Effectiveness of acupuncture in the treatment of cyclic mastalgia: a study protocol for a randomized controlled trial

Background

About 68% of women aged 18–44 years have experienced cyclic mastalgia (CM), which occurs during the luteal phase of the menstrual cycle when elevated hormone levels induce greater breast gland thickness. CM has a moderate-to-severe impact on a woman’s quality of life. Prior research has suggested that acupuncture may be beneficial for breast pain relief. In this study, we investigate the effectiveness of manual acupuncture (MA) in the treatment of CM compared with that of sham acupuncture (SA).

Methods

This is a multicenter, randomized, controlled trial. A total of 108 eligible CM patients will be randomly assigned to either MA (n = 54) or SA (n = 54) group using a 1:1 ratio and a stratified, blocked randomization. Acupuncture will be performed two weeks prior to menstruation and discontinued when menses begins. In both the MA and SA group, participants will be given acupuncture three times per week for 2 weeks per menstrual cycle for three consecutive menstrual cycles, encompassing a total of 18 sessions. The primary outcome will be the change in the average daily Breast Pain Visual Analog Scale (VAS-BP) over the first two weeks of menstruation from baseline to endpoints. The number of nominal days of breast pain (NDBP) two weeks before menstruation, World Health Organization Quality-of-Life Scale-Short Form scores, global patient assessment, breast glandular-section thickness, and breast-duct width three days before menstruation will also be measured as secondary outcomes.

Discussion

This prospective randomized trial will help evaluate the efficacy of acupuncture in treating CM. The results of this study will provide evidence of the therapeutic effectiveness of acupuncture on CM.

Trial registration

ClinicalTrials.gov Identifier: NCT05408377, registered on June 7, 2022. 

The Effect of Healthy Lifestyle Promotion Intervention on Quality of Life in Cyclic Mastalgia via Individual Counseling: A Randomized Controlled Clinical Trial

Background

Despite high number of visited cases, there are no certain therapeutic guidelines for mastalgia. Generally pain is associated with poor quality of life in all dimensions. The present study aimed to investigate the effect of healthy lifestyle promotion intervention on the quality of life in cyclic mastalgia.

Methods

This study was a randomized controlled trial (RCT) conducted on women suffering from cyclic mastalgia at the age of 20 and older before menopausal age referred to the health centers of Karaj,Iran from September 2017 to August 2018. The participants were randomly assigned to intervention (N=40) and control groups (N=40). Intervention was carried out in two 46-minute sessions and two 90-minute sessions for the intervention group. The quality of life was assessed before and after the intervention in both groups using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The data were analyzed through SPSS statistical software(version 21) using independent sample t-test, Chi-square,and Paired t-test. Besides, P<0.05 was considered as statistically significant.

Results

Before the intervention, both groups were matched in terms of marital status, educational level, occupation, history of breastfeeding, and mean scores of quality of life (P>0.05). After the intervention, the mean score of life quality in physical, social, environmental, and general health dimensions in the intervention group increased significantly compared to the control group (P&gt;0.001). This difference was not statistically significant in the mental health dimension (P=0.086).

Conclusion

The present study indicated that healthy lifestyle promotion intervention could improve the quality of life of women with cyclic mastalgia.Trial Registration Number: IRCT2017100236513N1.

Clinical management of idiopathic mastalgia: a systematic review

ABSTRACT INTRODUCTIONIdiopathic mastalgia (benign breast pain of unknown origin) is often poorly managed because of its subjective nature and unclear aetiology. Mastalgia is a reason for up to 50% of breast outpatient referrals. Existing systematic reviews discuss dated treatment options that provide limited symptomatic relief. METHODSA systematic review was conducted for aetiology and treatment of idiopathic mastalgia in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidance. Databases such as PubMed, MEDLINE, Cochrane Database and the Clinical Trial Registry were searched (February 2016). RESULTSReassurance plus bra-fitting advice provides relief for most women. If symptoms persist, addition of topical non-steroidal anti-inflammatory drugs (NSAIDs) provides relief in 70–92% of women. There is some benefit in reducing dietary coffee and fat intake. Medical treatments have serious side-effects (often androgenic or menopausal) and should be considered only in cases resistant to simpler measures. Dopamine agonists are useful, but less effective than endocrine treatments such as Danazol or Tamoxifen. Of the Selective Oestrogen Receptor Modulator drugs, Ormeloxifene appears most effective, but is not licenced in the United Kingdom. Relaxation therapy, acupuncture and kinesiology may be useful but currently lack good evidence of effectiveness. DISCUSSIONFirst-line management of breast pain should be explanation, reassurance and a bra-fitting advice. Subsequent drug therapy should be balanced against its side-effects; topical NSAIDs and Ormeloxifene show greatest benefit with least side-effects. Newer agents (Ormeloxifene) currently being used for mastalgia in India could be considered in the developed world.

Chinese medicine and integrative medicine in the United States

Health wellness is a state of the homeostasis. Chinese medicine incorporate many concept including holistic medicine and individualized medicine to promote health wellness. Different domains of Chinese medicine were exclusively adopted after the first introduction of acupuncture to USA. Mayo as one of the best USA hospital created a foundation for the more widespread introduction of Chinese medicine into the US especially on the health wellness promotion.

