
control group (Table 3). There was no statistically significant
difference in serum NO levels when the acupressure group
was compared with the control group (p0.46).
Discussion
Women experience menstrual distress and related dis-
comforts during the menstrual period that result in impaired
quality of life, fatigue, irritability, and depression. These lead
to negative impacts on the emotional health, performance,
and functioning of women.
2,6,7,9,10,31,32
The auricular points
including endocrine, uterus, shenmen, brain, liver, spleen,
kidney, etc. have often been used for dysmenorrhea. Three
selected auricular acupressure points—liver, kidney, and en-
docrine in the present study—are considered to encircle the
reproductive organs, simultaneously activate the endocrine
system, store blood, and ensure the smooth flow and direc-
tion of Qi movement in the body. Although the applied acu-
pressure points and ways of doing acupressure in the pres-
ent study differed from those used in other studies,
13–15
the
reported effects of acupressure are generally similar to those
of previous studies in the same area. The effect of acupres-
sure on the management of primary dysmenorrhea has been
proven.
13–15
Furthermore, acupressure is effective in reduc-
ing low back pain,
33
labor pain,
34,35
and pain relief for pa-
tients with sickle cell disease.
18
Thus, acupressure, with no
complications, appears to be effective for pain management
and the decrease of the severity of primary dysmenorrhea.
14
Actual differences or improvements in outcome measures
between the two groups are significantly obvious, and thus
may be clinically meaningful. In the present study, there
were greater improvements in negative affect and pain. This
may suggest that acupressure may also induce the relaxation
response. This was further supported by the improvement
of mood swings, irritability, and anxiety in this study. Such
findings are comparable to acupressure studies that found
that acupressure treatment is effective in decreasing anx-
iety,
16
preoperative anxiety,
19
parental preoperative anx-
iety,
20
stress,
21
and improvements in quality of life.
17,18
This study design is unique in the comparison of the ef-
fects of auricular acupressure using S. vaccariae seeds and
acupressure without seed attachment. Females college stu-
dents undergoing auricular acupressure treatment by the
seed-pressure method experienced a statistically significant
and overall improvement in menstrual symptoms as com-
pared to those who received acupressure without seed at-
tachment to the points. There is a possible reason for such a
WANG ET AL.240
T
ABLE
2. T
HE
M
OST
10 C
OMMONLY
R
EPORTED
C
OMPLAINTS OF
M
ENSTRUAL
S
YMPTOMS
Category Mean (SD) Menstrual symptom Mean (SD) Rank
Pain 61.9 (14.6) Fatigue 1.6 (0.95) 2
Backache 1.5 (0.96) 5
Cramp 1.2 (0.96) 8
General aches and pains 0.9 (0.95) 9
Water retention 69.2 (18.7) Abdominal swelling 1.7 (1.08) 1
Tender breasts, breast swelling 1.3 (1.10) 6
Skin disorders 1.2 (0.92) 7
Negative affect 56.8 (16.2) Mood swings 1.6 (1.06) 3
Irritability 1.5 (1.10) 4
Restlessness 0.8 (0.86) 10
SD, standard deviation.
T
ABLE
3. C
OMPARISONS AND
D
IFFERENCES IN
MDQ
S AND
S
ERUM
L
EVELS OF
N
ITRIC
O
XIDE
(NO) A
MONG
G
ROUPS
Acupressure group (n36) Control group (n35)
Pre-test Post-test Mean Pre-test Post-test Mean
Mean (SD) Mean (SD) difference Mean (SD) Mean (SD) difference 95% CI p-value ES
MDQs
Pain 60.9 (11.1) 45.6 (9.19) 15.2 62.9 (17.5) 57.0 (13.3) 5.9 16.4–2.2 0.01** 0.45
Water retention 68.5 (18.2) 52.9 (12.8) 15.5 69.9 (19.4) 60.7 (13.8) 9.2 14.6–2.1 0.14 0.28
Autonomic reactions 58.7 (18.3) 47.3 (9.5) 11.4 58.7 (19.9) 55.1 (14.4) 3.6 16.4–0.7 0.19 0.31
Negative affect 54.9 (13.2) 42.2 (8.2) 12.7 58.6 (18.8) 50.8 (12.1) 7.8 11.9–2.0 0.04* 0.38
Total score 242.97 (44.9) 188.08 (30.1) 54.8 250.1 (57.4) 223.7 (43.6) 26.4 49.8–6.5 0.01** 0.43
Serum NO level 0.353 (0.12) 0.366 (0.24) 0.340 (0.16) 0.321 (0.22) 0.01–0.1 0.46 0.45
The ES represents effect sizes of the post-test between both groups. The 95% CI is the confidence interval for differences.
