| Objective:In this study,chronic pelvic inflammatory disease(CPID)was taken as the research object,randomized controlled trial was used to explore the characteristics of acupoint sensitization in CPID,observe the clinical effects of acupuncture at sensitive acupoints in treating CPID,analyze the change regularity of the difference in acupoint mechanical pain threshold,and provide a basis for the clinical treatment of CPID.Methods:In this randomized controlled trial,a total of 197 eligible subjects were included,including 147 CPID patients and 50 healthy subjects.CPID patients were randomly assigned to high-sensitive acupoint group,non/low-sensitive acupoint group and waiting-list group in a ratio of 1:1:1,with 49 cases in each group.50 healthy subjects were included in the healthy group for baseline assessment and acupoint sensitization detection only.The difference of acupoint mechanical pain threshold was calculated according to the average acupoint mechanical pain threshold of the healthy group.The high-sensitive acupoint group was treated with acupuncture at the five acupoints with the largest difference of mechanical pain threshold.The non/low-sensitive acupoint group was treated with acupuncture at the five acupoints with the smallest difference of mechanical pain threshold.The waiting-list group did not receive acupuncture treatment during the observation period.CPID patients were treated with acupuncture 3 times a week,once every other day,2 days off on weekends,for 4 weeks,a total of 12 sessions.The primary outcome measure was the visual analogue scale(VAS)for pain.The secondary outcomes included the short form Mc Gill pain questionnaire(SF-MPQ),the12-item short form health survey(SF-12),traditional Chinese medicine syndrome score,McCormack score,the zung self-rating anxiety scale(SAS)and the zung self-rating depression scale(SDS),all the above outcomes were evaluated at weeks 0,2,4,and 8,respectively.In addition,the mechanical pain threshold of acupoints was detected and the change regularity of the difference in mechanical pain threshold of acupoints was analyzed at weeks 0,2,and 4.The outcome evaluation was mainly based on the results of full analysis set(FAS)and supplemented by the results of per protocol set(PPS).Results:1.Clinical efficacy evaluation of acupuncture at sensitive acupoints in the treatment of CPID(1)Baseline analysis: There was no statistical difference in demographic characteristics of CPID patients in the three groups and healthy subjects(P>0.05),the groups were balanced and comparable.(2)Pain VAS score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of pain VAS score in the high-sensitive acupoint group was better than that in the waiting-list group,and the differences were statistically significant at weeks 2,4 and 8(P<0.05).The improvement of pain VAS score in the high-sensitive acupoint group was better than that in the non/low-sensitive acupoint group,and the differences were statistically significant at weeks 4 and 8(P<0.05).The improvement of pain VAS score in the non/lowsensitive acupoint group was better than that in the waiting-list group at weeks 2 and 8(P<0.05).(3)SF-MPQ score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of SF-MPQ score in the high-sensitive acupoint group was better than that in the waiting-list group,and the differences were statistically significant at weeks 2,4 and 8(P<0.05).The improvement of SF-MPQ score in the high-sensitive acupoint group was better than that in the non/low-sensitive acupoint group,and the difference were statistically significant at weeks 4 and 8(P<0.05).There was no significant difference in the improvement of SF-MPQ score between the non/low-sensitive acupoint group and the waiting-list group(P>0.05).(4)Traditional Chinese medicine syndrome score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of traditional Chinese medicine syndrome score in the highsensitive acupoint group was better than that in the non/low-sensitive acupoint group and the waiting-list group,and the differences were statistically significant at weeks 4 and 8(P<0.05).There was no significant difference in the improvement of traditional Chinese medicine syndrome score between the non/low-sensitive acupoint group and the waiting-list group(P>0.05).