Meta-analysis of clinical effect

In the current study, we systematically reviewed the results of 10 RCTs comparing the outcomes of acupuncture with those of other therapies (sham acupuncture, Western medicine, or Traditional Chinese Medicine) in the treatment of endometriosis-related pain. Among the 10 RCTs included, six reported variations in main pain level, four reported variations in peripheral blood CA-125 levels, and seven reported the clinical effective rate of acupuncture as a treatment for endometriosis-related pain. In all 10 of the studies, the interventions were acupuncture, and the control interventions were placebo [25], Western medicine [17, 19–20, 26], or Traditional Chinese Medicine. Because so few studies were included, we did not carry out a subgroup analysis.

Only one of the included RCTs [25] selected sham acupuncture as the control intervention; fourteen participants completed this study in accordance with the protocol. Participants in the active acupuncture group (n = 9) experienced a mean 4.8-point (SD = 2.4-point) reduction on an 11-point scale (62%) in pain after 4 weeks; this differed significantly from the control group’s (n = 5) mean reduction of 1.4 points (SD = 2.1 points; P = 0.004). Reduction in pain in the acupuncture group persisted throughout the 6-month assessment. Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents.

Four of the included RCTs selected Western medicine as the control intervention [17, 19–20, 26]. Specifically, the studies used danazol, mifepristone, or goserelin acetate, and showed that acupuncture was better than Western medicine in relieving pain and reducing the concentration of CA-125.

Five of the RCTs selected Traditional Chinese Medicine [17, 19–20, 26] as the control intervention, and all showed that acupuncture is better than Traditional Chinese medicine in relieving pain. However, we must acknowledge that few properly blinded trials [25] have addressed this issue, and that the effects of expectation or other non-specific factors may have contributed to the benefits seen in the present study. Nonetheless, based on a single placebo-controlled study and on other studies comparing acupuncture to Western medicine and Eastern herbs, acupuncture appears to be effective in reducing pain and serum CA-125 levels in endometriosis.

Our findings were similar to those of Lund I [37] and Zhu X [38], although we considered a greater number of databases than these previous studies; we also identified more RCTs that included three outcome measures (variation in main pain level, variation in peripheral blood CA-125 level, and clinical effective rate) in our meta-analysis.