Jiande hospital of integrated traditional Chinese and Western Medicine, Hangzhou, China.
The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China.
Front Endocrinol (Lausanne). 2023 Jan 5;13:1016222. doi: 10.3389/fendo.2022.1016222. eCollection 2022.
Auricular acupressure (AA) is widely used in treatment of dysmenorrhea, but the safety and efficacy of auricular acupressure on dysmenorrhoea are still lack of evidence-based basis.
The purpose of meta-analysis was to evaluate the effects of auricular acupressure on dysmenorrhea.
A systematic search was conducted in six electronic databases, including PubMed, Embase, Cochrane Central Register of Controlled Trials (CINAHL), Weipu (CQVIP), China National Knowledge Infrastructure (CNKI), and Wanfang databases, to retrieve studies published from the inception dates to June 10, 2022.
Randomized controlled trials (RCTs) that investigated the effectiveness of AA on dysmenorrhea were identified.
The data extraction and quality assessment of the included studies were performed by two reviewers independently. Outcomes were abstracted to determine the effect measure by using mean differences (MD), standardized mean differences (SMD), or odds ratio (OR) from a random effects model.
Cure rate, total effective rate, and visual analogue scale (VAS) were described as primary outcomes; Short-form Menstrual Distress Questionnaire (MDQs), symptom scores, serum nitric oxide (NO) level, and adverse events were recorded as secondary outcomes.
Thirty-five RCTs involving 3960 participants were included in this study. Our findings indicated that, overall, AA was associated with a significant benefit in cured rate (OR = 1.95, 95%CI: [1.34, 2.83], P=0.0004, I = 75%), total effective rate (OR = 3.58, 95%CI: [2.92, 4.39], P<0.00001, I = 67%), VAS score (MD = -1.45, 95%CI: [-1.73, -1.17], P<0.00001, I = 67%), and symptom scores compared to the control group (SMD = -0.85, 95%CI: [-1.28, -0.43], P<0.0001, I = 91%). However, no difference in serum NO (SMD = 0.77, 95%CI: [-0.39, 1.92], P = 0.19, I = 89%) and MDQs (SMD = -0.58, 95%CI: [-1.26, 0.10], P = 0.10, I = 79%) was found between the two groups. Furthermore, subgroup analysis results indicated that AA showed significant superiorities in increasing cured rate and total effective rate, and reducing VAS score and symptom scores when compared to analgesics and non-intervention. Moreover, AA presented the same superiorities when used as an adjunctive strategy to other therapy. However, these benefits were not detected in AA used alone when compared to the therapies, including Chinese herbs, acupuncture, external application of Chineseherbal medicine, moxibustion, auricular needle, and health education.
Overall, AA, as a potential safety therapy, is effective for the management of dysmenorrhea, such as increasing cured rate, total effective rate, VAS, and symptom scores. Nevertheless, AA showed no significant improvement in serum NO and MDQs. It is furtherly found that AA used alone is superior to analgesics and non-intervention regarding cured rate, total effective rate, VAS, and symptom scores. Furthermore, the same superiorities are observed when AA serves as an adjunctive strategy to other therapy. However, AA alone has little effect on them compared to other therapies, and there is no definite conclusion on the benefits of AA compared to placebo for patients with dysmenorrhea. Rigorous RCTs with blind method and placebo control are warranted to confirm these findings.
https://www.crd.york.ac.uk/prospero/, identifier CRD42022338524.
耳穴按压（AA）在痛经治疗中被广泛应用，但 AA 治疗痛经的安全性和疗效仍缺乏循证依据。
本荟萃分析旨在评估 AA 治疗痛经的效果。
我们在 6 个电子数据库（PubMed、Embase、Cochrane 对照试验中心注册库（CINAHL）、维普（CQVIP）、中国知网（CNKI）和万方数据库）中进行了系统检索，检索时间截至 2022 年 6 月 10 日，以获取关于 AA 治疗痛经的随机对照试验（RCT）的研究。
我们确定了评估 AA 治疗痛经有效性的 RCT。
两位评审员独立对纳入研究进行数据提取和质量评估。使用随机效应模型，通过均数差值（MD）、标准化均数差值（SMD）或比值比（OR）来确定疗效测量指标。
治愈率、总有效率和视觉模拟评分（VAS）被描述为主要结局；短期月经困扰问卷（MDQ）、症状评分、血清一氧化氮（NO）水平和不良反应被记录为次要结局。
我们纳入了 35 项 RCT，共涉及 3960 名参与者。我们的研究结果表明，总体而言，AA 与治愈率（OR=1.95，95%CI：[1.34，2.83]，P=0.0004，I²=75%）、总有效率（OR=3.58，95%CI：[2.92，4.39]，P<0.00001，I²=67%）、VAS 评分（MD=-1.45，95%CI：[-1.73，-1.17]，P<0.00001，I²=67%）和症状评分（SMD=-0.85，95%CI：[-1.28，-0.43]，P<0.0001，I²=91%）相比对照组均有显著改善。然而，两组之间血清 NO 水平（SMD=0.77，95%CI：[-0.39，1.92]，P=0.19，I²=89%）和 MDQ 评分（SMD=-0.58，95%CI：[-1.26，0.10]，P=0.10，I²=79%）无显著差异。此外，亚组分析结果表明，与镇痛药和非干预相比，AA 在提高治愈率和总有效率、降低 VAS 评分和症状评分方面具有显著优势。此外，当 AA 作为其他治疗的辅助策略时，也表现出相同的优势。然而，与中药、针灸、中药外治法、艾灸、耳针和健康教育等治疗方法相比，AA 单独使用时，这些益处并未被发现。
总的来说，AA 作为一种潜在的安全疗法，对痛经的管理是有效的，例如提高治愈率、总有效率、VAS 和症状评分。然而，AA 对血清 NO 和 MDQ 没有显著改善。进一步发现，AA 单独使用时在治愈率、总有效率、VAS 和症状评分方面优于镇痛药和非干预。此外，当 AA 作为其他治疗的辅助策略时，也观察到相同的优势。然而，与其他治疗方法相比，AA 单独使用对它们的效果不大，与安慰剂相比，AA 对痛经患者的益处也没有明确的结论。需要进行严格的、采用盲法和安慰剂对照的 RCT 来证实这些发现。
