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Study summary omitted key detail about acupressure for menstrual pain relief

Acupressure for menstrual pain

Our Review Summary

This news release, issued by a university in Berlin, Germany, concludes that use of an app-based acupressure program can achieve a “sustained reduction in menstrual pain” in some women when assessed at 3- and 6-month intervals. The release does a reasonable job of describing the study outcomes, how researchers went about conducting a randomized controlled trial using a “self care” app, and in describing statistically significant pain reduction over six months in some women.

Careful readers will likely come away with the idea that acupressure — essentially massage and manipulation applied to certain parts of the torso — is not the final answer to menstrual pain. The release could have done more to make clear that hormone and non-steroidal anti-inflammatory drugs were still used by the study participants, and to better list the adverse effects.

 

Why This Matters

As the release notes, most young women experience cramps, bloating, headaches, backaches, and other discomforts — often severe — at some point of their lives during their monthly menses. An entire industry, pharmaceutical and otherwise, has grown up around this perpetual “market,” with a growing complementary/alternative “self-care” therapy sector that includes yoga, meditation, herbal medicines, and app-based regimens. As the study summary reports, research results on the use of acupressure for menstrual pain relief have been inconclusive or negative, and controlled clinical trials of the technique are extremely rare. Thus, a release with positive results, about a distinctly, albeit limited, controlled trial in more than 200 women, is newsworthy and could encourage the use of smart phone apps for this purpose. That makes it all the more important to include as many important details about the makeup of the study group and the quality of the data as possible. Because acupressure is considered safe, its use as an add-on to drug and other active therapies has the potential to be widely and inexpensively adapted. But potential users of the method also need to be aware that more research, with longer follow-ups, will be needed to determine accupressure’s true effectiveness over time.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The release did not mention it, but the app is “gratis” according to the Luna app website (in German). Most apps of this kind are sponsored and free, and even those that are not free of charge are mostly very inexpensive.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Satisfactory

The release put the benefits experienced by the treatment and control groups in numerical context:

“After three months, 37 percent of participants in the acupressure group reported a 50 percent reduction in pain intensity. After six months, this proportion had increased to more than half of the women in this group (58 percent). Only 25 percent of women in the control group reported a similar reduction in pain intensity at both the 3-month and 6-month marks. Women in the acupressure group also used less pain medication than women in the control group and reported lower levels of pain overall.”

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The news release leaves the impression that there were no ill effects, but the study summary itself notes that some women in the acupressure group experienced bruising, nausea, dizziness or chest pressure.

According to the study, 15 participants experienced an adverse effect.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

The release states that the study was randomized and controlled and that it included 221 young women that were assigned to one of two treatment groups. Only the treatment group (those doing acupressure) were given instructions on how to administer self-acupressure before and during menstruation. Participants were assessed on their pain levels at 3- and 6-months.

Some limitations described in the study but not mentioned in the release: about 90% percent of volunteers had at least 12 years of school education, higher than the average population which would affect the generalizability of the results to the general population. Researchers also stated that the relatively short follow-up time could have resulted in an overestimation of the treatment’s benefit.

Does the news release commit disease-mongering?

Satisfactory

Although the vast majority of women are estimated to have mild to moderate menstrual pain, and menstruation has often been inappropriately construed as a “disease” always in need of medical intervention, this release presented the issue matter-of-factly, and reasonably.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The release doesn’t say how the research was funded. The last line of the release notes the trade name of the app used in the study but not the developer.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The release notes that the trial aimed to evaluate whether women achieved greater reduction from acupuncture as an add-on treatment than from “usual care alone.” Usual care was described as pain medication and hormonal contraceptives.

The release would have been improved had it made it explicit that the study participants continued to use other pain relief therapies while doing acupressure and that the acupressure study was designed to test the technique’s value as an adjunct therapy.

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

The release links to a website where the app is available in German and where it can be downloaded for free.

Does the news release establish the true novelty of the approach?

Satisfactory

The release notes that there’s been only limited research into the therapeutic benefits of smart phone apps and that only a few have been randomized controlled trials. It does not claim to be the first to test an app for acupressure and menstrual pain.

Total Score: 7 of 10 Satisfactory

Comments (3)

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Rich Sagall

April 9, 2018 at 10:16 am

One additional concern about the acupressure study – did both groups have the same amount of contact with the researchers? In other words, did the acupuncture group have more sessions with anyone (teaching them techniques, evaluating progress, etc.) than the control group had? More contacts can bias the results in favor of the treatment group.

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Janet Camp

April 10, 2018 at 12:18 pm

You are way too generous with this “study”. Was it even blinded? Participants “reported” less pain, etc. Is that a valid measurement?
To say nothing of the fact that they used other (effective) treatments as well.
Just how is it that the acupressure helped them? Is there even any plausibility for this? Pressure on parts of the torso help? Which parts? Were they compared to other random parts? Were they compared to a hot water bottle?
Give me a break.

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Kathlyn Stone

April 10, 2018 at 2:48 pm

Good observation, Rich. And thanks for your comment as well, Janet. The relevant questions you raised are addressed in the review.

Both arms did get the app, which included visualization of the menstrual cycle, survey questions, diary instructions etc, but only one group (randomized) got the app whose acupressure-specific info was activated, and only that same group got instruction about acupressure from a health care professional. At the end of the study, the acupressure feature of the app was also activated for the control group, which also was offered a “personal introduction” to the use of the technique. Clearly the acupressure intervention group got more personal time with investigators or their agents, and specific info about acupressure and how to use it. So yes, there was a strong potential for bias in the results. The release should have pointed that out.
— Kathlyn Stone, associate editor

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