Endometriosis is a prevalent gynaecological condition, significantly affecting women's lives. Clinical presentations may vary from absence of symptoms to complaints of chronic pelvic pain, most notably dysmenorrhoea. The management of pain in endometriosis is currently inadequate. Acupuncture has been studied in gynaecological disorders but its effectiveness for pain in endometriosis is uncertain. To determine the effectiveness and safety of acupuncture for pain in endometriosis. We searched the Cochrane Menstrual Disorders and Subfertility Group (MSDG) Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI and TCMDS (from inception to 2010) and reference lists of retrieved articles. Randomised single or double‐blind controlled trials enrolling women of reproductive age with a laparoscopically confirmed diagnosis of endometriosis and comparing acupuncture (body, scalp or auricular) to either placebo or sham, no treatment, conventional therapies or Chinese herbal medicine. Three authors independently assessed risk of bias and extracted data; we contacted study authors for additional information. Meta‐analyses were not performed as only one study was included. The primary outcome measure was decrease in pain from endometriosis. Secondary outcome measures included improvement in quality of life scores, pregnancy rate, adverse effects and rate of endometriosis recurrence. Twenty‐four studies were identified that involved acupuncture for endometriosis; however only one trial, enrolling 67 participants, met all the inclusion criteria. The single included trial defined pain scores and cure rates according to the Guideline for Clinical Research on New Chinese Medicine. Dysmenorrhoea scores were lower in the acupuncture group (mean difference ‐4.81 points, 95% confidence interval ‐6.25 to ‐3.37, P < 0.00001) using the 15‐point Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis scale. The total effective rate ('cured', 'significantly effective' or 'effective') for auricular acupuncture and Chinese herbal medicine was 91.9% and 60%, respectively (risk ratio 3.04, 95% confidence interval 1.65 to 5.62, P = 0.0004). The improvement rate did not differ significantly between auricular acupuncture and Chinese herbal medicine for cases of mild to moderate dysmenorrhoea, whereas auricular acupuncture did significantly reduce pain in cases of severe dysmenorrhoea. Data were not available for secondary outcomes measures. The evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review. This review highlights the necessity for developing future studies that are well‐designed, double‐blinded, randomised controlled trials that assess various types of acupuncture in comparison to conventional therapies. Acupuncture pour la douleur associée à l'endométriose L'endométriose est une affection gynécologique fréquente, qui affecte de manière significative la vie des femmes. Les manifestations cliniques sont variables allant de l'absence de symptômes à des plaintes de douleurs pelviennes chroniques, principalement de dysménorrhée. La prise en charge de la douleur associée à l'endométriose est actuellement insuffisante. L'acupuncture a été étudiée dans les troubles gynécologiques, mais son efficacité pour la douleur associée à l'endométriose est incertaine. Déterminer l'efficacité et l'innocuité de l'acupuncture pour la douleur associée à l'endométriose. Nous avons effectué des recherches dans le registre spécialisé du groupe Cochrane sur les troubles menstruels et de la fertilité (MSDG), le registre Cochrane des essais contrôlés (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI et TCMDS (de leur origine respective à 2010) et dans les références bibliographiques des articles trouvés. Essais contrôlés randomisés en simple aveugle ou en double‐aveugle portant sur des femmes en âge de procréer chez lesquels il a été établi un diagnostic d'endométriose confirmé par laparoscopie et comparant l'acupuncture (corps, cuir chevelu ou oreille) avec un placebo ou traitement fictif, l’absence de traitement, des traitements standard ou par les plantes médicinales chinoises. Trois auteurs ont évalué indépendamment le risque de biais et extrait les données ; nous avons contacté les auteurs des études pour plus d'informations. Aucune méta‐analyse n'a été effectuée car une seule étude a été incluse. Le critère de jugement principal était la diminution de la douleur associée à l'endométriose. Les critères de jugement secondaires étaient notamment l'amélioration des scores de qualité de vie, le taux de grossesses, les effets indésirables et le taux de récidive d'endométriose. Vingt‐quatre études portant sur l'acupuncture pour l'endométriose ont été identifiées ; toutefois un seul essai, incluant 67 participants, répondait à tous les critères d'inclusion. Le seul essai inclus définissait les scores de douleur et les taux de guérison conformément aux Guideline for Clinical Research on New Chinese Medicine. Les scores de dysménorrhée, calculés à l'aide de l'échelle d'évaluation en 15 points des Guideline for Clinical Research on New Chinese Medicine for Treatment of Pelvic Endometriosis, étaient plus faibles dans le groupe traité par acupuncture (différence moyenne de ‐4,81 points, intervalle de confiance à 95 % de ‐6,25 à ‐3,37, p <0,00001). Le taux effectif global (« guérison », « efficacité significative » ou « efficacité ») pour l'acupuncture auriculaire et les plantes médicinales chinoises était de 91,9 % et 60 %, respectivement (risque relatif 3,04, intervalle de confiance à 95 % de 1,65 à 5,62, P = 0,0004). Le taux d'amélioration ne différait pas significativement entre l'acupuncture