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The PICO QUESTION IS “In women who suffer from dysmenorrhea will acupuncture or acupressure manages pain better than oral contraceptives.” The first 2 paragraph has been done, can you please do from results ,I have attached the article . Introduction (200 words) o Describe the aim of the report and briefly state the importance of the chosen topic o Describe your searchable question using the PICO method, including what the PICO is and the rationale for using the PICO (supported by evidence) o Present a table with the PICOinformation o Show the readers about what is to be reported in thisdocument • Methodology (500 words) o Describe the database used, search terms, Boolean operators, number of papers at each stage of the search, criteria used to eliminate papers, and how the best study was chosen. o Include your ‘Search History’ and then explainthe above search process o Provide a brief statement on the reasoning in the choice of paper and its relevance to the PICO question • Results (500 words) o State the research question in the study, the study design, and whether the design is appropriate to the question in the study o State the study setting and selection of participants, including sample size, any inclusion/exclusion criteria used, and comment on the adequacy of the sample o State the methods of data collection and whether they are appropriate o State the methods of data analysis and whether they are appropriate o Briefly state the findings, including the level of statistical significance o Do not copy any figures, diagrams, or tables from the included study o The included study is referenced once only, but other statements or rationales will be supported by research evidence • Discussion (500 words) o Discuss the validity, any biases, and design strengths o Appraise the significance of the results and note any limitations of the data presented o Comment on whether the data reported allows for determining clinical significance • Relevance for clinical practice (500words) o State the relevance of the paper to the question asked o Apply the evidence to clinical practice based on their analysis o Provide a concluding statement about the value of writing this report and applying evidence for clinical practice Efficacy of Acupuncture versus Combined Oral Contraceptive Pill in Treatment of Moderate-to-Severe Dysmenorrhea: A Randomized Controlled Trial Research Article Efficacy of Acupuncture versus Combined Oral Contraceptive Pill in Treatment of Moderate-to-Severe Dysmenorrhea: A Randomized Controlled Trial Intira Sriprasert,1 Suparerk Suerungruang,2 Porntip Athilarp,3 Anuchart Matanasarawoot,4 and Supanimit Teekachunhatean3,5 1Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand 2Health Promotion Center Region 10, Department of Health, Ministry of Public Health, Chiang Mai 50100, Thailand 3Center of Thai Traditional and Complementary Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand 4Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand 5Department of Pharmacology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand Correspondence should be addressed to Supanimit Teekachunhatean;
[email protected] Received 17 March 2015; Accepted 8 July 2015 Academic Editor: Abir El-Alfy Copyright © 2015 Intira Sriprasert et al.This is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. This open-label randomized controlled trial was designed to compare the efficacy of acupuncture and combined oral contraceptive (COC) pill in treating moderate-to-severe primary dysmenorrhea. Fifty-two participants were randomly assigned to receive either acupuncture (n = 27) or COC (n = 25) for three menstrual cycles. Mefenamic acid was prescribed as a recue analgesic drug with both groups. The statistical approach used for efficacy and safety assessments was intention-to-treat analysis. By the end of the study, both treatments had resulted in significant improvement over baselines in all outcomes, that is, maximal dysmenorrhea pain scores, days suffering from dysmenorrhea, amount of rescue analgesic used, and quality of life assessed by SF-36 questionnaire. Over the three treatment cycles, COC caused greater reduction in maximal pain scores than acupuncture, while improvements in the remaining outcomes were comparable. Responders were defined as participants whose maximal dysmenorrhea pain scores decreased at least 33% below their baseline. Response rates following both interventions at the end of the study were not statistically different. Acupuncture commonly causedminimal local side effects but did not cause any hormone-related side effects as did COC. In conclusion, acupuncture is an alternative option for relieving dysmenorrhea, especially when COC is not a favorable choice. 1. Introduction Dysmenorrhea is one of themost common gynecologic prob- lems affecting women of reproductive age with a prevalence of 50–90% [1–3]. One-third of women reported moderate- to-severe pain which impacts the quality of life as it leads to absence from school or work as well as decreased social inter- est andparticipation [4].Dysmenorrhea can be categorized as either primary dysmenorrhea which occurs without demon- strable disease or secondary dysmenorrhea which involves underlying pathology such as endometriosis, adenomyosis, or uterine myoma. Dysmenorrhea in young women is mostly primary dysmenorrhea, with the prevalence decreasing with age. The pathogenesis of primary dysmenorrhea is explained by the action of prostaglandins such as prostaglandin E2, prostaglandin F2?, endoperoxides, or vasopressin released from the endometrium at the onset of menstruation which stimulates pain neurons and induces excessive contraction of the uterus and adjacent organs causing ischemia which is perceived as pelvic pain [5]. Beside pelvic pain, some women experience associated symptoms such as nausea, vomiting, headache,migraine, dizziness, diarrhea, constipation, fatigue, or lightheadedness. A