OBJECTIVE:To evaluate a simple acupressure protocol in LIV3 and LI4 acupoints in women with primary dysmenorrhea.

METHODS:This paper reports a randomized, single blinded clinical trial. 90 young women with dysmenorrhea were recruited to three groups to receive 20min acupressure every day in either LIV3 or LI4, or placebo points. Acupressure was timed five days before menstruation for three successive menstrual cycles. On menstruation, each participant completed the Wong Baker faces pain scale, and the quality of life short form -12 (QOL SF-12).

RESULTS:Intensity and duration of pain between the three groups in the second and third cycles during the intervention (p<0.05) differed significantly. Significant differences were seen in all domains of QOL except for mental health (p=0.4), general health (p=0.7) and mental subscale component (p=0.12) in the second cycle, and mental health (p=0.9), and mental subscale component (p=0.14) in the third cycle.

CONCLUSION:Performing the simple acupressure protocol is an effective method to decrease the intensity and duration of dysmenorrhea, and improve the QOL. Registration ID in IRCT: IRCT2016052428038N1.

BACKGROUND:Acupuncture and other modalities of Chinese/East Asian medicine have been used to treat women's health for many centuries. Gynecology specialties focus particularly on menstrual and reproductive disorders. Both the adoption of the use of acupuncture outside Asia, and the incorporation of scientific analysis in Asia have challenged biomedical conceptions of what can be achieved with this treatment method. The scale of research activity in relation to acupuncture and women's health has increased over the last 20 years.

OBJECTIVE:This review aims to explore the research evidence in relation to acupuncture use for women's reproductive disorders, focusing on both clinical findings and experimental research on acupuncture's mechanisms of action in relation to women's health.

METHODS:A narrative literature search was undertaken using searches of electronic databases and manual searches of journals and textbooks. The search included all literature published prior to June 2013. The literature was assessed as to the nature of the study it was reporting and findings synthesized into a commentary.

RESULTS:For acupuncture's mechanism of action the search resulted in 114 relevant documents; in relation to clinical reports on the use of acupuncture for women's health 204 documents were found and assessed.

CONCLUSION:There is preliminary data indicating acupuncture may improve menstrual health and coping for women experiencing delays falling pregnant. There is experimental data showing that acupuncture can influence female reproductive functioning, although the actual mechanisms involved are not yet clarified. Further well-conducted clinical research would benefit our understanding of the usefulness of acupuncture to women's health.

OBJECTIVE:To determine if injection of vitamin K3 in an acupuncture point is optimal for the treatment of primary dysmenorrhoea, when compared with 2 other injection treatments.

SETTING:A Menstrual Disorder Centre at a public hospital in Shanghai, China.

PARTICIPANTS:Chinese women aged 14-25 years with severe primary dysmenorrhoea for at least 6 months not relieved by any other treatment were recruited. Exclusion criteria were the use of oral contraceptives, intrauterine devices or anticoagulant drugs, pregnancy, history of abdominal surgery, participation in other therapies for pain and diagnosis of secondary dysmenorrhoea. Eighty patients with primary dysmenorrhoea, as defined on a 4-grade scale, completed the study. Two patients withdrew after randomisation.

INTERVENTIONS:A double-blind, double-dummy, randomised controlled trial compared vitamin K3 acupuncture point injection to saline acupuncture point injection and vitamin K3 deep muscle injection. Patients in each group received 3 injections at a single treatment visit.

PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcome was the difference in subjective perception of pain as measured by an 11 unit Numeric Rating Scale (NRS). Secondary measurements were Cox Pain Intensity and Duration scales and the consumption of analgesic tablets before and after treatment and during 6 following cycles.

