Japanese-Style Acupuncture for Adolescent Endometriosis-Related Pain
Chronic pelvic pain in adolescent girls accounts for approximately 10% of outpatient gynecology visits. Up to 70% of these patients whose pain is unresponsive to first-line therapy have endometriosis. Surgical treatment with laparoscopy frequently fails to resolve adolescent endometriosis-related pelvic pain. Medical treatments with Gonadotrophin-releasing hormones (GnRH) analogues are not approved for use in adolescents under the age of 16 and elicit menopause-related side effects that some young adults find distressing. Growing evidence suggests that acupuncture may be a safe and effective intervention for a variety of pain syndromes, and that acupuncture is well received by adolescents and their families. To date, however, there have been no randomized controlled trials assessing acupuncture's effectiveness in adolescents suffering from a chronic pain condition.
As part of the NESA Acupuncture Research Collaborative, this pilot randomized controlled trial is assessing the feasibility of conducting a larger, subsequent trial of the efficacy of Japanese acupuncture in adolescent girls suffering from endometriosis-related chronic pelvic pain (CPP). The trial is recruiting and randomizing 42 patients to two arms: active and sham acupuncture. Treatment is offered as an augmentation to the current standard of care which consists of combination hormonal therapy of progestin and estrogen. Japanese acupuncture is an important variant of traditional acupuncture practice that is popular in North America and East Asia but has received little attention from researchers. Clinical reports suggest that the Japanese style, with its less invasive techniques, may be especially suited to this population. Secondary goals of the study are to: 1) assess whether treatment with acupuncture lowers inflammatory cytokine levels associated with the progression of endometriosis; 2) assess whether Oriental medical (OM) diagnostic categories predict patients' acupuncture treatment outcomes; 3) conduct an in-depth qualitative study of adolescent patients' experiences with acupuncture treatment.
Current Status: Study activities and primary data analysis have been completed; manuscript preparation continues.
- Highfield E, Kerr C, Laufer M, Schnyer R, Thomas P, Wayne PM. Adolescent endometriosis-related pelvic pain treated with acupuncture: Two case reports. Journal of Alternative and Complementary Medicine 2006; 12:317-22.
- Schnyer R.N., Iuliano D, Kay J, Shields MH, Wayne PM. Development of treatment protocols in a randomized sham controlled trial evaluating Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents. Submitted to Journal of Alternative and Complementary Medicine.
- Conboy, L.A., Quilty M, Kerr C, Shaw J, Wayne PM. A qualitative analysis of adolescents' experiences of active and sham Japanese-style acupuncture protocols administered in a clinical trial. Journal of Alternative and Complementary Medicine 2008 14 (6):699-705.
- Wayne PM, Kerr C, Schnyer RN, Legedza A, Savetsky German J, Shields MH, Davis RB, Buring JE, Conboy LA, Highfield E, Parton B, Thomas P, Laufer MR. Japanese-style acupuncture for endometriosis-related pelvic pain in adolescents and young women: Results of a randomized sham-controlled trial. Journal of Pediatric and Adolescent Gynecology 2008 Oct: 21(5):247-257.
Principal Investigators: Catherine Kerr, PhD (2) and Peter Wayne, PhD
Other NESA Participants: Rosa Schnyer, DiplAc, LicAc (Co-investigator); Lisa Conboy, ScD (Co-investigator); Ellen Highfield, LicAc (Consultant); Diane Iuliano, MAc, LicAc (Consultant); Jacqueline Savetsky German, MPH & NESA 3rd year Student (Research Coordinator); Barbara Parton, RN, LicAc (Research Assistant); Monica Shields, LicAc (Research Assistant); Joe Kay, LicAc (Consultant)
Acupuncture Providers: Kate Billings, LicAc; Joe Kay, LicAc; Diane Iuliano , LicAc; Susan Panarese, LicAc; Shaune Ralph , LicAc; Bella Rosner, LicAc; Ellen Highfield, LicAc; Sharon Rubrake, LicAc
Other Co-Investigators: Marc Laufer, MD (1); Anna Legedza ScD (2) (Biostatistician); Phaedra Thomas, RN (1) (Study Coordinator)
Collaborating Institutions: (1) Children's Hospital Boston, (2) Harvard Medical School's Osher Institute
Funding Agency: NCCAM---Grant # 5 U19AT 002022-03