The PICO QUESTION IS “In women who suffer from dysmeno
hea will acupuncture or acupressure manages pain better than oral contraceptives.”
The first 2 paragraph has been done, can you please do from results ,I have attached the article .
Introduction (200 words)
o Describe the aim of the report and
iefly state the importance of the chosen topic
o Describe your searchable question using the PICO method, including what the PICO
is and the rationale for using the PICO (supported by evidence)
o Present a table with the PICOinformation
o Show the readers about what is to be reported in thisdocument
• Methodology (500 words)
o Describe the database used, search terms, Boolean operators, number of papers at
each stage of the search, criteria used to eliminate papers, and how the best study
was chosen.
o Include your ‘Search History’ and then explainthe above search process
o Provide a
ief statement on the reasoning in the choice of paper and its relevance
to the PICO question
• Results (500 words)
o State the research question in the study, the study design, and whether the design is
appropriate to the question in the study
o State the study setting and selection of participants, including sample size, any
inclusion/exclusion criteria used, and comment on the adequacy of the sample
o State the methods of data collection and whether they are appropriate
o State the methods of data analysis and whether they are appropriate
o Briefly state the findings, including the level of statistical significance
o Do not copy any figures, diagrams, or tables from the included study
o The included study is referenced once only, but other statements or rationales will
e supported by research evidence
• Discussion (500 words)
o Discuss the validity, any biases, and design strengths
o Appraise the significance of the results and note any limitations of the data
presented
o Comment on whether the data reported allows for determining clinical significance
• Relevance for clinical practice (500words)
o State the relevance of the paper to the question asked
o Apply the evidence to clinical practice based on their analysis
o Provide a concluding statement about the value of writing this report and applying
evidence for clinical practice
Efficacy of Acupuncture versus Combined Oral Contraceptive Pill in Treatment of Moderate-to-Severe Dysmeno
hea: A Randomized Controlled Trial
Research Article
Efficacy of Acupuncture versus Combined Oral Contraceptive
Pill in Treatment of Moderate-to-Severe Dysmeno
hea:
A Randomized Controlled Trial
Intira Sriprasert,1 Suparerk Suerungruang,2 Porntip Athilarp,3
Anuchart Matanasarawoot,4 and Supanimit Teekachunhatean3,5
1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
2Health Promotion Center Region 10, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand
3Center of Thai Traditional and Complementary Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
4Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
5Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
Co
espondence should be addressed to Supanimit Teekachunhatean; XXXXXXXXXX
Received 17 March 2015; Accepted 8 July 2015
Academic Editor: Abir El-Alfy
Copyright © 2015 Intira Sriprasert et al.This is an open access article distributed under the Creative CommonsAttribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This open-label randomized controlled trial was designed to compare the efficacy of acupuncture and combined oral contraceptive
(COC) pill in treating moderate-to-severe primary dysmeno
hea. Fifty-two participants were randomly assigned to receive eithe
acupuncture (n = 27) or COC (n = 25) for three menstrual cycles. Mefenamic acid was prescribed as a recue analgesic drug with
oth groups. The statistical approach used for efficacy and safety assessments was intention-to-treat analysis. By the end of the
study, both treatments had resulted in significant improvement over baselines in all outcomes, that is, maximal dysmeno
hea pain
scores, days suffering from dysmeno
hea, amount of rescue analgesic used, and quality of life assessed by SF-36 questionnaire.
Over the three treatment cycles, COC caused greater reduction in maximal pain scores than acupuncture, while improvements
in the remaining outcomes were comparable. Responders were defined as participants whose maximal dysmeno
hea pain scores
decreased at least 33% below their baseline. Response rates following both interventions at the end of the study were not statistically
different. Acupuncture commonly causedminimal local side effects but did not cause any hormone-related side effects as did COC.
In conclusion, acupuncture is an alternative option for relieving dysmeno
hea, especially when COC is not a favorable choice.
1. Introduction
Dysmeno
hea is one of themost common gynecologic prob-
lems affecting women of reproductive age with a prevalence
of 50–90% [1–3]. One-third of women reported moderate-
to-severe pain which impacts the quality of life as it leads to
absence from school or work as well as decreased social inter-
est andparticipation [4].Dysmeno
hea can be categorized as
either primary dysmeno
hea which occurs without demon-
strable disease or secondary dysmeno
hea which involves
underlying pathology such as endometriosis, adenomyosis,
or uterine myoma. Dysmeno
hea in young women is mostly
primary dysmeno
hea, with the prevalence decreasing with
age. The pathogenesis of primary dysmeno
hea is explained
y the action of prostaglandins such as prostaglandin E2,
prostaglandin F2?, endoperoxides, or vasopressin released
from the endometrium at the onset of menstruation which
stimulates pain neurons and induces excessive contraction
of the uterus and adjacent organs causing ischemia which is
perceived as pelvic pain [5]. Beside pelvic pain, some women
experience associated symptoms such as nausea, vomiting,
headache,migraine, dizziness, dia
hea, constipation, fatigue,
or lightheadedness.
