Analgesia Effect of Verum and Sham Acupuncture Treatments in Primary Dysmenorrhea: A MRI Pilot Study.

Shin-Lei Peng,Chun-Ming Chen,Hui-Chieh Yang,Yu-Chen Lee,Ying-Yu Chen,Cheng-Hao Tu

doi:10.3390/jpm11121244

Shin-Lei Peng, Chun-Ming Chen + Show 4 more

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https://doi.org/10.3390/jpm11121244

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Abstract

Acupuncture is an alternative treatment for primary dysmenorrhea (PDM). However, mechanisms by which acupuncture exerts its analgesic properties are still unclear. This study aimed to explore the cerebral blood flow (CBF) response to verum and sham acupuncture treatments, and further investigate whether pre-treatment CBF is capable of assessing symptom changes after interventions. A total of 11 PDM patients in the verum group and 12 patients in the sham group participated in this study. Pain rating index (PRI), CBF, and gonadal hormone levels were acquired before and after 8-week treatments. Both verum and sham acupuncture treatments exert its analgesic effect on PDM after intervention as PRI reduced (p < 0.05). Blood gonadal levels were not significantly different after acupuncture in both groups (all p > 0.05). In the verum group, intervention-related decreases in CBF were observed in the right dorsal anterior cingulate cortex. In the sham group, regions identified as showing reductions in CBF after acupuncture included the left ventromedial prefrontal cortex, left caudate, and left insula. Patients with higher baseline CBF in the left precuneus and right hippocampus were accompanied with worse treatment response to acupuncture intervention. Mechanisms of verum and sham acupuncture treatments are dissimilar as manifested by different brain responses.

Highlights

Primary dysmenorrhea (PDM), the most common gynecological disease, is the occurrence of painful menstrual cramping of the uterus, affecting as many as 85% of women
The mechanisms of verum and sham acupuncture treatments are dissimilar, as manifested by different brain responses. Both verum and sham acupuncture treatments demonstrated a salutary effect on PDM; the changes in pain severity depended on the baseline cerebral blood flow (CBF), with patients having higher resting perfusion in the precuneus and hippocampus but minimal response to acupuncture treatment
Our results demonstrated that a higher baseline CBF in the precuneus and hippocampus was associated with a worse treatment response in patients with PDM

Summary

Introduction

Primary dysmenorrhea (PDM), the most common gynecological disease, is the occurrence of painful menstrual cramping of the uterus, affecting as many as 85% of women. PDM increases the risk of fibromyalgia [1]. Standard treatments for PDM including nonsteroidal anti-inflammatory drugs (NSAIDs) and hormonal contraceptive methods are used to exert hypoalgesic action [2,3]. Side effects such as gastrointestinal complaint and mild neurological symptoms may deter some females from these medications [4]. The National Institute of Health has recommended acupuncture as an effective treatment for pain alleviation in PDM [6]. Beneficial effects of acupuncture include increasing participation in daily activities and reducing the amount of ingested pain medication [7]. One meta-analysis suggested that acupuncture-related hypoalgesic effects on PDM were more effective compared with NSAIDs [8]

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