The BMEA study: the impact of meridian balanced method electroacupuncture on women with chronic pelvic pain-a three-arm randomised controlled pilot study using a mixed-methods approach

Ooi Thye Chong, Hilary O D Critchley, Andrew W Horne, Robert Elton, Erna Haraldsdottir, Marie Fallon, Ooi Thye Chong, Hilary O D Critchley, Andrew W Horne, Robert Elton, Erna Haraldsdottir, Marie Fallon

Abstract

Introduction: Chronic pelvic pain (CPP) affects 3-4% of women worldwide. Proven treatments for CPP are limited and unsatisfactory. The meridian balance method (BM) electroacupuncture (EA) treatment (BMEA + Traditional Chinese Medicine Health Consultation (TCM HC) may be effective for CPP. Previous EA studies have demonstrated an analgesic effect. Large-scale studies on acupuncture for other chronic pain conditions suggest that patient-healthcare provider interaction might play a role in pain reduction. We propose a pilot study to explore the effectiveness of the meridian BMEA treatment in managing women with CPP to inform a future large randomised controlled trial.

Methods and analysis: A 3-armed randomised controlled pilot study is proposed with an aim to recruit 30 women with CPP in National Health Service (NHS) Lothian. Randomisation will be to BMEA treatment, TCM HC or standard care (SC). Validated pain, physical and emotional functioning questionnaires will be administered to all participants at weeks 0, 4, 8 and 12. Focus group discussions will be conducted when week 12 questionnaires are completed. The primary objective is to determine, recruitment and retention rates. The secondary objectives are to assess the effectiveness and acceptability of the proposed methods of recruitment, randomisation, interventions and assessment tools.

Ethics and dissemination: Ethical approval has been obtained from the Scotland Research Ethics Committee (REC 14/SS/1022). Data will be published in peer-reviewed journals and presented at international conferences.

Trial registration number: NCT02295111.

Keywords: chronic pelvic pain; context effects; electro-acupuncture; mixed methods research.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
Flow of participants through the BMEA study.