The effect of psychoeducation on anxiety and pain in patients with mastalgia

BACKGROUND

Mastalgia is a debilitating disorder, which has serious effects on one's daily life and causes significant medical costs.

AIM

Mastalgia patients determine the overall approach and improve the quality of life of patients.

METHODS

In this study, the outcomes of psychoeducation on anxiety and pain in a group of patients with mastalgia without an organic etiology have been investigated. 88 patients were included in this study. The socio-demographic data form, the Symptom Checklist 90 (SCL-90), the Toronto Alexithymia Scale-20 (TAS-20), the Hamilton Anxiety Scorer (HAM-A), the State-Trait Anxiety Inventory (STAI-I, STAI-2) and the Visual Analogue Scale (VAS) were all applied to the patients. 64 randomly selected patients (Group 1) were given psychoeducation while the remaining 24 (Group 2) were not. All patients were called back after 1 month for repeats of the HAM-A, STAI-I, STAI-2 and VAS tests.

RESULTS

The results of this study demonstrated that psychoeducation has positive impacts on the perception of pain besides stationary, contemporary and total anxiety scores.

CONCLUSIONS

It is concluded that the administration of psychoeducation is a good choice in the degradation of anxiety symptoms and pain.

The principle of symmetry in acupuncture and its clinical applications

The clinical practice of acupuncture and study of the traditional Chinese medicine literature has led to the observation that if the diaphragm is used as an axis of symmetry, there are many symmetrical points on the upper and lower halves of the body. The symmetrical points share several common properties, including physiological functions, mechanisms of pathogenesis and therapeutic effects. Employing these corresponding points on the upper and lower parts of the body simultaneously can frequently enhance the therapeutic outcome rather substantially. This phenomenon may be called the Principle of Symmetry. Traditional and modern scientific literature already provides evidence that verifies the reliability of this principle. Furthermore, this principle may be viewed as the derivative of the Thalamic Neuron Theory.

Electroacupuncture and lumbar transplant of GDNF-secreting fibroblasts synergistically attenuate hyperalgesia after sciatic nerve constriction

Electroacupuncture (EA) has been shown to induce potent analgesic effects on neuropathic pain in both patients and rodents. Cell therapy to release antinociceptive agents near the pain processing centers of the spinal cord is a promising next step in the development of treatment modalities. This study investigated the effects of the combination of EA and cell therapy by glial cell line-derived neurotrophic factor (GDNF) on neuropathic pain in rats. The hyperalgesic state was induced by chronic constriction injury (CCI) of the sciatic nerve and fibroblasts genetically modified to secrete bioactive GDNF (FBs-GDNF) were used for cell therapy. Fifty-eight rats with neuropathic pain were randomly divided into five groups (CCI+PBS, n = 11; CCI+FBs-GDNF, n = 12; CCI+EA+PBS, n = 11; CCI+EA+FBs-pLNCX2, n = 12; CCI+EA+FBs-GDNF, n = 12). On the 7th day after CCI, the rats received intrathecal transplantation of FBs-GDNF or control fibroblasts (FBs-pLNCX2). In the meantime, EA was administered once every other day from the 7th day after CCI surgery for 21 days. The paw withdrawal latency (PWL) to radiant heat was measured every other day. The results showed that the ipsilateral PWL of the rats from all three EA treatment groups significantly increased starting on the 12th day compared with the PBS control group. Strikingly, the group which received EA treatment and FBs-GDNF transplantation (CCI+EA+FBs-GDNF) showed a significantly decreased thermal hyperalgesia after 2 weeks post CCI surgery compared with the groups which received EA treatment and FBs-pLNCX2 transplantation (CCI+EA+FBs-pLNCX2) or PBS (CCI+EA+PBS) as well as the FBs-GDNF transplantation group without EA treatment (CCI+FBs-GDNF). Our data suggest that EA and cell therapy can synergistically attenuate hyperalgesia in neuropathic pain rats.

Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials

Chronic low back pain is one of the most common reasons that people seek medical treatment, and the consequent disability creates a great financial burden on individuals and society. The etiology of chronic low back pain is not clear, which means it is often refractory to treatment. Acupuncture has been reported to be effective in providing symptomatic relief of chronic low back pain. However, it is not known whether the effects of acupuncture are due to the needling itself or nonspecific effects arising from the manipulation. To determine the effectiveness of acupuncture therapy, a meta-analysis was performed to compare acupuncture with sham acupuncture and other treatments. Overall, 2678 patients were identified from thirteen randomized controlled trials. The meta-analysis was performed by a random model (Cohen's test), using the I-square test for heterogeneity and Begg's test to assess for publication bias. Clinical outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life. Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture. Acupuncture achieved better outcomes when compared with other treatments. No publication bias was detected. Acupuncture is an effective treatment for chronic low back pain, but this effect is likely to be produced by the nonspecific effects of manipulation.