Jun Liu,1,2,* Yu Wang,1,* Juncha Zhang,1,2 Xisheng Fan,1,2 Hao Chen,1 Guang Zuo,1 Xuesong Wang,1 Yanfen She1,2 

1College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People’s Republic of China; 2Hebei International Joint Research Center for Dominant Diseases in Chinese Medicine and Acupuncture, Hebei University of Chinese Medicine, Shijiazhuang, Hebei, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xuesong Wang; Yanfen She, College of Acupuncture-Moxibustion and Tuina, Hebei University of Chinese Medicine, No. 3 Xingyuan Road, Shijiazhuang, Hebei, 050200, People’s Republic of China, Email wangxuesong@hebcm.edu.cn; 875107987@qq.com; sheyanfen@163.com

Background: This network meta-analysis (NMA) aimed to explore the impact of Non-pharmacological therapies (NPT) on alleviating primary dysmenorrhea (PD) symptoms and assess the effectiveness differences among various NPT.
Methods: We searched seven databases and summarized clinical trials of PD treated with NPT from inception to September 6, 2023. Randomized controlled clinical trials (RCTs) of PD treated with NPT. The outcomes were the Visual Analog Scale (VAS), the Cox menstrual symptom scale (CMSS), and response rate. Quality was assessed using the Cochrane risk of bias assessment tool. Pairwise meta-analysis and network meta-analysis (NMA) was performed by RevMan (5.4), Stata (15.0), and WinBUGS (1.4.3). The ranking probabilities for all treatment interventions were performed using the Surface Under the Cumulative Ranking curve (SUCRA).
Results: A total of 16 RCTs were finally included, involving 8 kinds of NPT. Results of pairwise meta-analyses: For the VAS score results, moxibustion (SMD: − 0.591,95% CI: − 0.916, − 0.266) was more effective than acupuncture, acupuncture (SMD: − 0.948,95% CI: − 1.853, − 0.044) was more effective than placebo, and yoga (SMD: 2.634,95% CI: − 4.28, − 0.988) was more effective than the blank control. NMA results: Compared to the blank control, acupuncture (SMD: − 4.81; 95% CI: − 6.63, − 3.00), auricular point therapy (SMD: − 4.36; 95% CI: − 7.18, − 1.60), yoga (SMD: − 2.12; 95% CI: − 3.13, − 1.09), moxibustion (SMD:5.54; 95% CI: 3.33, 7.68), and placebo (SMD: 3.10; 95% CI: 1.03, 5.27) proved to be a superior reduction in VAS. The use of acupressure (SMD: 2.49; 95% CI: 0.03, 5.03), moxibustion (SMD: − 2.45; 95% CI: − 4.06, − 0.71), and acupuncture (SMD: − 1.72; 95% CI: − 2.75, − 0.56) demonstrated a greater decrease in VAS efficacy than placebo. The consolidated ranking outcomes indicate that moxibustion, acupuncture, and auricular acupoint therapy occupy high SUCRA positions across various outcome metrics.
Conclusion: Acupuncture, moxibustion and auricular point may be the best treatment for PD. In the future, more trials are needed to obtain higher-quality evidence and the best protocols.

Keywords: non-pharmacological therapies, acupuncture, primary dysmenorrhea, network meta-analysis, randomized controlled trials