References

    1. Daniels J, Khan KS. Chronic pelvic pain in women. BMJ 2010;341:c4834 10.1136/bmj.c4834
    1. Latthe P, Latthe M, Say L et al. . WHO systematic review of prevalence of chronic pelvic pain: a neglected reproductive health morbidity. BMC Public Health 2006;6:177 10.1186/1471-2458-6-177
    1. Daniels J, Gray R, Hills RK et al. . Laparoscopic uterosacral nerve ablation for alleviating chronic pelvic pain: a randomized controlled trial. JAMA 2009;302:955–61. 10.1001/jama.2009.1268
    1. Howard FM. The role of laparoscopy as a diagnostic tool in chronic pelvic pain. Baillieres Best Pract Res Clin Obstet Gynaecol 2000;14:467–94. 10.1053/beog.1999.0086
    1. Cheong Y, Stones WR. Chronic pelvic pain: aetiology and therapy. Best Pract Res Clin Obstet Gynaecol 2006;20:695–711. 10.1016/j.bpobgyn.2006.04.004
    1. Tan R. Dr. Tan's strategy of twelve magical points. San Diego, CA: Richard Tan Publishing; 2003.
    1. Unschuld P. Huang Di Nei Jing Su Wen: nature, knowledge, imagery in an ancient Chinese medical text. California, USA: University of California Press, 2003.
    1. McCann H, Ross H. Practical Atlas of Tung's Acupuncture. 2nd edn Germany: Verlag Muller & Steinicke Munchen, 2013.
    1. Twicken D. I Ching acupuncture: the balance method. Philadelphia, USA: Singing Dragon, 2012.
    1. Tan R. Acupuncture 1, 2, 3 For Back Pain 2008 2009 Richard Tan Publishing.
    1. Dun AC. The Yellow Emperor's Inner Classic, Spiritual Pivot (Huang Di Nei Jing Su Wen Jiao Zhu Yu Yi). Tianjin, China: Tianjin Science and Technology Press, 1989.
    1. Dhond RP, Kettner N, Napadow V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007;13:603–16. 10.1089/acm.2007.7040
    1. Ulett GH, Han SP, Han JS. Electroacupuncture: mechanisms and clinical application. Biol Psychiatry 1998;44:129–38. 10.1016/S0006-3223(97)00394-6
    1. Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand 1994;38:63–9. 10.1111/j.1399-6576.1994.tb03839.x
    1. Haake M, Müller HH, Schade-Brittinger C et al. . German acupuncture trials (gerac) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med 2007;167:1892–8. 10.1001/archinte.167.17.1892
    1. Brinkhaus B, Witt CM, Jena S et al. . Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med 2006;166:450–7. 10.1001/archinte.166.4.450
    1. Melchart D, Streng A, Hoppe A et al. . The acupuncture randomised trial (ART) for tension-type headache—details of the treatment. Acupunct Med 2005;23:157–65. 10.1136/aim.23.4.157
    1. Endres H, Bowing G, Diener HC et al. . Acupuncture for tension-type headache: a multicentre, sham-controlled, patient-and observer-blinded, randomised trial. J Headache Pain 2007;8:306–14. 10.1007/s10194-007-0416-5
    1. Witt C, Jena S, Brinkhaus B et al. . Acupuncture for patients with chronic neck pain. Pain 2006;125:98–106. 10.1016/j.pain.2006.05.013
    1. Vickers AJ, Cronin AM, Maschino AC et al. . Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med 2012;172:1444–53. 10.1001/archinternmed.2012.3654
    1. Benedetti F. How the doctor's words affect the patient's brain. Eval Health Prof 2002;25:369–86. 10.1177/0163278702238051
    1. Price DD, Finniss DG, Benedetti F. A comprehensive review of the placebo effect: recent advances and current thought. Annu Rev Psychol 2008;59:565–90. 10.1146/annurev.psych.59.113006.095941
    1. Miller FG, Kaptchuk TJ. The power of context: reconceptualizing the placebo effect. J R Soc Med 2008;101:222–5. 10.1258/jrsm.2008.070466
    1. Kaptchuk T, Kelley JM, Conboy L et al. . Components of placebo effect: randomised controlled trial in patients with irritable bowel syndrome. BMJ 2008;336:999–1003. 10.1136/bmj.39524.439618.25
    1. Creswell J, Clark VLP. Designing and conducting mixed methods research. 2nd edn Sage, 2011:2–5.
    1. MacPherson H, Altman DG, Hammerschlag R et al. . Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. J Evid Based Med 2010;3:140–55. 10.1111/j.1756-5391.2010.01086.x
    1. Han JS, Terenius L. Neurochemical basis of acupuncture analgesia. Annu Rev Pharmacol Toxicol 1982;22:193–220. 10.1146/annurev.pa.22.040182.001205
    1. Morgan DL. Focus groups as qualitative research. 2nd edn London: Sage Publications, 1997:47–8.
    1. Finlay L. “Outing” the researcher: the provenance, process, and practice of reflexivity. Qual Health Res 2002;12:531–45. 10.1177/104973202129120052
    1. MacPherson H, Thomas K, Walters S et al. . The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001;323:486–7. 10.1136/bmj.323.7311.486
    1. Cummings M. Safety aspects of electroacupuncture. Acupunct Med 2011;29:83–5. 10.1136/acupmed-2011-010035
    1. Thompson JW, Cummings M. Investigating the safety of electroacupuncture with a Picoscope. Acupunct Med 2008;26:133–9. 10.1136/aim.26.3.133
    1. Deadman P, Al-Khafaji M, Baker K. A manual of acupuncture. England, UK: Journal of Chinese Medicine Publications, 2001:13–16.
    1. Pandolfi M. The autumn of acupuncture. Eur J Intern Med 2012;23:31–3. 10.1016/j.ejim.2011.07.017
    1. Langevin HM, Churchill DL, Wu JR et al. . Evidence of connective tissue involvement in acupuncture. FASEB J 2002;16:872–4. 10.1096/fj.01-0925fje
    1. Langevin H, Wayne PM, MacPherson H et al. . Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Altern Med 2011;2011:180805 10.1155/2011/180805
    1. Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls? Acupunct Med 2006;24:13–15. 10.1136/aim.24.1.13
    1. Kong J, Kaptchuk TJ, Polich G et al. . Expectancy and treatment interactions: a dissociation between acupuncture analgesia and expectancy evoked placebo analgesia. Neuroimage 2009;45: 940–9. 10.1016/j.neuroimage.2008.12.025
    1. Kaptchuk TJ. The placebo effect in alternative medicine: can the performance of a healing ritual have clinical significance? Ann Intern Med 2002;136:817–25. 10.7326/0003-4819-136-11-200206040-00011
    1. Paterson C, Dieppe P. Characteristic and incidental (placebo) effects in complex interventions such as acupuncture. BMJ 2005;330:1202–5. 10.1136/bmj.330.7501.1202
    1. Management of Chronic Pain, UK Scottish Intercollegiate Guideline Network (SIGN) Guideline #136.

Source: PubMed

3
Suscribir