Acupuncture therapies for relieving pain in pelvic inflammatory disease: A systematic review and meta-analysis

Pelvic inflammatory disease (PID) is a condition that affects millions of women worldwide, characterized by inflammation in the female reproductive organs, including the uterus, fallopian tubes, ovaries, and pelvic peritoneum. This condition represents a significant public health problem, with annual costs exceeding 4 billion dollars in the United States alone. The main symptom of PID is abdominal or pelvic pain, which can progress to chronic pelvic pain, one of the most frequent and debilitating complications. This persistent pain not only affects patients' quality of life but can also lead to psychological problems such as anxiety and depression.

Although conventional treatments include broad-spectrum antibiotics, their long-term efficacy is often limited, leaving patients with chronic pain that requires complementary treatment approaches.

This study aimed to evaluate the efficacy and safety of acupuncture therapies as complementary or alternative treatments for pain relief in patients with PID. The researchers conducted a systematic review and meta-analysis following rigorous international scientific standards. To do so, they performed a comprehensive search across eight medical databases, including both international and Chinese sources, covering publications from the inception of these databases through February 2023. Only randomized controlled clinical trials investigating different types of acupuncture, such as manual acupuncture, electroacupuncture, warm needling, and other related techniques, were included.

The researchers primarily evaluated abdominal and lumbosacral pain intensity scores using validated scales such as the visual analog scale. They also analyzed important secondary outcomes, including blood levels of inflammatory substances, anxiety scores, and quality of life.

The final analysis included 12 clinical trials conducted between 2016 and 2023, involving a total of 1,165 patients, all conducted in China. The results demonstrated that acupuncture, whether used alone or combined with conventional medical treatment, was significantly more effective than conventional treatment alone in reducing abdominal pain. This pain improvement remained evident for at least one month after the end of treatment, suggesting durable benefits. Acupuncture also showed superior efficacy in reducing lumbosacral pain associated with PID.

Beyond pain benefits, the study revealed that acupuncture produced important anti-inflammatory effects, increasing the levels of substances that combat inflammation (such as IL-2) and decreasing those that promote inflammation (such as IL-6 and TNF-α). The researchers also observed significant improvements in patients' anxiety levels and overall quality of life. Regarding safety, acupuncture did not increase the incidence of adverse effects compared with conventional treatment, and when they occurred, they were mild and self-limited.

For patients suffering from PID-related pain, these results suggest that acupuncture may be a valuable and safe therapeutic option, especially when used as a complement to conventional medical treatment. Acupuncture's ability to provide durable pain relief, reduce inflammation, and improve psychological well-being offers a holistic approach to managing this complex condition. For healthcare professionals, the study provides evidence that incorporating acupuncture into treatment plans can enhance therapeutic outcomes without compromising safety. The absence of significant adverse effects makes this therapy particularly attractive for patients seeking alternatives to pain medications or who experience side effects with conventional treatments.

The findings also highlight the potential of integrative medicine, where complementary therapies work in synergy with standard medical treatments.

It is important to recognize several limitations of this study that should be considered when interpreting the results. All included studies were conducted in China, which may limit the applicability of the findings to other populations and healthcare systems. In addition, the individual studies had relatively small samples and variable methodological quality, resulting in evidence rated as low to very low quality according to rigorous scientific criteria. The inability to fully blind acupuncture treatments (since both patients and providers knew they were receiving acupuncture) may have influenced the results.

The study also identified significant variability among the different acupuncture techniques used and in the selection of specific points, making it difficult to determine which approach is most effective. Although promising, these results should be interpreted with caution, and additional studies of higher methodological quality, with larger samples and conducted in different countries, are needed to definitively confirm the efficacy of acupuncture in treating PID-related pain and to establish standardized treatment protocols.