A nonsteroid anti-inflammatory drug (NSAID) is sug-
gested for dysmeno
hea pain relief as it inhibits activity of
cyclooxygenase and thereby the synthesis of prostaglandins
which are believed to cause dysmeno
hea [6]. A combined
oral contraceptive (COC) pill is also recommended for the
Hindawi Publishing Corporation
Evidence-Based Complementary and Alternative Medicine
Volume 2015, Article ID 735690, 10 pages
http:
dx.doi.org/10.1155/2015/735690
http:
dx.doi.org/10.1155/2015/735690
2 Evidence-Based Complementary and Alternative Medicine
treatment of primary dysmeno
hea due to its ability to
suppress ovulation and reduce menstrual prostanoids [5],
providing relief from dysmeno
hea pain in up to 70–80% of
women [7–10]. A COC containing low-dose ethinyl estradiol
and third generation progestin usually shows a decrease in
severity of dysmeno
hea after 3 to 6 treatment cycles [10].
However, even with the use of an NSAID and COC, 25%
of women with primary dysmeno
hea have reported no
esponse [11, 12] or treatment-related side effects such as
nausea, headaches, and weight gain [8, 13].
Acupuncture is a complementary therapy involving the
insertion of fine needles into the body at specific points
to achieve a therapeutic effect [14]. Acupuncture has been
eported to be successful in treating primary dysmeno
hea
[15, 16]. According to acupuncture theory, syndrome dif-
ferentiation of dysmeno
hea can be divided into “Excess”
type (i.e., stagnation of vital energy and blood, stagnation
of cold, and accumulation of damp-heat) and “Deficiency”
type (which is further subdivided into two categories: one
is vital energy and blood deficiency and the other is kidney
and liver deficiency). Acupuncture’s primary purpose is to
move vital energy and blood, scatter cold, clear damp-heat, o
tonify/nourish vital energy, blood, and internal organs with
espect to the syndrome differentiation. On a scientific basis,
acupuncture causes the central nervous system to release
endorphins, serotonin, and acetylcholine which results in
pain reduction [15]. A systematic review concluded that
acupuncture provides a reduction in dysmeno
hea pain
when compared to a placebo control [12]. In addition to pain
elief, acupuncture has been reported to improve quality of
life and decrease NSAID use after regular treatment for 3 to 6
months [16, 17].
Although several studies have reported benefits from
acupuncture treatment for dysmeno
hea [12, 15–17], no
head-to-head comparative study of the relative efficacy of
acupuncture and COC, especially in women with moderate-
to-severe primary dysmeno
hea, has been conducted. This
study aimed at investigating the relative efficacy of acupunc-
ture and COC in this clinical setting.
2. Materials and Methods
2.1. Design. This prospective, open-label, randomized con-
trolled trial was conducted during the period from January
2013 to Fe
uary 2014 at the Center of Thai Traditional and
Complementary Medicine (TTCM), Faculty of Medicine,
Chiang Mai University, Chiang Mai, Thailand. It was
approved by the Research Ethics Committee of the Faculty
of Medicine, Chiang Mai University. This study was also reg-
istered with the Chinese Clinical Trial Registry (http:
www
.chictr.org/, registration number: ChiCTR-TRC XXXXXXXXXX).
2.2. Sample Size Calculation. Calculation of sample size was
ased on the assumption that a percentage of responders
in each intervention group would be the main criterion fo
measuring efficacy and that the percentages of responders in
the acupuncture group and theCOCgroupwould be 65% [17]
and 85% [13], respectively. Additionally, the noninferiority
margin was assumed to be 15%. To establish one-sided
noninferiority of two parallel-sample proportions [19–21], the
equired sample size to achieve 80% power (? = 0.2) at
? = 0.05 for detecting such a difference was 18 participants
per group. With a projected dropout rate of 30%, at least 24
participants per treatment group or a total sample size of at
least 48 participants was needed. Fifty-two individuals met
the eligibility criteria and were randomized into one of the
two treatment groups in this study.
2.3. Participants. Women aged between 18 and 35 years were
ecruited fromChiangMai province,Thailand. During a run-
in period of one month, participants were instructed to dis-
continue all treatments for dysmeno
hea with the exception
of the rescue analgesic drug prescribed by the investigato
(see below). After the run-in period, participants who met
the eligibility criteria were randomly assigned to receive
one of two interventions, either COC pill or acupuncture.
Inclusion criteria were a history of dysmeno
hea within the
previous three consecutive months with a numeric rating
scale (NRS) of 5 or more, a ve
al multidimensional scoring
system (VMSS) of grade 2 or more, and the use of rescue
analgesic drug for dysmeno
hea (at least 1 tablet during
the run-in period). Exclusion criteria were contraindica-
tions to COC or acupuncture and underlying gynecologic
conditions associated with dysmeno
hea. Transabdominal
ultrasonography was performed by a gynecologist to rule out
abnormal gynecologic conditions such as uterine myoma,
endometrioma, and ovarian tumor. All participants were
informed about the study and gave written consent prior to
participation.
2.4. Interventions. After screening, the participants who met
the eligibility criteria were randomly assigned to receive
either COC pills (the COC group) or acupuncture (the
ACU group) for three consecutive menstrual cycles. The
andomization list was generated using a computer program.
The allocation process was accomplished by placing the
allocation cards in individual sealed envelopes to preserve
concealment. The envelopes were then numbered and given
to the participants after they had successfully completed all
aseline assessments. All participants in the study received a
supply of rescue NSAID, mefenamic acid (250mg per tablet),
prescribed at 1 tablet as needed for dysmeno
hea to be