RESULTS:Patients in all 3 groups experienced pain relief from the injection treatments. Differences in NRS measured mean pain scores between the 2 active control groups were less than 1 unit (-0.71, CI -1.37 to -0.05) and not significant, but the differences in average scores between the treatment hypothesised to be optimal and both active control groups (1.11, CI 0.45 to 1.78) and (1.82, CI 1.45 to 2.49) were statistically significant in adjusted mixed-effects models. Menstrualdistress and use of analgesics were diminished for 6 months post-treatment.

CONCLUSIONS:Acupuncture point injection of vitamin K3 relieves menstrual pain rapidly and is a useful treatment in an urban outpatient clinic.

TRIAL REGISTRATION NUMBER:NCT00104546; Results.

This study investigated the alleviating effects of aromatherapy massage and acetaminophen on menstrual pain in Korean high school girls. Subjects were divided into two groups: the aromatherapy massage (treatment) group (n = 32) and the acetaminophen (control) group (n = 23). Aromatherapy massage was performed on subjects in the treatment group. The abdomen was massaged once using clary sage, marjoram, cinnamon, ginger, and geranium in a base of almond oil. The level of menstrual pain was assessed using a visual analogue scale at baseline and twenty-four hours afterward. The reduction of menstrual pain was significantly higher in the aromatherapy group than in the acetaminophen group. Using multiple regression, aromatherapy massage was found to be more highly associated with reduction in the level of menstrual pain than acetaminophen. These finding suggest that aromatherapy massage may be an effective treatment for menstrual pain in high school girls. However, it could not be verified whether the positive effects derived from the aromatherapy, the massage, or both. Further rigorous studies should be conducted using more objective measures.

OBJECTIVE:To observe the clinical therapeutic effect of acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis, and to probe into the best therapy for this kind of disease.

METHODS:Seventy-three cases of dysmenorrhea caused by endometriosis were randomly divided into an acupuncture combined with acupoint sticking therapy group (observation group) and a medication group (control group). The observation group (36 cases) was treated with acupuncture combined with acupoint sticking therapy, Zhongji (CV 3), Guanyuan (CV 4), Zigong (EX-CA 1) etc. were selected; the control group (37 cases) was treated with oral administration of Jiawei Mojie tablet. The clinical effects, pain scores, onset time of producing analgesic and duration of both groups were observed before and after treatment.

RESULTS:The short term total effective rate of 91.2% (31/34) in observation group was better than that of 83.3% (30/36) in control group (P<0.05); the long term total effective rates were 97.1% (33/34) and 69.4% (25/36) in observation group and control group respectively, with significant difference between two groups (P<0. 05). The pain scores of both groups were decreased after treatment, and the improvement degree was more significant in observation group (P<0. 01); the onset time in observation group was shorter than that in control group (P<0. 05), the duration of effect in observation group was longer, and with a stable effect.

CONCLUSION:The therapeutic effect of acupuncture combined with acupoint sticking therapy is very significant for dysmenorrhea caused by endometriosis, and it is a good therapy for this kind of disease.

OBJECTIVE:To observe the clinical therapeutic effect of acupuncture combined with acupoint sticking therapy for treatment of dysmenorrhea caused by endometriosis, and to probe into the best therapy for this kind of disease.

METHODS:Seventy-three cases of dysmenorrhea caused by endometriosis were randomly divided into an acupuncture combined with acupoint sticking therapy group (observation group) and a medication group (control group). The observation group (36 cases) was treated with acupuncture combined with acupoint sticking therapy, Zhongji (CV 3), Guanyuan (CV 4), Zigong (EX-CA 1) etc. were selected; the control group (37 cases) was treated with oral administration of Jiawei Mojie tablet. The clinical effects, pain scores, onset time of producing analgesic and duration of both groups were observed before and after treatment.

RESULTS:The short term total effective rate of 91.2% (31/34) in observation group was better than that of 83.3% (30/36) in control group (P<0.05); the long term total effective rates were 97.1% (33/34) and 69.4% (25/36) in observation group and control group respectively, with significant difference between two groups (P<0. 05). The pain scores of both groups were decreased after treatment, and the improvement degree was more significant in observation group (P<0. 01); the onset time in observation group was shorter than that in control group (P<0. 05), the duration of effect in observation group was longer, and with a stable effect.

