Is acupuncture effective in the treatment of pain in endometriosis?
Lund & Lundeberg · Journal of Pain Research · 2016
OBJECTIVE
Review the efficacy of acupuncture in the treatment of visceral pelvic pain related to endometriosis
WHO
99 women aged 13-40 years with endometriosis confirmed by laparoscopy
DURATION
9-16 sessions over several weeks
POINTS
7-12 needles per session in lumbar/pelvic region, lower abdomen, hands, and feet
🔬 Study Design
True acupuncture
n=83
Traditional acupuncture based on TCM or Japanese technique
Controls
n=16
Non-specific points or non-penetrating needles
📊 Results in numbers
Reduction in pain intensity
Improvement in quality of life
Reduction in analgesic use
Serious adverse events
📊 Outcome Comparison
Pain intensity (before/after treatment)
This review suggests that acupuncture may be a safe and effective option for women with pelvic pain caused by endometriosis. Although the evidence is limited, all analyzed studies showed reduction in pain intensity after acupuncture treatment.
Article summary
Plain-language narrative summary
Endometriosis is an inflammatory, estrogen-dependent gynecologic condition that affects 5-15% of women of reproductive age, frequently causing persistent visceral pelvic pain and infertility. This systematic review analyzed three clinical studies that investigated the efficacy of acupuncture in the treatment of endometriosis-related pain, including a total of 99 women aged 13 to 40 years with diagnosis confirmed by laparoscopy. Acupuncture treatments varied between traditional Chinese medicine techniques and Japanese acupuncture, with individualized protocols based on the specific symptoms of each patient. All studies used between 7 and 12 needles per session, inserted mainly in the lumbar/pelvic region, lower abdomen, hands, and feet, with retention times of 15-25 minutes.
Treatments lasted from 9 to 16 sessions, administered once or twice weekly. The results were consistent across the three studies, regardless of study design or specific acupuncture technique used. All studies reported significant decreases in patient-rated pain intensity after treatment. Two studies also demonstrated improvements in health-related quality of life, including psychological well-being and social efficiency.
In addition, reductions were observed in analgesic medication use and in days absent from work or school. It is important to emphasize that none of the studies reported serious adverse events related to acupuncture treatment. From a physiological and Western medicine perspective, acupuncture can be understood as a type of sensory stimulation that induces changes in central nervous system functioning, which may partially explain the decrease in pain perception in response to treatment. Proposed mechanisms include activation of endogenous descending pain inhibition systems, deactivation of brain areas that transmit unpleasant pain-related sensations, and interaction between nociceptive impulses and somato-visceral reflexes.
The limitations of this review include the small number of available studies and the limited sample size, which makes the patterns of change more variable. Furthermore, creating truly inert placebo controls for acupuncture represents a significant methodological challenge, since any type of tactile stimulation can activate afferent nerve fibers. The authors suggest that future studies should focus on assessing effectiveness across different treatment strategies, rather than only efficacy, and include analyses of individual patient responses. This approach would be particularly relevant given that pain is a subjective experience and can vary significantly between individuals.
For patients with endometriosis who have not obtained adequate relief from conventional treatments or who have experienced significant side effects, acupuncture emerges as a promising and safe complementary therapeutic option.
Strengths
- 1Systematic analysis of multiple study types
- 2Focus on individual patient responses
- 3Excellent safety profile with no serious adverse events
Limitations
- 1Limited number of available studies
- 2Small sample sizes
- 3Difficulty in creating adequate placebo controls
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Endometriosis poses one of the greatest therapeutic challenges in chronic female pelvic pain — a condition that affects between 5% and 15% of women of reproductive age and that frequently arrives at the pain clinic after years of hormonal and surgical treatment without satisfactory relief. This systematic review positions acupuncture as a legitimate adjunct in this context, not as an alternative to conventional treatment, but as a resource capable of acting in dimensions that GnRH analogs and laparoscopy do not fully cover: central modulation of chronic visceral pain and quality-of-life aspects. The safety profile observed — zero serious adverse events in 99 patients — is clinically relevant when deliberating whether to add a new therapeutic modality for women who frequently already deal with significant side effects from long-term hormone therapy.
▸ Notable Findings
The most noteworthy finding is the consistency of results across the three included studies, regardless of the technique employed — whether acupuncture based on traditional Chinese medicine or Japanese technique, with individualized protocols. This convergence suggests that the common therapeutic denominator lies less in the specific point chosen and more in the sensory stimulation capable of recruiting endogenous descending pain inhibition systems and deactivating brain areas linked to the affective dimension of nociception. Two studies demonstrated improvement in psychological well-being and social efficiency — outcomes that conventional analgesics rarely modify substantively. The reduction in analgesic medication use and in school and work absenteeism, recorded in one of the studies, points to a functional impact that goes beyond the pain scale and that must be valued in clinical decision-making.
▸ From My Experience
In my practice at the Pain Center of HC-FMUSP, patients with endometriosis typically arrive after multiple unsuccessful approaches, with an established central sensitization phenotype — and it is precisely in this profile that I have observed the most expressive responses to acupuncture. I usually see the first signs of improvement in pelvic pain between the third and fifth sessions, with stabilization of therapeutic gain between the tenth and twelfth sessions, which aligns well with the 9 to 16 session range documented in this review. I routinely combine acupuncture with specialized pelvic physical therapy and, when there is a predominant visceral inflammatory component, with segmental auricular acupuncture — a combination that, in my perception, shortens the time to response. Young women between 13 and 25 years old, with severe dysmenorrheic pain and without complete response to anti-inflammatories, represent the group in which I most often indicate acupuncture early. I avoid initiating treatment during phases of acute hormonal exacerbation without adequate parallel clinical support.
Full original article
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Journal of Pain Research · 2016
DOI: 10.2147/JPR.S55580
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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