Clinical Evidence of Acupoint Stimulation for Primary Dysmenorrhea: A Systematic Review and Updated Meta-Analysis [Letter].

Jin H, Xu W, Zhou C
Journal of pain research · 2025 · doi:10.2147/jpr.s571264 · PMID:41103976 · PMC12523611
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⚙ AI-generated summary by claude@2026-07, 2026-07-29 ⓘ

This systematic review and meta-analysis evaluates clinical evidence for acupoint stimulation as a treatment for primary dysmenorrhea.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-06 · read from full text ⓘ

This paper is a letter commenting on a systematic review and updated meta-analysis by Wang et al. that integrated 22 randomized controlled trials assessing acupoint stimulation for primary dysmenorrhea, focusing on analgesic effects of invasive acupoint stimulation, while noting issues that may limit interpretation. The authors highlight that many included participants were adolescents (ages 14–35, with 10 trials including minors), yet the original meta-analysis did not conduct age-stratified analyses, and they discuss how adolescent sex-hormone dynamics differ from adults; they also point out that stimulation types varied and that “standardization of intervention dosage” (e.g., electroacupuncture wave patterns) was not stratified, potentially contributing to high heterogeneity (I² > 90%). They further argue that primary dysmenorrhea is chronic and recurrent, but follow-up was largely absent (only one 6-month follow-up study; most studies reported no longer-term data), so “long-term efficacy” relied on limited data across three cycles. Relevance to endometriosis: the letter explicitly discusses that estrogen and progesterone can alleviate pain associated with endometriosis, but the paper’s main focus is methodological critique of evidence for acupoint stimulation in primary dysmenorrhea.

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Dear

We read with interest the systematic review and meta-analysis, “Clinical Evidence of Acupoint Stimulation for Primary Dysmenorrhea: A Systematic Review and Updated Meta-Analysis” by Wang et al. 1 Integrating 22 randomized controlled trials and using rigorous statistical analysis, the study offers important evidence for non-pharmacological PD management, particularly the analgesic effects of invasive acupoint stimulation. However, to improve the clinical relevance and methodology, we respectfully highlight several overlooked issues that may influence result interpretation and application.

Lack

Wang et al included various types of acupoint stimulation methods (such as hand acupuncture, electroacupuncture, moxibustion, and auricular therapy); however, they overlooked the crucial issue of “standardization of intervention dosage”. Liu et al 4 used a continuous wave of 2Hz, while Yang et al 5 employed a sparse-dense wave of 50Hz. However, these differences were not stratified in the subgroup analyses. Studies have shown that the immediate analgesic effect of electroacupuncture treatment for dysmenorrhea using the dense-sparse wave is slightly better than that of continuous and intermittent waves, 6 which may be one of the reasons for the higher heterogeneity (I² > 90%) in the pain relief outcome.

Omission

Wang et al included patients aged 14–35 years, with 10 studies enrolling minors (<18 years); however, they did not conduct age-stratified analyses. Research has shown that progesterone and estrogen can alleviate pain associated with endometriosis. 2 However, the levels of sex hormones in adolescents differ significantly from those in adults, characterized by greater fluctuations and an unstable hypothalamic-pituitary-gonadal axis. 3 This physiological feature makes clinical treatment plans based directly on adult data potentially unsuitable for the adolescent population. Given that adolescents are a high-risk group for primary dysmenorrhea, this oversight may lead to a lack of targeted treatment recommendations.

Conclusion

In summary, current research on the efficacy of acupoint stimulation for primary dysmenorrhea reveals deficiencies in age stratification, standardized stimulation dosing, and long-term follow-up. Future studies should address these gaps by conducting age-stratified analyses, defining and standardizing the stimulation protocol, and ensuring adequate long-term follow-up. Clarifying these aspects will help provide stronger evidence to guide the clinical application of acupoint stimulation in treating primary dysmenorrhea.

Insufficient

Primary dysmenorrhea is a chronic and recurrent disease; therefore, long-term follow-up observation is required when evaluating intervention measures. However, the analysis by Wang et al did not meet this standard. Among the 22 included randomized controlled trials, only one study (Yang et al 5 ) conducted a 6-month follow-up, six studies had a follow-up period of three menstrual cycles, and 15 studies had no follow-up data. The combined results of “long-term efficacy” in the meta-analysis relied solely on the follow-up data of three cycles (standardized mean difference SMD = −3.74, 95% confidence interval CI −5.57 to −1.90), which was insufficient to reflect the persistence of the therapeutic effect of acupoint stimulation.

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Condition tags

dysmenorrhea

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