by Kristin Jenkins, Contributing Writer, MedPage Today
June 27, 2017

Acupuncture in the lumbosacral region appears to be an effective treatment for women with stress urinary incontinence that rivals behavioral treatments such as pelvic floor muscle training, researchers found.

In a randomized, participant-blinded, controlled clinical study, the mean decrease in urine leakage was 9.9 g at week 6 in 252 women treated with electroacupuncture, according to Baoyan Liu, MD, of the China Academy of Chinese Medical Sciences in Beijing, and colleagues. By comparison, the mean decrease in the same number of women who received sham electroacupuncture was 2.6 g (P<0.001) at week 6, they reported online in the Journal of the American Medical Association.

These findings are consistent with previous studies reporting a decrease of 5.1 g after 8 weeks and 8.9 g after 12 weeks of internet-based pelvic floor muscle training, the investigators noted. What’s more, women receiving electroacupuncture in this study were just as satisfied with the results as women in the pelvic floor muscle training study.

“The decreases from baseline in the International Consultation on Incontinence Questionnaire-Short Form score following electroacupuncture at week 18 and week 30 were clinically significant and comparable to a pelvic floor muscle training regimen,” they wrote.

Clinically meaningful decreases in 72-hour incontinence episodes — a measure of urinary incontinence frequency in daily life — were also consistent with previous findings of electroacupuncture treatment and similar to the effects of pelvic floor muscle training and duloxetine (Cymbalta) in earlier studies, Liu and colleagues said.

In women receiving electroacupuncture, 67.5% had at least a 50% reduction in the mean 72-hour incontinence episodes during weeks 27 to 30. By comparison, 69.8% of women in the earlier study of pelvic floor muscle training achieved a 50% decrease in urine leakage, which was considered a clinical improvement.

While the mechanisms of acupuncture for benefiting incontinence remain unclear, electroacupuncture may improve symptoms by enervating and strengthening pelvic floor muscles through stimulation of the S3 and the pudendal nerve at the lumbosacral region, the researchers said.

The study was conducted at 12 hospitals in China between Oct. 8, 2013, and May 15, 2015. Mean age of the participants was 55 years. Mean urine leakage — as measured by the 1-hour pad test — was 18.4 g at baseline for the electroacupuncture group and 19.1 g for the sham electroacupuncture group.

Mean 72-hour incontinence episodes were 7.9 for the electroacupuncture group and 7.7 for the sham electroacupuncture group, said the investigators, noting that the 1-hour pad test has a high compliance rate and a specificity of 65% to 89%. The incidence of treatment-related adverse events such as hematoma and fatigue was 1.6% in the electroacupuncture group and 2% in the sham electroacupuncture group; all were mild.

In a second report in JAMA, Xiao-Ke Wu, MD, PhD, of Heilongjiang University of Chinese Medicine in Harbin, China, and colleagues presented results from a study showing that acupuncture was not effective — either alone or when combined with clomiphene (Clomid) — in the treatment of infertility associated with polycystic ovary syndrome.

In the Polycystic Ovary Syndrome Acupuncture and Clomiphene Trial (PCOSAct), 1,000 women with polycystic ovary syndrome at 27 hospitals in mainland China were randomized to four treatment groups. The trial, which was double-blind (clomiphene versus placebo), and single-blind (active versus control acupuncture), was conducted between July 6, 2012, and Nov. 18, 2014 with 10 months’ of pregnancy follow-up completed on Oct. 7, 2015.

The study showed that the live birth rate was significantly higher among women treated with clomiphene compared with placebo (28.7% versus 15.4%) but there was no significant difference in live birth rate among women who received active versus control acupuncture (21.8% versus 22.4%).

In addition, there was no significant interaction between active acupuncture and clomiphene. Adverse effects included diarrhea and bruising, seen mostly in patients receiving active acupuncture.

“This trial found that clomiphene was superior to placebo for achieving live births among infertile women with PCOS and that active acupuncture provided no additional benefit over control acupuncture,” Wu and colleagues wrote. “Secondary outcomes of ovulation and pregnancy were more likely to occur after treatment with clomiphene than with placebo, but not with active acupuncture versus control acupuncture. These findings do not support acupuncture alone or combined with clomiphene as an infertility treatment in patients with PCOS.”

Put together, these studies “shed new light on when and when not to consider using acupuncture, although why and how this procedure may work requires further study,” Josephine Briggs, MD, and David Shurtleff, PhD, of the National Institutes of Health in Bethesda, Md., wrote in an accompanying editorial. “Clearly these ancient practices are helping reveal the complexity of the links between the mind and the body.”

In Germany, acupuncture is widely practiced by physicians and has been approved as a reimbursable treatment for low back pain, the editorialists pointed out, adding that in the U.S., the benefits and harms of acupuncture for the management of chronic pain are still under review. Reductions in nausea and vomiting associated with chemotherapy have been reported following acupuncture, but the available evidence doesn’t support its use in patients with stroke, asthma, bed-wetting, or shoulder and neck pain, Briggs and Shurtleff added.

Recently, the American College of Physicians issued guidelines on the use of non-invasive therapies such as acupuncture in the management of chronic low back pain. “The positive outcomes associated with pain relief are particularly important at a time when there is enormous concern about overuse of opioids,” they said.

• Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner