Effects of the Number of Acupoint Stimulation on Autonomic Nervous Activity and Symptom Improvements in Dysmenorrhea-A Randomized Clinical Trial

Objective: Acupuncture has been widely used as a complementary treatment for dysmenorrhea, yet whether the number of acupoint stimulation is related to the treatment efficacy remains unsure. The current study examined the relationship between the number of acupoints stimulated and the efficacy of acupuncture on dysmenorrhea and the effects on regulating the autonomic nervous system. Methods: We conducted a single-blind randomized clinical trial. A total of 60 patients were included and used in the analysis. Patients meeting the inclusion criteria were randomly allocated to the 12 or 6 acupoints stimulation group. Each participant received weekly acupuncture in the luteal phase for at least three cycles. The primary outcome was the autonomic nervous activity as measured by heart rate variation (HRV). The secondary outcomes were analgesics dependence, pain as measured by the Visual Analog Scale (VAS), Verbal Multidimensional Scoring System (VMSS) for dysmenorrhea, and the 12-Item Short-Form Health Survey (SF-12) quality of life. Results: Six acupoints stimulation was as effective as twelve acupoints stimulation in improving HRV in sympathetic nervous activity (HF%), parasympathetic nervous activity (LF%), and autonomic nervous activity (SDNN). For pain and symptom reduction, the 6 acupoints were not inferior to the 12 acupoints. Both groups improved significantly in symptoms, quality of life, and pain. Conclusion: The current trial indicates that improvement of dysmenorrhea by acupuncture is not determined by the number of acupoints or the number of acupoint stimulations. The choice of acupoint also plays a role. A more concise acupuncture experimental design is warranted for further study.

關鍵字

acupuncture ； autonomic nervous activity ； dysmenorrhea ； heart rate variability (HRV) ； pain ； quality of life

並列摘要

目的：針灸已廣泛應用於痛經為一種輔助替代治療，然而針灸針數的多寡是否和其療效相關，卻未有實證醫學探討。方法：本研究擬探討針灸針數（穴位數目）與對痛經療效的關係，及其對自律神經系統調節的影響。我們設計了一個單盲的隨機臨床試驗，共計60位患者被納入並完成分析。符合收案條件的受試者將隨機被分配到六針組或十二針組，每位受試者，將於黃體期期間每週接受針灸，並於針灸前後接受自律神經的測量，維持至去三個月經週期。試驗的主要目標為自律神經活性檢測，次要目標為疼痛分數（VAS），評估經痛的口語化多面向計分系統Verbal Multidimensional Scoring System（VMSS）及SF12生活品質量表測量。結果：試驗分析結果顯示6針組患者比12針組患者在交感神經（LF）及副交感神經（HF）的比例上都有顯著進步的趨勢（p=0.032）；對於代俵自律神經活性的SDNN（Standard deviation of NN intervals）也有顯著意義改善（p=0.049）。而在疼痛控制，症狀評估上，六針組的反應不亞於12針組，兩組在統計學上都有意義地改善了痛經的症狀和生活品質及疼痛分數！結論：此試驗證明針灸對痛經的改善並非取決於針數或穴位數目刺激的多寡，針灸穴位處方也扮演一定重要性。期待未來能有更深度精準的針灸相關實驗設計。

並列關鍵字

針灸；自律神經活性；痛經；心率變異；疼痛；生活品質

主題瀏覽