MDQs, Menstrual Distress Questionnaires; SD, standard deviation; CI, confidence interval; ES, effect sizes.
*p0.05; **p0.01.
difference in relieving menstrual symptoms (i.e., the effect
of seed-embedded acupressure to the applied points). Au-
ricular acupressure is thought to promote wellness and op-
timize overall health.
36
There is often a clear sensation of qi
when the seed is applied. Auricular acupressure by seed-
pressure method facilitates the movement of qi and Blood
through the channels. This method has a synergistic effect
compared with auricular acupressure with no seed placed.
It is possible that seeds could deeply stimulate the acupres-
sure points and work at a higher energy level. Thus, auric-
ular acupressure with the seed-pressure method may be
more effective to deal with menstrual symptoms than acu-
pressure with no seed-attachment method. Prior research has
not consistently identified the role S. vaccariae plays to
achieve a better therapeutic effect, but does indicate the con-
sistent use of S. vaccariae as a popular method for seed-press-
ing.
A possible mechanism of NO in response to the improve-
ment of menstrual distress was presented by a current
study.
25
They suggest that the NO pathway may be involved
in the pathophysiologic mechanism responsible for the dam-
aging effects of homocysteine on women with dysmenor-
rhea. An effect on NO level was expected after using acu-
pressure. Measurement of NO level increased slightly over
the study period (not significant) in the acupressure group
and decreased in the control group. However, there was also
no significant difference in serum NO level between the two
groups. This indicated that further research may be needed
to determine whether there is indeed an effect of auricular
acupressure as designed in the present study on NO level.
Limitations in this study must be considered when re-
viewing the results. The use of serum CA-125 testing may
have limited clinical value as a screening test for endome-
triosis and in evaluating women with dysmenorrhea. The
limitations also included the short time frame. The short time
frame made it unlikely that measurable changes in NO lev-
els would be evident.
Conclusions
Auricular acupressure by seed-pressure method effec-
tively improved menstrual symptoms of women. An ex-
pected effect of auricular acupressure on NO level was not
found. However, findings from this study have implications
for health care providers to consider incorporating auricular
acupressure in their clinical practice when caring for women
with menstrual symptoms. It is also important for women to
consider administering auricular acupressure technique for
themselves through appropriate training and find relief
through self-management.
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Address reprint requests to:
Chi-Feng Liu, Ph.D.
Graduate Institute of Integration of Traditional Chinese
Medicine with Western Nursing
National Taipei College of Nursing
No. 365, Ming-Te Road
Pei-Tou 112
Taipei City, Taiwan
Republic of China
E-mail: chifeng@mail1.ntcn.edu.tw
WANG ET AL.242
... Acupressure is one of the complementary treatment methods for PD, which is widely used [14,20,22]. It can activate the flow of body energy and blood, stimulate endorphin production, and lead to pain relief [23][24][25]. In addition, acupressure can reduce the social and economic consequences of PD [17,26]. ...
... The characteristics of the 28 studies are presented in Tables 1, 2, 3, 4, and 5. The studies were conducted in 8 different countries, mostly in Iran [4,5,14,17,19,20,24,26,[32][33][34] and Taiwan [1,2,22,23,25,35,36]. The other countries were Germany [15], China [18], Korea [3,16], United States of America (USA) [37,38], India [39][40][41], and Indonesia [42]. ...
... The Effect of Acupressure on Primary Dysmenorrhea www.journal-jams.org 45 using cowherb seeds with adhesive patches, which were embedded at auricular points (n = 4) [2,23,35,36]. In a study in Korea, needles on skin paper tape were applied to the ear (n = 1) [3]. ...
