Endometriosis
Endometriosis is a chronic, oestrogen-dependent, inflammatory disease that affects 5%–15% of reproductive-age women, causing infertility and pain—specifically chronic pelvic pain, deep dyspareunia, dysmenorrhoea, dyschezia, and dysuria [1–4]. It may be that endometriosis-related changes are caused by changes in the peripheral and central nervous systems, and such changes may in fact predispose for other long-lasting pain conditions [5]. Therefore, it is important that treatments develop strategies to alleviate pain.
Current pain therapies often involve various pharmacological and surgical treatments, and the symptoms of endometriosis are frequently treated using oestrogen–gestagen combinations or gonadotropin-releasing hormone (GnRH) agonists that block the menstrual cycle. However, many such interventions do not sufficiently affect perceived pain, and pain relapses are possible [6–8]. Furthermore, they can have considerable side effects, such as menopausal disorders, that represent an additional handicap for affected women [9].
Thus, acupuncture may serve as a complement or alternative to these treatments. The pain-alleviating effects of acupuncture have been attributed to various physiological and psychological processes, such as activation of endogenous descending pain inhibitory systems, deactivation of brain areas that transmit pain-related signals, interaction between pain impulses and somato-visceral reflexes, and the expectation of symptom relief [10–12].
Cancer antigen 125 (CA-125), a well-established marker of epithelial cell ovarian cancer, is derived from coelomic epithelia, including those of the endometrium, fallopian tubes, ovaries, and peritoneum [13]. In endometriosis, CA-125 levels are elevated through stimulation of coelomic epithelia [14]. In previous studies, we have found a strong association between preoperatively elevated CA-125 levels and advanced stage of disease [15]. Similarly, Amaral et al. reported that women with more advanced degrees of endometriosis showed higher CA-125 levels in both serum and peritoneal fluid [16]. However, many studies have reported that acupuncture can reduce the level of serum CA-125, relieving the pelvic cavity pain that is associated with endometriosis [17–20]
Conclusions
Acupuncture can alleviate the pain of dysmenorrhoea and reduce peripheral blood CA-125. As a result, the therapy could be applied as a complementary treatment for endometriosis-related pain. However, few randomised, blinded clinical trials have addressed the efficacy of acupuncture in treating endometriosis-related pain. Nonetheless, the current literature consistently finds that acupuncture yields better reductions in pain and serum CA-125 levels than do control treatments, regardless of the control intervention used. To confirm this finding, additional studies with proper controls, blinding methods, and adequate sample sizes are needed.
References
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