Acupuncture for pain and pain-related disability in deep infiltrating endometriosis

This prospective pilot study investigated the effects of acupuncture in women with deep infiltrating endometriosis (DIE), a complex gynecologic condition that causes significant chronic pain and impacts quality of life. Deep endometriosis is characterized by lesions extending more than 5 mm beneath the peritoneal surface, causing debilitating symptoms such as severe dysmenorrhea, dyspareunia, chronic pelvic pain, and dyschezia. Conventional treatment frequently includes surgery and hormonal therapies, but many patients continue to experience significant pain and functional limitations. The research involved 34 women with a mean age of 33.8 years who had histologically confirmed endometriosis.

After a 2-month observation period to establish baseline, participants received 15 acupuncture sessions over 6 months, beginning with weekly treatments for 12 weeks followed by monthly sessions for 3 months. The protocol used a standardized acupuncture formula with 11 specific points bilaterally, selected based on Traditional Chinese Medicine principles to address blood stasis and Qi deficiency in the abdomen and uterus. Results were notable across multiple dimensions. Dysmenorrhea intensity dropped dramatically from 8.0 at baseline to 3.4 at the fourth month of treatment, representing a reduction of more than 50%.

The number of days of dysmenorrhea per menstrual cycle also decreased significantly from 2.9 to 1.28 days. Dyspareunia showed steady improvement, with intensity decreasing from 5.7 to 3.8, while non-cyclic pelvic pain decreased from 6.3 to 4.44. Equally important was the reduction in symptom-related functional disability. The percentage of women with moderate-to-severe disability related to dysmenorrhea fell dramatically from 89.7% at baseline to only 6.9% at the fourth and fifth months of treatment.

For dyspareunia, moderate-to-severe disability decreased from 73.7% to 36.9%, and for pelvic pain, from 83.3% to 33.3%. Analgesic use also decreased substantially. Whereas 63% of patients reported regular use of nonsteroidal anti-inflammatory drugs at baseline, this number fell to 36.7% during treatment. More importantly, perceived analgesic efficacy increased from 29% to 65% of patients reporting effective relief.

The study demonstrated an excellent safety profile, with only two cases (6.7%) of hematoma at the needle insertion site and no serious adverse events. The response rate was exceptionally high, with only 2 of 30 patients (6.7%) reporting no benefit from treatment, well below the typical 20-30% non-response rate observed in the general population for acupuncture. The acupuncture points were selected strategically to address the underlying energetic patterns in endometriosis according to Chinese medicine. Points such as LR-3 (Taichong) and SP-6 (Sanyinjiao) were included to address blood stasis and promote circulation, while points such as CV-6 (Qihai) and CV-3 (Zhongji) were chosen to strengthen Qi and act specifically on the uterus.

Limitations include the small sample size, typical of pilot studies, the absence of a placebo control group due to technical difficulties in creating valid acupuncture controls, and possible selection bias since some participants actively sought acupuncture treatment. Despite these limitations, the results provide encouraging evidence that acupuncture may be a valuable intervention for the management of pain related to deep endometriosis, potentially offering an alternative or complement to conventional treatments with a more favorable adverse-effect profile.