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Primary dysmenorrhea is defined as cramping pain in the lower abdomen with no pelvic diseases, and it has a high prevalence in many countries. Acupressure is a widely used complementary treatment method for primary dysmenorrhea. This review examined experimental studies to determine the effects of acupressure on primary dysmenorrhea using the databases PubMed, Google Scholar, and CINAHL with the keywords “Acupressure” and “Dysmenorrhea”. There were 2227 records in the databases, and 330 articles were published between 1989 and March 2020. Experimental studies in the English language were reviewed according to the PRISMA guidelines. This review included 28 published studies that were assessed using the Jadad score for quality. The studies were categorized as studies of acupressure at the LR3 point (n = 4), at the SP6 point (n = 9), at auricular points (n = 5), at multiple points (n = 8), and with devices (n = 2). Moreover, studies of self-acupressure (n = 9) were identified. The studies demonstrated that acupressure could reduce menstrual symptoms, the severity and duration of menstrual pain, distress, and anxiety. Furthermore, it helped improve the quality of life and well-being of patients and provide psychological support and self-care. Acupressure is an inexpensive, easy-to-apply, and non-pharmacological treatment and is useful for reducing primary dysmenorrhea, and women can apply this method anywhere by themselves. However, high-quality randomized controlled trials with larger samples are necessary to establish the evidence for acupressure as an effective intervention.
... AT can regulate flow of Qi and blood in the body, compensate for deficiencies, reduce their excess anywhere in the body and resolve stagnation and blockage of free flowing Qi (26)(27)(28)(29)(30). AT can therefore affect normalization of hormone levels (26). AT is extensively used for treating fertility problems and gynecological diseases, including dysmenorrhea, postpartum pains, postmenopausal musculoskeletal pains, and polycystic ovarian syndrome (28,(30)(31)(32), as well as sexual problems such as loss of libido and impotence (32)(33)(34). Breastfeeding, breast changes, fatigue associated with the maternal role, and childrearing can change sexual relationships during breastfeeding. ...
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Objective: Majority of breastfeeding women experience changes in sexual function. The present study was designed to assess effectiveness of auriculotherapy on improving sexual function in breastfeeding women. Method: In this randomized sham controlled trial, accomplished from January 2018 to May 2019 in a referral sexual health clinic in city of Qom, Iran, 60 eligible participants were assigned to either intervention and control groups via block randomization. In the intervention group, electrical stimulation was applied for 15 seconds on Shen Men, Zero, Thalamic, Master Cerebral, Libido, Relax, Excitement, Ovary, and Uterus points in 10 auriculotherapy sessions. Then, Vaccaria seeds were stuck on these points. The control group received the same procedure with the device off as a sham method. Data were gathered using the Female Sexual Function Index (FSFI) at three different time points. Results: At baseline, mean scores of sexual function dimensions were not significantly different between the intervention and control groups except for orgasm. Post-intervention, the results showed significant differences in sexual desire (P = 0.002), sexual arousal (P = 0.008), lubrication (P = 0.001), sexual satisfaction (P = 0.001), and orgasm (P = 0.009). One month after the intervention, the results showed significant differences in sexual desire, sexual arousal, lubrication, sexual satisfaction (P = 0.001), orgasm (P = 0.006), and dyspareunia (P = 0.015). Differences in mean score of sexual function in post-intervention and one-month follow-up were only significant in the intervention group (P = 0.001). Conclusion: Based on evidence from this study, auriculotherapy is an effective technique for improving sexual function in breastfeeding women.
... Acupuncture analgesic mechanisms are not fully understood; however, multiple scientific studies suggested different theories, including release of endogenous opiate peptides, activation of the pain-related neuromatrix, and modulation of the hypothalamiclimbic system in human brain. [15][16][17] Previous meta-analyses and randomized clinical trials concluded that auricular therapy is effective in reducing pain and opioid requirement, [18][19][20][21][22][23][24][25][26][27][28][29][30] while other clinical trials found no significant difference between auricular therapy and control groups. [31][32][33][34][35][36] The difference in outcomes in studies that have shown no benefit from acupuncture use may be attributed to differences in smaller sample sizes. ...
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Introduction: The risks from opioid use are well known in and mandate nonpharmacological modalities for the management of postoperative pain. The aim of this study was to investigate the effectiveness of battlefield acupuncture (BFA) as an adjunct therapy for postoperative pain in U.S. veteran patients undergoing major surgery under general anesthesia. Methods: Patients undergoing major surgery performed under general anesthesia from June 2017 to June 2018 were enrolled in the study. Patients were randomly assigned to receive either BFA or sham acupuncture. Outcomes such as pain intensity measured by visual analog scale score, opioid consumption, and the incidence of analgesia-related adverse effects were compared between the study groups. Results: A total of 72 subjects were included in this study (36 subjects in each study group). The median 24-h opioid postoperative consumption measured in morphine milligram equivalent (MME) was lower in the BFA group compared to the sham acupuncture group (18.3 [±12.2] MME vs. 38.6 [±15.9] MME, p < 0.001). Pain intensity reported by patients at 6, 12, 18, and 24 h postoperatively was lower in the BFA group compared to the sham acupuncture group. The incidence of postsurgical nausea and vomiting was lower in patients receiving BFA compared to patients receiving sham acupuncture. There were no intergroup differences in terms of postoperative anxiety or hospital length of stay. Conclusion: The results from this study reveal the potential clinical benefits of using BFA for reducing pain intensity and opioid requirements in surgical patients.