auriculaire et les plantes médicinales chinoises dans les cas de dysménorrhée légère à modérée, alors que l'acupuncture auriculaire n'a pas entraîné de diminution significative de la douleur dans les cas de dysménorrhée sévère. Il n'y avait pas de données disponibles pour les critères de jugement secondaires. Les preuves attestant de l'efficacité de l'acupuncture pour la douleur associée à l'endométriose sont limitées ; elles ne reposent que sur les résultats de la seule et unique étude incluse dans cette revue. Cette revue souligne la nécessité de développer d'autres études à l'avenir, sous forme d'essais contrôlés randomisés, en double aveugle, bien conçus, qui évaluent différents types d'acupuncture par rapport aux traitements standard. Acupuntura para tratamento de dor em endometriose A endometriose é uma condição ginecológica muito frequente que afeta significativamente a vida das mulheres. As manifestações clínicas podem variar desde ausência de sintomas até queixas de dor pélvica crônica, especialmente dismenorréia. O controle da dor da endometriose ainda é inadequado. A acupuntura tem sido estudada para algumas doenças ginecológicas, mas sua efetividade no controle da dor da endometriose ainda é incerta. Avaliar a efetividade e segurança da acupuntura no controle da dor da endometriose. Nós procuramos nas seguintes bases de dados eletrônicas: Cochrane Menstrual Disorders and Subfertility Group (MSDG) Specialised Register of controlled trials, Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, CINAHL, AMED, PsycINFO, CNKI and TCMDS (desde o começo até 2010) e também nas listas de referência dos artigos incluídos. Ensaios clínicos controlados uni‐ ou duplo‐cegos envolvendo mulheres em idade reprodutiva com diagnóstico de endometriose confirmado por laparoscopia que compararam acupuntura (corporal, nocouro cabeludo ou auricular) com placebo ou acupuntura fictícia (sham), nenhum tratamento, terapias convencionais ou medicina chinesa com ervas. Três autores independentes avaliaram o risco de viés e extraíram os dados dos estudos; os autores dos estudos foram contatados para se obter informações adicionais. Não foi possível fazer meta‐análises já que encontramos apenas um estudo. O desfecho primário foi diminuição da dor decorrente da endometriose. Os desfechos secundários foram modificações na qualidade de vida avaliada através de escalas, taxa de gravidez, efeitos colaterais e taxa de recorrência da endometriose. Foram encontrados 24 estudos que analisaram a acupuntura para o tratamento da dor na endometriose. Porém, apenas um ensaio clínico, com 67 participantes preencheu todos os critérios de inclusão. Este único estudo usou o Guideline for Clinical Research on New Chinese Medicine para avaliar a dor e a taxa de cura. A pontuação na escala de dismenorréia foi menor no grupo que recebeu acupuntura (diferença média ‐4.81 pontos, intervalo de confiança de 95% ‐6.25 a ‐3.37, P < 0,00001) na escala de 15 pontos Pelvic Endometriosis scale recomendada pelo Guideline. A taxa total de efetividade (‘curado’, ‘significativamente efetivo’ ou ‘efetivo’) da acupuntura auricular foi de 91,9% e de 60% para a medicina chinesa (risco relativo 3,04, IC 95% 1,65 a 5,62, P = 0,0004). A taxa de melhora não foi significativamente diferente entre o grupo de acupuntura auricular e de medicina chinesa com ervas para as participantes com dismenorréia leve a moderada. Por outro lado, a acupuntura auricular reduziu significativamente a dor em casos de dismenorréia grave. Não encontramos dados sobre os desfechos secundários. As evidências para apoiar a efetividade da acupuntura para o tratamento da dor na endometriose são limitadas, sendo provenientes de apenas um único estudo. Esta revisão aponta para a necessidade da condução de novos ensaios clínicos de boa qualidade, duplo‐cegos, comparando diversos tipos de acupuntura com técnicas convencionais de tratamento para dor em pacientes com endometriose.

Background: Quality acupuncture influences the outcomes of clinical research, and issues associated with effective administration of acupuncture in randomized controlled trials need to be addressed when appraising studies. Objective: The study objective was to achieve consensus on domains and items for inclusion in a rating scale to assess quality acupuncture administered in clinical research. Study design and subjects: An active group of Australian acupuncture researchers initially identified a pool of items assessing quality. The Delphi consensus process was then used to select and reduce the number of items, and an additional expert panel of 42 researchers were invited to participate. Participants initially ranked items along a five-point scale for the first Delphi round, and indicated an agree or disagree response during the second round. For an item to be retained into the second round, an item had to attain greater than 80% agreement that the item described a dimension of quality acupuncture and related study design. Results: Thirty-two (32) experts agreed to participate in the study. After two rounds of the Delphi process, consensus was reached on 14 domains and 26 items relating to quality acupuncture. Domains, items, and minimum standards related to study design; rationale of the intervention; criteria relating to needling stimulation either manual or electrostimulation; duration and frequency of treatment; and practitioner training. Conclusions: Items for inclusion in an instrument to assess quality acupuncture in clinical research were identified. Further development of the instrument including relative weighting of items and reliability testing is under way.