Ravi Poornima, Boopalan Deenadayalan, Vijayakumar Venugopal, Anandhan Akila, Vanamoorthy Mahesh Kannan, Chidambaram Yogapriya, Kasi Madhesh, Kuppusamy Maheshkumar
Department of Clinical Research, Senior Research Fellow, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Department of Neurology, Senior Research Fellow, National Institute of Mental Health and Neurosciences, Bengaluru, India.
Med Acupunct. 2024 Aug 21;36(4):178-188. doi: 10.1089/acu.2023.0100. eCollection 2024 Aug.
Available literature highlights the effectiveness of Acupuncture or Acupressure on the Spleen 6 acupoint ( or SP-6) for pain management in primary dysmenorrhea (PD). The objective of the current systematic review and meta-analysis is to provide an updated assessment of available randomized and non-randomized controlled trials and to compare the effectiveness of acupressure and acupuncture stimulation of among patients with PD.
We conducted a comprehensive literature search on various electronic databases including Embase, PubMed, and the Cochrane Library from January 1990 to March 2023 to identify the comparative studies (randomized and non-randomized controlled trials) that assessed the effects of acupressure or acupuncture on the acupoint in patients with PD. We assessed the studies' risk of bias in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and certainty of evidence using the Grading of Recommendations Assessment. Subsequently, a fixed-effects meta-analysis was performed using the Der-Simonian and Laird method to combine intervention effects from the included studies. The primary outcome of interest was a reduction in pain.
We included 19 studies (9 acupressure and 10 acupuncture) with 1171 PD patients. This meta-analysis showed a significant (Standardized Mean Difference, SMD: -0.29, 95% confidence interval -0.41 to -0.17, < 0.001) reduction in pain, for both acupressure and acupuncture at acupoint with considerable heterogeneity. Acupressure was found to be more effective than acupuncture stimulation in reducing pain associated with PD (SMD: -0.52, 95% confidence interval -0.71 to -0.33, < 0.001).
The findings of this updated systematic review and meta-analysis suggest that both acupuncture and acupressure on acupoint could effectively reduce pain associated with PD. Acupressure stimulation, in particular, was found to be more effective than acupuncture stimulation of the acupoint in reducing pain associated with PD.
现有文献强调了针刺或指压三阴交穴（SP-6）在原发性痛经（PD）疼痛管理中的有效性。本系统评价和荟萃分析的目的是对现有随机和非随机对照试验进行更新评估，并比较指压和针刺刺激对PD患者的有效性。
我们对1990年1月至2023年3月期间的多个电子数据库进行了全面的文献检索，包括Embase、PubMed和Cochrane图书馆，以识别评估指压或针刺对PD患者三阴交穴效果的比较研究（随机和非随机对照试验）。我们根据《Cochrane干预系统评价手册》评估了研究的偏倚风险，并使用推荐分级评估法评估了证据的确定性。随后，采用Der-Simonian和Laird方法进行固定效应荟萃分析，以合并纳入研究的干预效果。主要关注的结局是疼痛减轻。
我们纳入了19项研究（9项指压和10项针刺），共1171例PD患者。该荟萃分析显示，三阴交穴的指压和针刺均能显著减轻疼痛（标准化均数差，SMD：-0.29，95%置信区间-0.41至-0.17，P<0.001），但存在相当大的异质性。在减轻与PD相关的疼痛方面，发现指压比针刺刺激更有效（SMD：-0.52，95%置信区间-0.71至-0.33，P<0.001）。
本次更新的系统评价和荟萃分析结果表明，针刺和指压三阴交穴均可有效减轻与PD相关的疼痛。特别是，在减轻与PD相关的疼痛方面，发现指压刺激比针刺刺激三阴交穴更有效。
