Acupuncture and Chinese herbal medicine may help women with chronic pelvic pain

Professor George Lewith, from the Complementary and Integrated Medicine Research Unit, University of Southampton, was the lead author of the paper entitled, Acupuncture and Chinese herbal medicine for women with chronic pelvic pain.

The paper, constructed by the RCOG’s Scientific Advisory Committee, looks at the evidence relating to the use of some complementary and alternative medicine interventions in the treatment of diseases that are known to be associated with, and cause, CPP.

It is estimated that one in six women are affected by CPP which can be defined as intermittent or constant pain in the lower abdomen or pelvis for over six months and many will use some form of complementary medicine to help their symptoms.

Acupuncture is a safe intervention and involves the insertion of fine needles into specific points on the body. Stimulation of these points is believed to induce a local and systemic healing response.

A literature search, by the paper’s authors, did not find any trials of acupuncture relating specifically to CPP; however, it did identify trials on closely related conditions such as dysmenorrhoea, pelvic inflammatory disease and IBS. These are all known to contribute to CPP.

Two small trials included in a recent Cochrane review found that acupuncture treatment significantly reduced menstrual symptoms compared to standard non-steroidal anti-inflammatory drugs. However more research is needed in this area.

The opinion paper recommends that anyone considering acupuncture treatment should find a practitioner registered with one of the major acupuncture associations such as the British Acupuncture Council, the Association of Traditional Chinese Medicine, and the British Medical Acupuncture Society.

Chinese herbal medicine (CHM) developed alongside acupuncture in China and other East Asian countries over 2000 years ago.

A Cochrane review of CHM for dysmenorrhoea included 39 randomised controlled trials and reported promising results for CHM when compared to the use of pharmaceutical drugs such as NSAIDs and the oral contraceptive pill. However there are limitations as some trials had poor methodological quality and small sample sizes.

The paper recommends that people only consult members of the Register of Chinese Herbal Medicine or the Association of Traditional Chinese Medicine.

In conclusion, the authors of the paper say that while there is no compelling evidence that acupuncture or CHM are effective in the treatment of CPP, they may have roles to play in the treatment of dysmenorrhoea, endometriosis, IBS and pelvic inflammatory disease.

Moreover, women should be aware of the provisional nature of the evidence supporting these alternative approaches.

Professor George Lewith says: “Some small trials suggest that acupuncture and Chinese herbal medicine may be beneficial for chronic pelvic pain. However, the current evidence lacks rigour and the available trials are poorly designed and inadequately reported so we can only consider this preliminary evidence.

“Many women use acupuncture and Chinese herbal medicine for chronic pelvic pain so this area clearly requires further rigorous investigation and we would support further well-designed research for this problematic condition.”

RCOG Green-top Guideline on Chronic Pelvic Pain: Initial Management: http://www.rcog.org.uk/womens-health/clinical-guidance/initial-management-chronic-pelvic-pain-green-top-41