CONCLUSION:The therapeutic effect of acupuncture combined with acupoint sticking therapy is very significant for dysmenorrhea caused by endometriosis, and it is a good therapy for this kind of disease.

The purpose of this study was to investigate the effect of aromatherapy massage on dysmenorrhea. The study used a quasiexperimental design with the subjects as their own control. Every participant applied both aromatherapy massage with lavender oil and placebo massage with odorless liquid petrolatum [soft paraffin]. The population comprised 438 midwifery and nursing students. The 150 students who had declared that they had suffered from dysmenorrhea used a visual analog scale to indicate their level of pain. Higher scores reflected a greater severity of dysmenorrhea. Forty-four students volunteered to participate in the study. When the lavender massage and the placebo massage were compared, the visual analog scale score of the lavender massage was found to decrease at a statistically significant rate. This study showed that massage was effective in reducing dysmenorrhea. In addition, this study showed that the effect of aromatherapy massage on pain was higher than that of placebo massage.

OBJECTIVE:This meta-analysis investigates the effect of aromatherapy massage on pain in primary dysmenorrhea.

METHODS:Randomized controlled trials were searched by keywords in several databases (Pubmed, ISI Web of Sciences, and Google Scholar). Six randomized controlled trials that included 362 participants with primary dysmenorrhea, comparing abdominal aromatherapy massage (n = 184) with massage with placebo oils (n = 178), were analyzed in the meta-analysis. The change in the visual analogue scale (VAS) pain score from the first menstruation cycle to the second cycle at the first menstruation day was used as the primary outcome.

RESULTS:Aromatherapy massage with essential oils was superior to massage with placebo oils (standardized mean difference = -1.06 [95% CI: -1.55 to -0.55]).

CONCLUSION:Abdominal aromatherapy massage with essential oils is an effective complementary method to relieve pain in primary dysmenorrhea.

OBJECTIVE: The purpose of this study was to explore the effect of aromatherapy on menstrual cramps and symptoms of dysmenorrhea. DESIGN: The study was a randomized placebo-controlled trial. SUBJECTS: The subjects were 67 female college students who rated their menstrual cramps to be greater than 6 on a 10-point visual analogue scale, who had no systemic or reproductive diseases, and who did not use contraceptive drugs. INTERVENTION: Subjects were randomized into three groups: (1) an experimental group (n = 25) who received aromatherapy, (2) a placebo group (n = 20), and (3) a control group (n = 22). Aromatherapy was applied topically to the experimental group in the form of an abdominal massage using two drops of lavender (Lavandula officinalis), one drop of clary sage (Salvia sclarea), and one drop of rose (Rosa centifolia) in 5 cc of almond oil. The placebo group received the same treatment but with almond oil only, and the control group received no treatment. OUTCOME MEASURES: The menstrual cramps levels was assessed using a visual analogue scale and severity of dysmenorrhea was measured with a verbal multidimensional scoring system. RESULTS: The menstrual cramps were significantly lowered in the aromatherapy group than in the other two groups at both post-test time points (first and second day of menstruation after treatment). From the multiple regression aromatherapy was found to be associated with the changes in menstrual cramp levels (first day: Beta = -2.48, 95% CI: -3.68 to -1.29, p < 0.001; second day: Beta = -1.97, 95% CI: -3.66 to -0.29, p = 0.02 and the severity of dysmenorrhea (first day: Beta = 0.31, 95% CI: 0.05 to 0.57, p = 0.02; second day: Beta = 0.33, 95% CI: 0.10 to 0.56, p = 0.006) than that found in the other two groups. CONCLUSIONS: These findings suggest that aromatherapy using topically applied lavender, clary sage, and rose is effective in decreasing the severity of menstrual cramps. Aromatherapy can be offered as part of the nursing care to women experiencing menstrual cramps or dysmenorrhea.

