Acupuncture for cyclic and noncyclic breast pain in women: A systematic review and meta-analysis of randomized controlled trials

Introduction

Breast pain is a frequently encountered problem in both pre- and postmenopausal women. The pain can be severe and persistent, and interferes with women's daily life. Acupuncture has been widely used for women with cyclic and noncyclic breast pain with possible favorable effects and few adverse events, however, the data have not been systematically reviewed. This systematic review aims to investigate the efficacy of acupuncture on alleviating breast pain.

Methods

Seven databases including Medline, Embase, Pubmed, CNKI, etc. were searched for English and Chinese literature from their inception to 22 January 2024. We included randomized clinical trials that assessed the effectiveness of acupuncture in reducing pain intensity for cyclic and noncyclic mastalgia unrelated to cancer. Two independent reviewers screened the retrieved studies and extracted the data. Risk of bias of included studies was assessed according to Cochrane Risk-of-Bias (RoB) tool version 2. Meta-analysis was conducted where applicable.

Results

Eleven studies were included. Eight studies with 588 women focused on cyclic breast pain (CBP), three studies with 210 women focused on noncyclic breast pain (NCBP). For CBP, the overall response rate of acupuncture was comparable to tamoxifen (3 studies, n=243; RR 1.24, 95% CI 0.75 to 2.06, p=0.39; very low certainty), however, the effect of acupuncture measured by visual analogue scale (VAS) score was inconsistent when compared with sham acupuncture in 3 studies (n=141; MD 11.08, 95% CI -3.95 to 26.10; p = 0.15; very low certainty). For NCBP, acupuncture provided significantly more reduction in VAS score than antibiotics for mastitis (2 studies, n=148; MD 12.69, 95% CI 8.38 to 17.00; p < 0.001; low certainty). A total of five cases of adverse events were reported.

Conclusion

Acupuncture may have similar effects to tamoxifen in treating women with CBP, and may be more effective than antibiotics in alleviating breast pain for women with mastitis. Acupuncture may be an effective complementary treatment for breast pain. However, the overall certainty of evidence was very low. The evidence was not conclusive and requires further investigation with robust methodological quality.

Registration number

CRD42020220134