Analgesic Efficacy of Acupuncture on Chronic Pelvic Pain: A Systematic Review and Meta-Analysis Study

Chronic pelvic pain represents one of the most complex challenges in modern medicine, affecting millions of people worldwide and causing significant impact on both patients' quality of life and health care systems. Defined as pain in the pelvic region that persists for more than six months, this condition can manifest in different forms and may be associated with various urinary, sexual, bowel, muscular, or gynecologic disorders. Epidemiologic data reveal the magnitude of this problem, with prevalence rates varying drastically across different regions of the world — from 2.1% to 24% for noncyclic chronic pelvic pain, from 16.8% to 81% when associated with dysmenorrhea, and from 8% to 21.1% in intermittent cases related to dyspareunia. Particularly concerning is the fact that women are affected twice as often as men, and direct and indirect costs of this condition in the United States were estimated to have reached billions of dollars as early as the 1990s.

Management of chronic pelvic pain has proven especially challenging for health care professionals. A recent survey of members of the Royal College of Obstetricians and Gynaecologists revealed that 45% of respondents considered the treatment of chronic pelvic pain in women to be "poor" or "very poor" in the United Kingdom. Even more telling was the fact that more than half of professionals identified "pain control" as the most important aspect of care, surpassing even "identifying the cause of the pain." This reality has led to recognition that medication alone is often inadequate, with multidisciplinary approaches that combine different therapeutic strategies — including physical therapy, cognitive behavioral therapy, dietary modifications, neuromodulation, and lifestyle counseling — increasingly recommended.

This study aimed specifically to evaluate the analgesic efficacy of acupuncture in the treatment of chronic pelvic pain through a systematic review and meta-analysis of randomized controlled trials. The researchers conducted comprehensive searches in the PubMed and Embase databases, covering the period from January 2011 to September 2022, with no language restrictions. Various types of acupoint-stimulation–based interventions were included, such as electroacupuncture, manual acupuncture, moxibustion, abdominal acupuncture, catgut implantation, laser acupuncture, and acupressure. To assess outcomes, validated pain scales were used, including the visual analog scale, numeric rating scale, and the total pain scores of the National Institutes of Health Chronic Prostatitis Symptom Index.

The rigorous methodology included independent quality assessment of the studies by multiple reviewers and statistical analysis using random-effects models.

The results of this meta-analysis were consistently favorable to acupuncture. Seventeen studies involving 1,455 patients were included in the final analysis, encompassing 867 women and 588 men with different etiologies of chronic pelvic pain, including endometriosis, inflammatory pelvic pain, pregnancy-related pelvic pain, and chronic pelvic pain syndrome/chronic prostatitis. The data revealed that acupuncture produced significantly lower pain levels compared with control groups, both when assessed by NIH-CPSI pain scores and by VAS/NRS scales. Particularly notable was the finding that virtually all acupuncture methods tested — including electroacupuncture, manual acupuncture, moxibustion, abdominal acupuncture, and auricular acupuncture — demonstrated superior efficacy compared with control treatments, with the exception of laser acupuncture.

The analysis also revealed that acupuncture maintained its efficacy both when used as adjunctive therapy and as monotherapy, suggesting it can be a valid option even when used alone.

The clinical implications of these results are substantial for both patients and health care professionals. For patients suffering from chronic pelvic pain, acupuncture represents a therapeutic option with proven efficacy that can be integrated into existing treatment plans or used as an alternative when other approaches have not been satisfactory. The versatility of acupuncture is particularly valuable, as it can be combined with other treatments or used alone, offering flexibility in personalized pain management. In addition, acupuncture has especially attractive features such as low cost, few side effects, and high compatibility with other therapeutic modalities.

For health care professionals, these findings provide robust evidence for including acupuncture in chronic pelvic pain treatment guidelines, especially given that pain control was identified as the highest priority in managing this condition. The efficacy of acupuncture as monotherapy also offers an important option for patients who cannot tolerate conventional medications, experience refractory pain, or have comorbidities that limit other therapeutic approaches.

Although the results are encouraging, several important limitations should be considered when interpreting these findings. First, for some specific methods such as moxibustion, auricular acupuncture, and abdominal acupuncture, only one study was included in the analysis, limiting the robustness of conclusions for these specific modalities. Second, most of the included studies showed some concerns regarding risk of bias, particularly in the "outcome measurement" domain, mainly because of the subjective nature of pain assessment by the patients themselves. Third, the significant heterogeneity found across some studies suggests that there may be important variations in treatment protocols, patient populations, or other factors influencing outcomes.

Future research should include larger-scale multicenter studies, more objective pain assessment systems, standardization of acupuncture protocols for different etiologies of chronic pelvic pain, and more detailed cost-effectiveness analyses. Despite these limitations, this meta-analysis provides convincing evidence that acupuncture can play a valuable role in the therapeutic arsenal for chronic pelvic pain, offering hope for millions of people suffering from this debilitating condition and contributing to more integrated and effective treatment approaches.