Original Studies| Volume 21, ISSUE 5, P247-257, October 2008

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Japanese-Style Acupuncture for Endometriosis-Related Pelvic Pain in Adolescents and Young Women: Results of a Randomized Sham-Controlled Trial


      Study Objective

      To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis.


      Randomized, sham-controlled trial.


      Tertiary-referral hospital.


      Eighteen young women (13–22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain.


      A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks.

      Main Outcome Measures

      Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation.


      Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control group's (n = 5) average reduction of 1.4 (SD = 2.1) points (P = 0.004). Reduction in pain in the active group persisted through a 6-month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported.


      Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.

      Key Words

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        • Duleba A.J.
        • Keltz M.D.
        • Olive D.L.
        Evaluation and management of chronic pelvic pain.
        J Am Assoc Gynecol Laparosc. 1996; 3: 205
        • Laufer M.R.
        • Sanfilippo J.
        • Rose G.
        Adolescent endometriosis: diagnosis and treatment approaches.
        J Pediatr Adolesc Gynecol. 2003; 16: S3-S11
        • Gortmaker S.L.
        • Walker D.K.
        • Weitzman M.
        • et al.
        Chronic conditions, socioeconomic risks, and behavioral problems in children and adolescents.
        Pediatrics. 1990; 85: 267
        • Boekaerts M.
        • Roder I.
        Stress, coping, and adjustment in children with a chronic disease: a review of the literature.
        Disabil Rehabil. 1999; 21: 311
        • Olive D.L.
        • Pritts E.A.
        The treatment of endometriosis: a review of the evidence.
        Ann N Y Acad Sci. 2002; 955: 360
        • ACOG Committee
        Opinion. Number 310, April 2005. Endometriosis in adolescents.
        Obstet Gynecol. 2005; 105: 921
        • Black A.Y.
        • Jamieson M.A.
        Adolescent endometriosis.
        Curr Opin Obstet Gynecol. 2002; 14: 467
      1. Laufer M: Adolescent endometriosis. In: Up To Date. Edited by B. Rose. Wellesley, MA; 2007

