The Effect of Laser Biostimulation at Sensitized Acupoints on Chronic Pelvic Pain and Quality of Life in Women with Pelvic Inflammatory Disease: A Randomized Controlled Trial
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Abstract
Background and Objectives
Chronic pelvic pain (CPP) is a common complication of pelvic inflammatory disease (PID). Although acupuncture has been increasingly used for the management of CPP, there is insufficient research to support the use of laser stimulation of sensitized acupoints. This study aimed to investigate the effects of laser on sensitized acupoints on pelvic pain perception and quality of life in women with pelvic inflammatory disease.
Materials and Methods
Thirty-six women with CPP caused by chronic pelvic inflammatory disease were randomly divided into two equal groups. Both groups received non-steroidal anti-inflammatory drugs, while the study group also received a low-level laser at sensitized acupoints for 6 weeks. All the patients were evaluated before and after the intervention. The 12-item Short-Form Health Survey (SF-12) was used to measure the quality of life, while a pressure algometer and visual analog scale for pain (VAS-P) were used to measure pain sensitivity and intensity, respectively. A mixed MANOVA was used to investigate the effects of the treatment.
Results
A mixed MANOVA on VAS, SF-12, and PPT scores revealed significant interaction effects of treatment and time (F = 38.34, p = 0.001, partial η2 = 0.96) and main effects of treatment (F = 9.74, p = 0.001) and time (F = 110.1, p = 0.001). Post-treatment, the study group showed greater reductions in VAS (MD = -1.00, p = 0.001), improvements in SF-12 (MD = 9.11, p = 0.001), and increased Pressure Pain Thresholds (PPT) at multiple anatomical points (p = 0.001-0.01).
Conclusions
Laser biostimulation of neurogenic-sensitized acupoints significantly improves pain perception, intensity, and quality of life in women with CPP. suggested that the utilization of laser therapy at sensitized acupoints should be considered a potential component of a rehabilitation program for females suffering from chronic pelvic pain resulting from pelvic inflammatory disease. (Clinicaltrials.gov identifier: NCT05537207; Date of registration: 13 September 2022).
Zipper R et al., 2021·Women's health reports (New Rochelle, N.Y.)·Free full text on PubMed Central
Chronic pelvic pain (CPP) is a common and debilitating condition that affects millions of U.S. women. Most treatments are ineffective and innovative new therapies are desperately needed. Large, controlled studies show that photobiomodulation (PBM) can reduce pain in patients with other chronic pain conditions, such as low back pain, neck pain, and fibromyalgia. The objective of this pilot study was to determine if transvaginal PBM (TV-PBM) can reduce pain in women with CPP. We conducted a before and after, observational, pilot study. Patients completed the Short Form-McGill Pain Questionnaire (SF-MPQ) at baseline, 1 week, 3 months, and 6 months after nine treatments of TV-PBM. Clinicians completed the Clinical Global Impression Scale (CGI) assessing patient illness severity at the same time. Wilcoxon rank-sum t-tests and effect size using Cohen's d coefficient (low effect size if d < 0.2, medium if 0.2 < d > 8, and high if d > 0.8) was used to measure degree of pain improvement, which was also considered clinically significant if pain reduction was >30%. Thirteen women completed 9 treatments, and 10 women were successfully followed to 6 months. At baseline, the mean SF-MPQ score was 19.7 (standard deviation [SD] ± 5.9). Compared with baseline, 60% improved; the mean SF-MPQ score decreased to 10.0 (SD ±7.5, p = 0.004, d = 1.6) at 1 week after treatment, to 9.7 (SD ±7.9, p = 0.005, d = 1.7) at 3 months, and 8.2 (SD ±8.1, p = 0.002, d = 1.9) at 6 months. Transvaginal PBM provided significant and sustained pain relief to women with CPP up to 6 months. Further controlled studies are needed to confirm these findings, however, in this initial pilot, TV-PBM shows promise.