... In Modern medicine, it is believed that the excessive production and release of endometrial prostaglandin (PG) during menstruation may significantly induce uterine hypercontractility, reduce uterine blood flow, and trigger hypersensitive pain fibers [7]. Other studies suggest that menstrual cramp gets worse as PGF 2a increases and PGE 2 decreases because the former pain mediator causes contraction and the latter relaxes the uterine smooth muscle [8]. So, an increase in the ratio of PGF 2a to PGE 2 can be used as predictor of uterine contraction and thereby dysmenorrhea [9]. ...
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BackgroundThough moxibustion is frequently used to treat primary dysmenorrhea in China, relevant evidence supporting its effectiveness is still scanty. Methods This study was a pragmatic randomized, conventional drug controlled, open-labeled clinical trial. After initial screen, 152 eligible participants were averagely randomized to receive two different treatment strategies: Moxibustion and conventional drugs. Participants and practi�tioners were not blinded in this study. The duration of each treatment was 3 months. The pri�mary outcome was pain relief measured by the Visual Analogue Scale. The menstrual pain severity was recorded in a menstrual pain diary. Results 152 eligible patients were included but only 133 of them eventually completed the whole treatment course. The results showed that the menstrual pain intensity in experimental group and control group was reduced from 6.38±1.28 and 6.41±1.29, respectively, at baseline, to 2.54±1.41 and 2.47±1.29 after treatment. The pain reduction was not significantly different between these two groups (P = 0.76), however; the pain intensity was significantly reduced relative to baseline for each group (P<0.01). Three months after treatment, the effectiveness of moxibustion sustained and started to be superior to the drug’s effect (-0.87, 95%CI -1.32 to -0.42, P<0.01). Secondary outcome analyses showed that moxibustion was as effective as drugs in alleviating menstrual pain-related symptoms. The serum levels of pain mediators, such as PGF2α, OT, vWF, β-EP, PGE2, were significantly improved after treatment in both groups (P<0.05). No adverse events were reported in this trial. Conclusions Both moxibustion and conventional drug showed desirable merits in managing menstrual pain, given their treatment effects and economic costs. This study as a pragmatic trial only demonstrates the effectiveness, not the efficacy, of moxibustion for menstrual pain. It can’t rule out the effect of psychological factors during treatment process, because no blind procedure or sham control was used due to availability. In clinical practice, moxibustion should be used at the discretion of patients and their physicians.
... However, as the pharmacological treatment has many negative effects such as fatigue, headache, anger, depression, and gastrointestinal bleeding and requires long-term procedures, nonpharmacological methods are preferred more in the treatment of PMS [18,19]. Nonpharmacological methods such as reflexology, acupressure, massage therapy, music therapy, yoga, progressive relaxation exercises, cognitive behavioral therapy, and diet therapy are frequently preferred because they are safer and have fewer side effects than the pharmacological treatment [11,[19][20][21][22][23][24][25][26][27][28][29]. An analysis of the nonpharmacological methods used shows that acupressure decreases menstrual distress, premenstrual symptoms, and backache in women who have dysmenorrhea [30][31][32][33]. ...
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Objective This study aims to identify the effects of acupressure and yoga for coping with premenstrual syndromes (PMS) on the premenstrual symptoms and quality of life. Methods This study adopted a randomized intervention design with a pretest-posttest control group. The sample consisted of 155 students with PMS complaints (50 in yoga, 51 in acupressure, and 54 in control group). The students in the intervention groups did yoga and received acupressure throughout 12 weeks. Results It was found that the Premenstrual Syndrome Scale posttest mean score of the students was lower, and the physical health, psychological health, and environment sub-scale mean scores of the World Health Organization Quality of Life Questionnaire were higher in the yoga group in comparison to the other groups (p < 0.05). Conclusion Yoga was found to be a more effective non-pharmacological method for coping with premenstrual symptoms.