        • Cassidy C.M.
        Chinese medicine users in the United States. Part I: Utilization, satisfaction, medical plurality.
        J Altern Complement Med. 1998; 4: 17
        • Bullock M.L.
        • Pheley A.M.
        • Kiresuk T.J.
        • et al.
        Characteristics and complaints of patients seeking therapy at a hospital-based alternative medicine clinic.
        J Altern Complement Med. 1997; 3: 31
        • Cherkin D.C.
        • Eisenberg D.
        • Sherman K.J.
        • et al.
        Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain.
        Arch Intern Med. 2001; 161: 1081
        • Xu X.
        Acupuncture in an outpatient clinic in China: a comparison with the use of acupuncture in North America.
        South Med J. 2001; 94: 813
        • Beer A.M.
        • Ostermann T.
        On the use of classical homeopathy and complementary medicine procedures in hospitals and clinics practicing gynecology and obstetrics in Germany. Results of a questionnaire survey.
        Gynecol Obstet Invest. 2003; 55: 73
        • Newton K.
        • Buist D.
        • Keenan N.
        • et al.
        Use of alternative therapies for menopause symptoms: results of a population-based survery.
        Obstet Gynecol. 2002; 100: 18
        • Lee A.C.
        • Highfield E.S.
        • Berde C.B.
        • et al.
        Survey of acupuncturists: practice characteristics and pediatric care.
        West J Med. 1999; 171: 153
        • Kemper K.J.
        • Sarah R.
        • Silver-Highfield E.
        • et al.
        On pins and needles? Pediatric pain patients experience with acupuncture.
        Pediatrics. 2000; 105: 941
        • Ottolini M.C.
        • Hamburger E.K.
        • Loprieato J.O.
        • et al.
        Complementary and alternative medicine use among children in the Washington, DC area.
        Ambul Pediatr. 2001; 1: 122
        • Zeltzer L.K.
        • Tsao J.C.
        • Stelling C.
        • et al.
        A phase I study on the feasibility and acceptability of an acupuncture/hypnosis intervention for chronic pediatric pain.
        J Pain Symptom Manage. 2002; 24: 437
        • Humaidan P.
        • Brock K.
        • Bungum L.
        • et al.
        Pain relief during oocyte retrieval–exploring the role of different frequencies of electro-acupuncture.
        Reprod Biomed Online. 2006; 13: 120
        • Helms J.
        Acupuncture for the management of primary dysmenorrhea.
        Obstet Gynecol. 1987; 69: 51
        • Highfield E.S.
        • Laufer M.R.
        • Schnyer R.N.
        • et al.
        Adolescent endometriosis-related pelvic pain treated with acupuncture: two case reports.
        J Altern Complement Med. 2006; 12: 317
        • Bedaiwy M.A.
        • Falcone T.
        • Sharma R.K.
        • et al.
        Prediction of endometriosis with serum and peritoneal fluid markers: a prospective controlled trial.
        Hum Reprod. 2002; 17: 426
        • Jeong H.J.
        • Kim B.S.
        • Oh J.G.
        • et al.
        Regulatory effect of cytokine production in asthma patients by SOOJI CHIM (Koryo Hand Acupuncture Therapy).
        Immunopharmacol Immunotoxicol. 2002; 24: 265
        • Son Y.S.
        • Park H.J.
        • Kwon O.B.
        • et al.
        Antipyretic effects of acupuncture on the lipopolysaccharide-induced fever and expression of interleukin-6 and interleukin-1 beta mRNAs in the hypothalamus of rats.
        Neurosci Lett. 2002; 319: 45
        • Shima M.
        • Chace C.
        The Channel Divergences: Deeper Pathways of the Web.
        Blue Poppy Press, Boulder2001
        • Manaka Y.
        • Itaya K.
        • Birch S.
        Chasing the Dragon's Tail: The Theory and Practice of Acupuncture in the Work of Yoshio Manaka.
        Paradigm Publications, Boston1995
        • Birch S.
        • Felt R.
        Understanding Acupuncture.
        Churchill Livingstone, New York1999
        • Birch S.
        • Jamison R.N.
        Controlled trial of Japanese acupuncture for chronic myofascial neck pain: assessment of specific and nonspecific effects of treatment.
        Clin J Pain. 1998; 14: 248
        • Schnyer R.
        • Iuliano D.
        • Kay J.
        • et al.
        Development of protocols for randomized sham-controlled trials of complex treatment interventions: Japanese acupunture for endometriosis-related pelvic pain.
        J Alter Compl Med. 2008; 14: 515-522
        • Allen J.
        • Schnyer R.
        • Hitt S.K.
        The efficacy of acupuncture in the treatment of major depression in women.
        Psychol Sci. 1998; 9: 397
        • Kaptchuk T.J.
        • Stason W.B.
        • Davis R.B.
        • et al.
        Sham device v. inert pill: randomised controlled trial of two placebo treatments.
        BMJ. 2006; 332: 391
        • Wayne P.M.
        • Krebs D.E.
        • Macklin E.A.
        • et al.
        Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study.
        Arch Phys Med Rehabil. 2005; 86: 2248
        • Macklin E.A.
        • Wayne P.M.
        • Kalish L.A.
        • et al.
        Stop Hypertension with the Acupuncture Research Program (SHARP): results of a randomized, controlled clinical trial.
        Hypertension. 2006; 48: 838
        • Schnyer R.N.
        • Allen J.J.
        Bridging the gap in complementary and alternative medicine research: manualization as a means of promoting standardization and flexibility of treatment in clinical trials of acupuncture.
        J Altern Complement Med. 2002; 8: 623
        • Schnyer R.N.
        • Conboy L.A.
        • Jacobson E.
        • et al.
        Development of a Chinese medicine assessment measure: an interdisciplinary approach using the delphi method.
        J Altern Complement Med. 2005; 11: 1005
        • Hammerschlag R.
        Methodological and ethical issues in clinical trials of acupuncture.
        J Altern Complement Med. 1998; 4: 159
        • Oleson T.
        Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture.
        Churchill Livingstone, Edinburgh2002
        • Streitberger K.
        • Kleinhentz J.
        Introducing a placebo needle into acupuncture research.
        Lancet. 1998; 352: 992
        • Fink M.
        • Gutenbrunner C.
        • Rollnik J.
        • et al.
        Credibility of a newly designed placebo needle for clinical trials in acupuncture research.
        Forsch Komplementarmed Klass Naturheilkd. 2001; 8: 368
        • White P.
        • Lewith G.
        • Hopwood V.
        • et al.
        The placebo needle, is it a valid and convincing placebo for use in acupuncture trials? A randomised, single-blind, cross-over pilot trial.