Kohli N et al., 2021·Journal of comparative effectiveness research
This research is the first to evaluate the effectiveness of trans-vaginal photobiomodulation therapy (TV-PBMT) for chronic pelvic pain. Materials & Observational analysis of 128 women, undergoing TV-PBMT for chronic pelvic pain. Minimal clinically important difference, defined as ≥2-point drop on a 0-10 numeric pain rating scale (NPRS), and effect size Cohen d coefficient, was calculated over nine treatments for overall pain, and pain with activities. Compared with baseline, 64.5% of women showed improvement in overall pain, pain with bowel movement, intercourse, exercise, urination, sitting and vulvar pain (minimal clinically important difference = -2.4, -2.0, -2.4, -2.1, -2.1, -2.0, -3.1; d = 0.9, 0.7, 0.9, 0.7, 0.7, 0.7, 0.9) by treatment 9. In this cohort, TV-PBMT resulted in improvement of pelvic pain without serious adverse events.
Wayne PM et al., 2008·Journal of pediatric and adolescent gynecology·Free full text on PubMed Central
To assess feasibility, and collect preliminary data for a subsequent randomized, sham-controlled trial to evaluate Japanese-style acupuncture for reducing chronic pelvic pain and improving health-related quality of life (HRQOL) in adolescents with endometriosis. Randomized, sham-controlled trial. Tertiary-referral hospital. Eighteen young women (13-22y) with laparoscopically-diagnosed endometriosis-related chronic pelvic pain. A Japanese style of acupuncture and a sham acupuncture control. Sixteen treatments were administered over 8 weeks. Protocol feasibility, recruitment numbers, pain not associated with menses or intercourse, and multiple HRQOL instruments including Endometriosis Health Profile, Pediatric Quality of Life, Perceived Stress, and Activity Limitation. Fourteen participants (out of 18 randomized) completed the study per protocol. Participants in the active acupuncture group (n = 9) experienced an average 4.8 (SD = 2.4) point reduction on a 11 point scale (62%) in pain after 4 weeks, which differed significantly from the control group's (n = 5) average reduction of 1.4 (SD = 2.1) points (P = 0.004). Reduction in pain in the active group persisted through a 6-month assessment; however, after 4 weeks, differences between the active and control group decreased and were not statistically significant. All HRQOL measures indicated greater improvements in the active acupuncture group compared to the control; however, the majority of these trends were not statistically significant. No serious adverse events were reported. Preliminary estimates indicate that Japanese-style acupuncture may be an effective, safe, and well-tolerated adjunct therapy for endometriosis-related pelvic pain in adolescents. A more definitive trial evaluating Japanese-style acupuncture in this population is both feasible and warranted.
Gentles AJ et al., 2025·The journal of pain·Free to read
There is increasing recognition that nociplastic pain and central sensitization may play a role in endometriosis-associated pain. The Pain Sensitivity Questionnaire Minor (PSQ-M) evaluates subjective widespread pain sensitivity, and is linked to pain outcomes in chronic pain populations. However, evidence connecting the PSQ-M to central sensitization in endometriosis is limited. Using the Central Sensitization Inventory (CSI) as a comparison, this study compared the PSQ-M as a clinical proxy for central sensitization in endometriosis individuals. Data collected from 983 endometriosis participants (mean age of 34 years), between January 2020 and December 2022, were analyzed from a prospective registry. A significant but weak positive correlation was observed between PSQ-M and CSI scores (r=0.099, p<0.001). A significant but weak correlation was found between the number of central sensitivity syndromes and pelvic pain-related comorbidities with the PSQ-M (r=0.093, p<0.001), compared to a stronger correlation with the CSI (r=0.687, p<0.05). PSQ-M scores were not significantly associated with baseline (r=0.013, p=0.797) or post-operative (r=-0.046, p=0.801) quality-of-life. There was no change in the PSQ-M and a small change in CSI after endometriosis surgery, suggesting that surgical treatment of endometriosis does not directly address central sensitization. In conclusion, the PSQ-M may not be the optimal clinical proxy for central sensitization in endometriosis. This study evaluates the Pain Sensitivity Questionnaire - Minor (PSQ-M) as a proxy for central sensitization in endometriosis. The PSQ-M showed weak correlations with central sensitivity syndromes and pain scores and was not associated with post-surgical quality-of-life, suggesting it may not be the optimal tool for assessing central sensitization in endometriosis.