(5)McCormack score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of McCormack score in the high-sensitive acupoint group was better than that in the waiting-list group at weeks 2,4 and 8(P<0.05).The improvement of McCormack score in the high-sensitive acupoint group was better than that in the non/low-sensitive acupoint group at weeks 4 and 8(P<0.05).The improvement of McCormack score in the non/lowsensitive acupoint group was better than that in the waiting-list group at weeks 2,4 and 8(P<0.05).(6)SF-12 score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of SF-12 score(PCS)in the high-sensitive acupoint group was better than that in the non/low-sensitive acupoint group at week 4 and week 8(P<0.05).The improvement of SF-12 score(PCS)in the high-sensitive acupoint group was better than that in the waiting-list group at week 4(P<0.05).There was no significant difference in the improvement of SF-12score(PCS)between the non/low-sensitive acupoint group and the waiting-list group(P>0.05).The improvement of SF-12 score(MCS)in the high-sensitive acupoint group was better than that in the waiting-list group at week 8(P<0.05).There was no significant difference in the improvement of SF-12 score(MCS)between the non/low-sensitive acupoint group and the waiting-list group(P>0.05).(7)SAS score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of SAS score in the high-sensitive acupoint group was better than that in the waiting-list group at week 8(P<0.05).There was no significant difference in the improvement of SAS score between the non/low-sensitive acupoint group and the waiting-list group(P>0.05).(8)SDS score: Intra-group comparison showed that all three groups improved at different time points compared with baseline(P<0.05).Compared between groups,the improvement of SDS score in the high-sensitive acupoint group was better than that in the waiting-list group at week 8(P<0.05).The improvement of SDS score in non/low-sensitive acupoint group was better than that in the waiting-list group at week 8(P<0.05).2.The effect of acupuncture at sensitive acupoint on the difference of mechanical pain threshold in CPID(1)The average mechanical pain thresholds of acupoints in CPID patients were lower than that in healthy subjects(P<0.05).(2)Compared within the group,in the high-sensitive acupoint group,the differences of mechanical pain threshold of Daimai(right),Daimai(left),Tianshu(right),Tianshu(left),Qihai,Guanyuan,Shuidao(right),Shuidao(left),Zigong(right),Zigong(left),Guilai(right),Guilai(left),Qichong(right),Qichong(left),Zhongji,Qugu,Xuehai(right),Xuehai(left),Yinlingquan(right),Sanyinjiao(right)and Sanyinjiao(left)were significantly improved at week 4 compared with baseline(P<0.05).In the non/low-sensitive acupoint group,the differences of mechanical pain threshold of Tianshu(left),Qihai,Guanyuan,Shuidao(right),Zigong(right),Guilai(right),Guilai(left),Qugu and Xuehai(left)were significantly improved at week 4 compared with baseline(P<0.05).In the waiting-list group,the differences of mechanical pain threshold of Zhongji,Yinlingquan(left)and Sanyinjiao(left)were significantly improved at week 2 compared with baseline(P<0.05),and the differences of mechanical pain threshold of Zigong(right),Guilai(right),Guilai(left),Yinlingquan(right),Yinlingquan(left),Zusanli(left)and Sanyinjiao(left)were significantly improved at week 4compared with baseline(P<0.05).(3)Compared between groups,the difference of mechanical pain threshold of Taichong(right)was significantly lower than that in waiting-list group at week 4(P<0.05),while the differences of mechanical pain threshold of other acupoints were not statistically significant among the three groups(P>0.05).Conclusion:1.Acupoint pain sensitization exists in CPID.2.Acupuncture at high-sensitive acupoints and non-/low sensitive acupoints were both effective in treating CPID.Acupuncture at high-sensitive acupoints has more advantages than acupuncture at non/low sensitive acupoints in reducing the pain degree of CPID,ameliorating the traditional Chinese medicine syndrome,improving the quality of life,and regulating emotions.3.After acupuncture treatment,the condition of CPID was improved,and the difference of the acupoint pain threshold between the patients and the healthy group gradually decreased,approaching the healthy level,indicating that the acupoints may gradually change from the "active state" in pathological condition to the "resting state" in physiological state. |
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