Grand Rounds

Can Self-Acupressure Apps Relieve Dysmenorrhea?

BACKGROUND AND PURPOSE:

Primary dysmenorrhea is common among women of reproductive age, with only approximately a 25% success rate with current treatment (NSAID and OCPs)
There is some, potentially biased, evidence regarding benefits of self-acupressure
Smartphone apps are becoming more popular to address health issues
Mobile health (mHealth) solutions have not been studied using well designed studies/RCTs
Blödt et al. (AJOG, 2017) examined whether app-based self-acupressure is effective for women with menstrual pain

Two-armed randomized pragmatic trial
Inclusion: Women 18-24 years with self-reported cramping pain ≥6 on a numeric rating scale (NRS 0-10)
Followed over 6 menstrual cycles
All women receive the app, which included visualization of the menstrual cycle, questionnaires and diaries
Women were randomized into groups:
- Intervention: Acupressure specific app features
  - Reminded by app every day, 5 days before expected onset of menses, to apply self-acupressure
  - Explanations of acupressure procedures
  - Timer to guide one-minute acupressure of each point
  - Study data entered through the app
- Control: Followed usual care only
Primary outcome was the mean pain intensity on the days with pain during the third menses cycle
Secondarily, pain intensity was assessed at the 1^st, 2^nd, 3^rd, and 6^thmenstruation cycle

221 women with a mean age 24.0 years
The acupressure group had significantly lower mean pain intensity during the third menstruation cycle 4.4 (95% CI, 4.0-4.7) vs 5.0 (95% CI, 4.6-5.3)
At the sixth cycle, the mean difference between the groups was -1.4 (p<0.001) and reached clinical relevance
At the third and sixth menstruation cycle, responder rate was 37% and 58% respectively in the acupressure group, and 23% and 24% in the control group
The acupressure group had lower worst pain intensity and the number of days with pain at both third and sixth cycle
The acupressure group had fewer women requiring pain medications
- Odd ratio 0.5 (95% CI, 0.3-0.9) at third cycle and 0.3 (95% CI, 0.2-0.5) at the sixth cycle
The number of sick days did not differ between groups
On a scale from 0-6, mean satisfaction with the intervention at the third cycle was 3.7, recommendation of the intervention to others was 4.3, appropriateness of acupressure for menstrual pain was 3.9
Two third of the women (67.6%) still applied acupressure on all days with pain even after the 6^th cycle

App-based self-acupressure reduced menstrual pain, with increasing effectiveness over time and good adherence

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