Comparative Effectiveness of Non-Pharmacological Interventions for Pain and Quality of Life in Women with Endometriosis: A Systematic Review and Network Meta-Analysis

Zheng X, Wang Y, Li H, Zhang J, Liu J, Fan G, Sun Y, Li B, Jiao Roger J., Zuo G, Fan X, She C Y
In: Journal of Pain Research, Vol Volume 19, Iss Issue 1, Pp 1-13 (2026) · 2026 · W7131201412
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This network meta-analysis found physical therapy and acupuncture to be most effective among non-pharmacological interventions for improving pain and quality of life in women with endometriosis.

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⚙ AI-generated deep summary by qwen3.7-flash, 2026-08-21 · read from full text ⓘ

This systematic review and network meta-analysis evaluated the comparative effectiveness of various non-pharmacological interventions for managing pain and quality of life in women with endometriosis. The study analyzed data from thirty-three randomized controlled trials involving 2323 participants, comparing acupuncture, exercise, nutritional supplementation, physical therapy, and psychological interventions against conventional care. Results indicated that physical therapy and acupuncture were the most effective treatments for overall pain, pelvic pain, and quality of life improvements, while no significant differences were found among the interventions regarding anxiety reduction. This paper is centrally about endometriosis — specifically evaluating non-pharmacological therapies for symptom management in this condition.

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Abstract

Xiaojun Zheng,1,* Yu Wang,1,* Haiping Li,1 Juncha Zhang,1 Jun Liu,1 Xihui Zheng,1 Jie Zhang,1 Guangya Fan,1 Yi Sun,1 Bingxian Li,1 Jingyi Jiao,1 Guang Zuo,1 Xisheng Fan,1,2 Yanfen She1,2 1College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China; 2Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xisheng Fan, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected] Yanfen She, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected]: Endometriosis is a chronic gynecological disorder characterized by pain and impaired quality of life (QoL). While pharmacological and surgical options exist, their limitations necessitate complementary strategies. The comparative effectiveness of non-pharmacological interventions remains uncertain.Objective: This network meta-analysis (NMA) aimed to evaluate and rank the efficacy of non-pharmacological therapies for pain and QoL in women with endometriosis.Methods: We systematically searched PubMed, Embase, CENTRAL, Web of Science, and CNKI from inception to August 31, 2025. Eligible randomized controlled trials (RCTs) compared structured non-pharmacological interventions—acupuncture (ACU), exercise (EXE), nutritional supplementation (NUT), physical therapy (PHY), or psychological interventions (PSY)—against conventional care (CON). Primary outcomes were pain (overall, pelvic, dysmenorrhea) and QoL; the secondary outcome was anxiety.Results: Thirty-three RCTs involving 2323 women were included. For overall pain, PHY (SMD = − 1.44), ACU (SMD = − 1.27), and PSY (SMD = − 1.22) were significantly superior to CON, with PHY ranking highest (SUCRA = 74.4%). ACU was most effective for pelvic pain (SMD = − 4.53; SUCRA = 99.1%), while PHY was optimal for dysmenorrhea (SMD = − 1.30; SUCRA = 82.3%). Both ACU (SMD = 4.09) and PHY (SMD = 4.18) significantly improved QoL compared to CON. No statistically significant differences were observed among interventions for anxiety.Conclusion: Non-pharmacological interventions, particularly PHY and ACU, provide significant benefits for pain and QoL in endometriosis, with subtype-specific advantages. These findings support their integration into multimodal management pathways.Keywords: endometriosis, non-pharmacological interventions, pain management, quality of life, network meta-analysis, randomized controlled trials
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Journal of Pain Research (Feb 2026) Comparative Effectiveness of Non-Pharmacological Interventions for Pain and Quality of Life in Women with Endometriosis: A Systematic Review and Network Meta-Analysis Abstract Xiaojun Zheng,1,* Yu Wang,1,* Haiping Li,1 Juncha Zhang,1 Jun Liu,1 Xihui Zheng,1 Jie Zhang,1 Guangya Fan,1 Yi Sun,1 Bingxian Li,1 Jingyi Jiao,1 Guang Zuo,1 Xisheng Fan,1,2 Yanfen She1,2 1College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China; 2Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, Shijiazhuang City, Hebei Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xisheng Fan, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected] Yanfen She, College of Acupuncture-Moxibustion and Tuina & Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang City, Hebei Province, 050200, People’s Republic of China, Email [email protected]: Endometriosis is a chronic gynecological disorder characterized by pain and impaired quality of life (QoL). While pharmacological and surgical options exist, their limitations necessitate complementary strategies. The comparative effectiveness of non-pharmacological interventions remains uncertain.Objective: This network meta-analysis (NMA) aimed to evaluate and rank the efficacy of non-pharmacological therapies for pain and QoL in women with endometriosis.Methods: We systematically searched PubMed, Embase, CENTRAL, Web of Science, and CNKI from inception to August 31, 2025. Eligible randomized controlled trials (RCTs) compared structured non-pharmacological interventions—acupuncture (ACU), exercise (EXE), nutritional supplementation (NUT), physical therapy (PHY), or psychological interventions (PSY)—against conventional care (CON). Primary outcomes were pain (overall, pelvic, dysmenorrhea) and QoL; the secondary outcome was anxiety.Results: Thirty-three RCTs involving 2323 women were included. For overall pain, PHY (SMD = − 1.44), ACU (SMD = − 1.27), and PSY (SMD = − 1.22) were significantly superior to CON, with PHY ranking highest (SUCRA = 74.4%). ACU was most effective for pelvic pain (SMD = − 4.53; SUCRA = 99.1%), while PHY was optimal for dysmenorrhea (SMD = − 1.30; SUCRA = 82.3%). Both ACU (SMD = 4.09) and PHY (SMD = 4.18) significantly improved QoL compared to CON. No statistically significant differences were observed among interventions for anxiety.Conclusion: Non-pharmacological interventions, particularly PHY and ACU, provide significant benefits for pain and QoL in endometriosis, with subtype-specific advantages. These findings support their integration into multimodal management pathways.Keywords: endometriosis, non-pharmacological interventions, pain management, quality of life, network meta-analysis, randomized controlled trials

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