nonsteroid anti-inflammatory drug (NSAID) is sug- gested for dysmenorrhea pain relief as it inhibits activity of cyclooxygenase and thereby the synthesis of prostaglandins which are believed to cause dysmenorrhea [6]. A combined oral contraceptive (COC) pill is also recommended for the Hindawi Publishing Corporation Evidence-Based Complementary and Alternative Medicine Volume 2015, Article ID 735690, 10 pages http://dx.doi.org/10.1155/2015/735690 http://dx.doi.org/10.1155/2015/735690 2 Evidence-Based Complementary and Alternative Medicine treatment of primary dysmenorrhea due to its ability to suppress ovulation and reduce menstrual prostanoids [5], providing relief from dysmenorrhea pain in up to 70–80% of women [7–10]. A COC containing low-dose ethinyl estradiol and third generation progestin usually shows a decrease in severity of dysmenorrhea after 3 to 6 treatment cycles [10]. However, even with the use of an NSAID and COC, 25% of women with primary dysmenorrhea have reported no response [11, 12] or treatment-related side effects such as nausea, headaches, and weight gain [8, 13]. Acupuncture is a complementary therapy involving the insertion of fine needles into the body at specific points to achieve a therapeutic effect [14]. Acupuncture has been reported to be successful in treating primary dysmenorrhea [15, 16]. According to acupuncture theory, syndrome dif- ferentiation of dysmenorrhea can be divided into “Excess” type (i.e., stagnation of vital energy and blood, stagnation of cold, and accumulation of damp-heat) and “Deficiency” type (which is further subdivided into two categories: one is vital energy and blood deficiency and the other is kidney and liver deficiency). Acupuncture’s primary purpose is to move vital energy and blood, scatter cold, clear damp-heat, or tonify/nourish vital energy, blood, and internal organs with respect to the syndrome differentiation. On a scientific basis, acupuncture causes the central nervous system to release endorphins, serotonin, and acetylcholine which results in pain reduction [15]. A systematic review concluded that acupuncture provides a reduction in dysmenorrhea pain when compared to a placebo control [12]. In addition to pain relief, acupuncture has been reported to improve quality of life and decrease NSAID use after regular treatment for 3 to 6 months [16, 17]. Although several studies have reported benefits from acupuncture treatment for dysmenorrhea [12, 15–17], no head-to-head comparative study of the relative efficacy of acupuncture and COC, especially in women with moderate- to-severe primary dysmenorrhea, has been conducted. This study aimed at investigating the relative efficacy of acupunc- ture and COC in this clinical setting. 2. Materials and Methods 2.1. Design. This prospective, open-label, randomized con- trolled trial was conducted during the period from January 2013 to February 2014 at the Center of Thai Traditional and Complementary Medicine (TTCM), Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand. It was approved by the Research Ethics Committee of the Faculty of Medicine, Chiang Mai University. This study was also reg- istered with the Chinese Clinical Trial Registry (http://www .chictr.org/, registration number: ChiCTR-TRC-13003236). 2.2. Sample Size Calculation. Calculation of sample size was based on the assumption that a percentage of responders in each intervention group would be the main criterion for measuring efficacy and that the percentages of responders in the acupuncture group and theCOCgroupwould be 65% [17] and 85% [13], respectively. Additionally, the noninferiority margin was assumed to be 15%. To establish one-sided noninferiority of two parallel-sample proportions [19–21], the required sample size to achieve 80% power (? = 0.2) at ? = 0.05 for detecting such a difference was 18 participants per group. With a projected dropout rate of 30%, at least 24 participants per treatment group or a total sample size of at least 48 participants was needed. Fifty-two individuals met the eligibility criteria and were randomized into one of the two treatment groups in this study. 2.3. Participants. Women aged between 18 and 35 years were recruited fromChiangMai province,Thailand. During a run- in period of one month, participants were instructed to dis- continue all treatments for dysmenorrhea with the exception of the rescue analgesic drug prescribed by the investigator (see below). After the run-in period, participants who met the eligibility criteria were randomly assigned to receive one of two interventions, either COC pill or acupuncture. Inclusion criteria were a history of dysmenorrhea within the previous three consecutive months with a numeric rating scale (NRS) of 5 or more, a verbal multidimensional scoring system (VMSS) of grade 2 or more, and the use of rescue analgesic drug for dysmenorrhea (at least 1 tablet during the run-in period). Exclusion criteria were contraindica- tions to COC or acupuncture and underlying gynecologic conditions associated with dysmenorrhea. Transabdominal ultrasonography was performed by a gynecologist to rule out abnormal gynecologic conditions such as uterine myoma, endometrioma, and ovarian tumor. All participants were informed about the study and gave written consent prior to participation. 2.4. Interventions. After screening, the participants who met the eligibility criteria were randomly assigned to receive either COC pills (the COC group) or acupuncture (the ACU group) for three consecutive menstrual cycles. The randomization list was generated using a computer program. The allocation process was accomplished by placing the allocation cards in individual sealed envelopes to preserve concealment. The envelopes were then numbered and given to the participants after they had successfully completed all baseline assessments. All participants in the study received a supply of rescue NSAID, mefenamic acid (250mg per tablet), prescribed at 1 tablet as needed for dysmenorrhea to be