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Objective: Hemodialysis is one of the most common treatment methods in kidney patients. To do this, repeated insertion of the needle into the vessel is necessary. Patients treated with hemodialysis are exposed to stress and pain caused by perforation of their arteriovenous fistula about 300 times a year. More than 1/5 of hemodialysis patients express this pain as unbearable. This study aims to evaluate the effect of acupressure at SP6 and ST36 acupoints on the pain caused by fistula needle placement in hemodialysis patients. Methods: This study is a double-blind randomized clinical trial conducted in 2016 on 90 hemodialysis patients with arteriovenous fistula in Mashhad, Iran. They were randomly divided into three groups of SP6, ST36, and control. Data were collected after obtaining a written informed consent by a demographic form and the Visual Analog Scale (VAS). Data analysis was performed in SPSS v.16 software by using Kolmogorov-Smirnov test, Kruskal-Wallis test, one-way ANOVA, paired t-test, and Chi-square test. Results: There was a statistically significant difference between VAS scores after the intervention in all three group (P
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Objective To describe how menstrual cramps vary from cycle to cycle within a woman over time. To examine the influence of weight and lifestyle factors on occurrence, duration, and severity of menstrual pain. Design A one-year prospective menstrual diary study. Participants One hundred and sixty-five women aged 17 to 19 years entering a local university in 1985. Main outcome measures The occurrence, length, and maximum severity of pain during a menstrual period. Results Menstrual pain occurred during 71.6% of observed menstrual bleeds, most commonly beginning the first day of menses. The median duration was two days. Sixty percent of women reported at least one episode of severe pain, while 13% reported severe pain more than half the time. Earlier age at menarche and long menstrual periods increased the occurrence, duration and severity of pain. In smokers, cramps tended to last longer. Being overweight was an important risk factor for menstrual cramps and doubled the odds of having a long pain episode. Frequent alcohol consumption decreased the probability of having menstrual cramps, but in women who had pain it increased duration and severity. Physical activity was not associated with any pain parameter. Conclusions Women who have pain lasting three days are an important target group for prophylactic therapy. The occurrence and severity of menstrual cramps is influenced by potentially modifiable characteristics including weight, smoking, and alcohol consumption. Doctors may wish to counsel women presenting with dysmenorrhoea about the importance of healthy lifestyles and about the inefficacy of alcohol consumption as a treatment for dysmenorrhoea.
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Factors influencing the prevalence and severity of dysmenorrhoea were assessed longitudinally in a representative sample of young women born in 1962. The prevalence of dysmenorrhoea was lower (P less than 0.01) at 24 years of age than at 19 years of age. At 24 years of age, 67% of the women still experienced dysmenorrhoea; 10% reported dysmenorrhoea which limited daily activity. The severity of dysmenorrhoea (linear analogue scale) was lower (P less than 0.001) at 24 years of age (3.4, SD 2.8) than at 19 years (4.1, SD 3.2). The prevalence and severity of dysmenorrhoea were reduced (P less than 0.05) in women who were parous in 1986 and nulliparous in 1981, but was unchanged in women who were still nulliparous or women who had had a miscarriage or abortion. Dysmenorrhoea was reduced (P less than 0.001) in oral contraceptive users. The severity of dysmenorrhoea was significantly associated with the duration of menstrual flow, menarcheal age and cigarette smoking. The severity of dysmenorrhoea was not associated with age as an isolated factor, nor with height, weight, length of menstrual cycle or frequency of physical exercise.
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The development of a Menstrual Distress Questionnaire (MDQ) is described. Each of 839 women rated their experience of 47 symptoms on a six-point scale separately for the menstrual, premenstrual, and intermenstrual phases of her most recent menstrual cycle and for her worst menstrual cycle. The 47 symptoms were intercorrelated and factor analyzed separately for each phase, and eight basically replicated factors were extracted from each of these analyses. These fac- tors, which represent separate but empirically intercorrelated clusters of symptoms, were labeled pain, concentration, behavioral change, autonomic reactions, water retention, negative affect, arousal, and control. Scores on these eight clusters of symptoms were slightly correlated with age and parity. The scores were not af- fected by the specific menstrual cycle phase a woman was in when filling out the questionnaire or by the length of time since the woman had experienced the symptoms. Menstrual cycle symptom-profiles graphically depicting a woman's menstrual symptomatology were constructed and illustrated. The need for and utility of standard methods with which to measure menstrual cycle symptomatology is discussed.