        Pain. 2003; 106: 401
        • Miller J.D.
        Quantification of endometriosis-associated pain and quality of life during the stimulatory phase of gonadotrophin-releasing hormone agonist therapy: A double-blind, randomized, placebo-controlled trial.
        Am J Obstet Gynecol. 2000; 182: 1483
        • Jones G.
        • Kennedy S.
        • Barnard A.
        • et al.
        Development of an endometriosis quality-of-life instrument: The Endometriosis Health Profile-30.
        Obstet Gynecol. 2001; 98: 258
        • Jones G.
        • Jenkinson C.
        • Kennedy S.
        Evaluating the responsiveness of the Endometriosis Health Profile Questionnaire: the EHP-30.
        Qual Life Res. 2004; 13: 705
        • Jones G.
        • Jenkinson C.
        • Taylor N.
        • et al.
        Measuring quality of life in women with endometriosis: tests of data quality, score reliability, response rate and scaling assumptions of the Endometriosis Health Profile Questionnaire.
        Hum Reprod. 2006; 21: 2686
        • Varni J.W.
        • Seid M.
        • Kurtin P.S.
        PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations.
        Med Care. 2001; 39: 800
        • Varni J.W.
        • Burwinkle T.M.
        • Katz E.R.
        • et al.
        The PedsQL in pediatric cancer: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales, Multidimensional Fatigue Scale, and Cancer Module.
        Cancer. 2002; 94: 2090
        • Varni J.W.
        • Burwinkle T.M.
        • Jacobs J.R.
        • et al.
        The PedsQL in type 1 and type 2 diabetes: reliability and validity of the Pediatric Quality of Life Inventory Generic Core Scales and type 1 Diabetes Module.
        Diabetes Care. 2003; 26: 631
        • Varni J.W.
        • Burwinkle T.M.
        • Rapoff M.A.
        • et al.
        The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module.
        J Behav Med. 2004; 27: 297
        • Cohen S.
        • Kamarck T.
        • Mermelstein R.
        A global measure of perceived stress.
        J Health Soc Behav. 1983; 24: 385
        • Cohen S.
        • Williamson G.M.
        Perceived stress in a probability sample of the United States.
        in: Spacapan S. Oskamp S. The Social Psychology of Health. Sage, Newbury Park, CA1988 (p. 31-64)
        • Beurskens A.J.
        • de Vet H.C.
        • Koke A.J.
        • et al.
        Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires.
        Spine. 1995; 20: 1017
        • Kalauokalani D.
        • Cherkin D.C.
        • Sherman K.J.
        • et al.
        Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects.
        Spine. 2001; 26: 1418
        • Bausell R.B.
        • Lao L.
        • Bergman S.
        • et al.
        Is acupuncture analgesia an expectancy effect? Preliminary evidence based on participants' perceived assignments in two placebo-controlled trials.
        Eval Health Prof. 2005; 28: 9
        • Kalish L.A.
        • Buczynski B.
        • Connell P.
        • et al.
        Stop Hypertension with the Acupuncture Research Program (SHARP): clinical trial design and screening results.
        Control Clin Trials. 2004; 25: 76
        • Ballweg M.L.
        Tips on treating teens with endometriosis.
        J Pediatr Adolesc Gynecol. 2003; 16 (S27)
        • Gao X.
        • Yeh Y.C.
        • Outley J.
        • et al.
        Health-related quality of life burden of women with endometriosis: a literature review.
        Curr Med Res Opin. 2006; 22: 1787
        • Waterhouse M.
        • Stelling C.
        • Powers M.
        • et al.
        Acupuncture and hypnotherapy in the treatment of chronic pain in children.
        Clin Acupunct Oriental Med. 2000; 1: 139
        • Lin Y.C.
        • Lee A.C.
        • Kemper K.J.
        • et al.
        Use of complementary and alternative medicine in pediatric pain management service: a survey.
        Pain Med. 2005; 6: 452
        • Sun Y.Z.
        • Chen H.L.
        [Controlled study on Shu-Mu point combination for treatment of endometriosis].
        Zhongguo Zhen Jiu. 2006; 26: 863
        • Chen H.M.
        • Chen C.H.
        Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea.
        J Adv Nurs. 2004; 48: 380
        • Feinstein L.
        • Bynner J.
        The importance of cognitive development in middle childhood for adulthood socioeconomic status, mental health, and problem behavior.
        Child Dev. 2004; 75: 1329
        • Hewell S.W.
        • Andrews J.L.
        Contraceptive use among female adolescents.
        Clin Nurs Res. 1996; 5: 356
        • Kaiser M.M.
        • Hays B.J.
        Recruiting and enrolling pregnant adolescents for research.
        Issues Compr Pediatr Nurs. 2006; 29: 45
        • Brown J.J.
        • Zacharin M.R.
        Attempted randomized controlled trial of pamidronate versus calcium and calcitriol supplements for management of steroid-induced osteoporosis in children and adolescents.
        J Paediatr Child Health. 2005; 41: 580
        • Diviak K.R.
        • Wahl S.K.
        • O'Keefe J.J.
        • et al.
        Recruitment and retention of adolescents in a smoking trajectory study: who participates and lessons learned.
        Subst Use Misuse. 2006; 41: 175
        • Allen J.J.
        • Schnyer R.N.
        • Chambers A.S.
        • et al.
        Acupuncture for depression: a randomized controlled trial.
        J Clin Psychiatry. 2006; 67: 1665
        • Broide E.
        • Pintov S.
        • Portnoy S.
        • et al.
        Effectiveness of acupuncture for treatment of childhood constipation.
        Dig Dis Sci. 2001; 46: 1270
        • Ng D.K.
        • Chow P.Y.
        • Ming S.P.
        • et al.
        A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis.
        Pediatrics. 2004; 114: 1242
        • Gmyrek G.B.
        • Sieradzka U.
        • Goluda M.
        • et al.
        Differential flow cytometric detection of intracellular cytokines in peripheral and peritoneal mononuclear cells of women with endometriosis.
        Eur J Obstet Gynecol Reprod Biol. 2008; 137: 67-76
        • Martinez S.
        • Garrido N.
        • Coperias J.L.
        • et al.
        Serum interleukin-6 levels are elevated in women with minimal-mild endometriosis.
        Hum Reprod. 2007; 22: 836
        • Koga K.
        • Osuga Y.
        • Yoshino O.
        • et al.
        Elevated interleukin-16 levels in the peritoneal fluid of women with endometriosis may be a mechanism for inflammatory reactions associated with endometriosis.
        Fertil Steril. 2005; 83: 878