The Affection Of Temporal Factors On Moxibustion Therapy For Primary Dysmenorrhea:A Systematic Review

ObjectiveTo quantify the overall effects of moxibustion compared with non-moxibustion treatments for primary dysmenorrhea（PD）by adopting the outcomes of pain assessment,effective rate,and the level of PGF_2αin serum,as well as to determine whether there was difference on clinical effects of moxibustion with different durations,intervention times,interval times and frequency,and the course of treatment.MethodsWe conducted literature searches in the following databases from their respective dates of inception until March 2016:CENTRAL,MEDLINE,EMBASE,AMED,CINAHL+,Web of Science,CBM,CNKI,VIP,and WanFang Data.We also searched the ClinicalTrials.gov Database and Chinese Clinical Trial Register（ChiCTR）to collect potentially relevant clinical trials.Two reviewers independently perform the literatures searching study selection and data extraction.The methodological quality for each included studies were assessed according to the Cochrane Handbook and the data analysis was performed by RevMan5.2 software provided by the Cochrane Collaboration.ResultsTwelve studies involving a total of 786 participants of PD were included.Among the12 studies,the overall risk of bias was evaluated as unclear,and 2 studies reported adverse events.Results of meta-analysis were listed as follows:（1）EffectivenessWe discussed the efficacy of moxibustion synthetically by adopting three kinds of outcomes:effective rate,pain remission and the level of PGF_2α.（1）The total effective rate:relative risk（RR）=1.14,95%CI（1.06¹.23）,P=0.0006;（2）Pain remission:standardized mean difference（SMD）=-0.37,95%CI（-1.58⁰.84）,P=0.55;（3）The level of PGF_2α:mean difference（MD）=-4.65,95%CI（-8.42^-0.88）,P=0.02.（2）Intervention timesSeven RCTs reported the therapeutic interventional time.The subgroup analysis showed there was no significantly different among 3 days,5 days,7 days and two weeks before menstruation to start the moxa moxibustion treatment on improving the effective rate（P=0.12）.（3）Durations:Twelve studies reported the durations,the result of adjusted indirect meta-analysis showed that there was no statistical significance between the group of moxibustion for20-40 minutes and above 40 minutes on improving the effective rate[RR=1.123,95%CI=0.931¹.356].（4）Interval times and frequencyThe interval times of studies included were pooled for 9 studies,the meta-analysis showed that there was no statistical significance between once a day and every other day to treat PD（P=0.64）.As for the frequency of moxibustion,the subgroup analysis showed there was no significantly different among the group of 5 times,6 times or 7times each menstrual cycle on improving the effective rate（P=0.09）.（5）CoursesThree menstrual cycles was reported as the course by 9 studies,the result showed that moxibustion can improve the overall efficiency[RR=1.16,95%CI（1.06¹.27）,P=0.001],3 menstrual cycles can be used as a routine treatment of PD.ConclusionMoxibustion is a relatively safe and effective treatment for PD patients.Comparing to non-moxibustion treatments,moxibustion was more effective to increase the total effective rate,reduce the level of PGF_2αin serum,and the long-term analgesic effect was better.Current clinical evidence suggested there was no significantly different on clinical effects of moxibustion with different durations,intervention times,interval times and frequency,and 3 menstrual cycles can be used as a routine treatment of PD.However,due to the limitations of the quality of studies,application of the conclusions should be cautious.With the specificity of the operation technology of traditional Chinese medicine,patients and healthcare providers could not be blinded.Hence,separating the researchers,operators and outcome measurers as well as expanding the sample size of trials can improve the methodological quality of researches on Traditional Chinese Medicine.