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The aims of the study were to investigate whether a nitric oxide-cyclic guanosine monophosphate relaxation pathway is present in the human uterus and whether it differentially inhibits contractility during pregnancy and labor. Myometrial strips were obtained from pregnant women who were either in labor or not in labor and from nonpregnant women. Nitrites and cyclic guanosine monophosphate production by the tissues and contractile responses to nitric oxide modifiers were measured. Biochemical assays revealed that nitric oxide (nitrites) and cyclic guanosine monophosphate are generated by the human uterus. Cyclic guanosine monophosphate production by the uterus was increased by L-arginine (the substrate for nitric oxide) and diethylamine/nitric oxide (a nitric oxide donor) and decreased by nitro-L-arginine methyl ester (an inhibitor of nitric oxide synthase). Spontaneous contractility in vitro was increased by nitro-L-arginine methyl ester and decreased by diethylamine/nitric oxide, which furthermore produced a dose-dependent inhibition of contractility, and the median effective dose of inhibition in tissues from nonlaboring pregnant patients (1.5 +/- 0.4 mumol/L) is substantially lower than in tissues from laboring pregnant (21.7 +/- 7.4 mumol/L or nonpregnant (20.8 +/- 4.4 mumol/L) women. These studies show that the nitric oxide-cyclic guanosine monophosphate system exists in the human uterus and that it inhibits contractility. Furthermore, the relaxation responsiveness to nitric oxide is elevated during pregnancy and decreased during labor. A nitric oxide-cyclic guanosine monophosphate relaxation pathway is present in the human uterus and may be responsible for maintaining uterine quiescence during pregnancy. A decrease in uterine relaxation responsiveness to nitric oxide at term may play a role in the initiation of labor.
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13 women admitted consecutively in preterm labour were recruited to an observational study of the effect of glyceryl trinitrate (GTN) patches on uterine contractions and prolongation of pregnancy. All twenty episodes of preterm labour (at 23-33 weeks' gestation) responded. 1 patient delivered because of cervical incompetence despite cessation of uterine contractions. The mean prolongation of pregnancy was 34 days. 8 babies have been born so far, and are progressing well. GTN patches appear to be a safe, well-tolerated, and non-invasive method of suppressing uterine contractions in preterm labour.
Article
We intended to demonstrate the presence of an L-arginine-nitric oxide system in human myometrium and to clarify the mechanisms of action of nitric oxide on rat myometrium during gestation. By examining very small myometrial muscle strips (approximately 750 muscle cells), characteristic features of contraction of rat longitudinal muscle at the midstage of gestation (day 16) and during delivery at term were determined. Spontaneous contractions were significantly different during delivery compared with the midstage of gestation of rat myometrium. L-Arginine relaxed spontaneous and carbachol-induced, but not potassium chloride-evoked, contractions at both stages. However, much higher concentrations of L-arginine were required during delivery, 8-Bromo-cyclic guanosine monophosphate inhibited spontaneous contractions from concentrations of 1 nmol/L in the midstage of gestation and from 0.1 mmol/L during delivery. In human myometrial tissues L-arginine also inhibited contractions during the late stages of gestation. (1) The experimental model is sufficient to compare properties of longitudinal myometrial strips during gestation. (2) In rat and human myometrium an L-arginine-nitric oxide system has an important role in inhibiting uterine contractility and possibly maintaining pregnancy. (3) The relaxing effect of the nitric oxide system is largely because of the voltage-independent action of cyclic guanosine monophosphate systems.
Article
Four groups of women were compared in terms of their perimenstrual symptoms, reported menstrual blood loss and period pain, and neuroticism scores: three patient groups were referred to a Gynaecology Outpatient Clinic because of menorrhagia (N = 101), PMS (N = 104), dysmenorrhea (N = 56), and a control group (N = 105). The three patient groups showed considerable overlap in a number of symptoms. This has led us to postulate three factors contributing to perimenstrual complaints: a) a 'timing factor' linked to the ovarian cycle; b) a 'menstruation factor,' associated with the buildup of the endometrium and its shedding; and c) a 'vulnerability factor,' one aspect of which, 'neuroticism,' was measured in this study. Depressive symptoms, which were the most important in leading women to seek help for their PMS, were related to all three factors. Depressive mood changes seemed to be linked to the 'timing factor' but were noticeably worse and more prolonged in women with high neuroticism, heavy bleeding, or severe pain. One premenstrual symptom, food craving, was of considerable interest. This was weakly related to neuroticism, not apparently affected by the 'menstruation factor' and differed in severity between those in the PMS group and the other three groups. It is potentially relevant that both carbohydrate craving and depression are linked to serotonergic changes in the brain, which may prove to be particularly marked in the late luteal phase.