BACKGROUND:The purpose of the present study is to explore the effect of yoga on the serum levels of homocysteine and nitric oxide (NO) in a cohort of women with primary dysmenorrhea and normal healthy controls.

METHODS:A prospective controlled trial was conducted in 35 women with primary dysmenorrhea and 35 healthy controls in a community-based study. Short-form Menstrual Distress Questionnaires (MDQs) were administered to assess the menstrual symptoms. All participants were provided yoga intervention, twice a week at 30 minutes/session, consecutively for 8 weeks. Blood samples were drawn from each woman on the third day of the menstrual cycle. Assessments of MDQs and blood samples for the determination of homocysteine and NO concentrations were performed at baseline and within the first 3 days of their next menses after completion of yoga intervention.

RESULTS:A total of 30 women from the dysmenorrheal group and 30 from the control group completed the study. Homocysteine levels were higher in those with dysmenorrhea when compared with healthy controls before yoga intervention (Mann-Whitney U test, p<0.05); however, no statistically significant differences were found between the two groups after 8 weeks of yoga training (p<0.05). The concentrations of homocysteine in both the dysmenorrheal and control groups after 8 weeks decreased by 51.37% and 46.46%, respectively (p<0.001). There were no statistically significant differences in NO levels between the two groups at baseline and after intervention. The total scores on the MDQs decreased significantly after yoga intervention in the dysmenorrheal group (p<0.05).

CONCLUSIONS:Yoga intervention was found to be associated with reductions in severity of dysmenorrhea and may be effective in lowering serum homocysteine levels after an intervention period of 8 weeks. These observations suggest that yoga may have therapeutic effects in women by restoring endothelial function.

BACKGROUND:Primary dysmenorrhea is common among women of reproductive age. Non-steroidal anti-inflammatory drugs and oral contraceptives are effective treatments, although the failure rate is around 20-25%. Therefore additional evidence-based treatments are needed. In recent years, the use of smartphone applications (apps) has increased rapidly and may support individuals in self-management strategies.

OBJECTIVE:We aimed to investigate the effectiveness of app-based self-acupressure in women with menstrual pain.

MATERIALS AND METHODS:A two-armed randomized pragmatic trial was conducted from December 2012 to April 2015 with recruitment until August 2014 in Berlin, Germany, among women aged 18-34 years with self reported cramping pain≥6 on a numeric rating scale (NRS) for the worst pain intensity during the previous menstruation. After randomization women performed either app-based self-acupressure (n=111) or followed usual care only (n=110) for six consecutive menstruation cycles. The primary outcome was the mean pain intensity (NRS 0-10) on the days with pain during the third menstruation. Secondary outcomes included worst pain intensity during menstruation, duration of pain, 50% responder rates (reduction of mean pain by at least 50%), medication intake, sick leave days and body efficacy expectation assessed at the 1st, 2nd, 3rd, and 6th menstruation cycle.

RESULTS:We included 221 women (mean age 24.0 (sd 3.6) years). The mean pain intensity difference during the third menstruation was statistically significant in favor for acupressure (acupressure: 4.4 95% CI [4.0; 4.7]; usual care 5.0 [4.6; 5.3]; mean difference -0.6 [-1.2; -0.1], p=0.026). At the sixth cycle, the mean difference between the groups -1.4 [-2.0; -0.8] (p<0.001) reached clinical relevance. At the third and sixth menstruation cycle, responder rate was 37% and 58% respectively in the acupressure group in contrast to 23% and 24% in the usual care group. Moreover, the worst pain intensity (group difference -0.6 [-1.2; -0.02] and -1.4 [-2.0; -0.7]), the number of days with pain (-0.4 [-0.9; -0.01] and -1.2 [-1.6; -0.7]) and the proportion of women with pain medication at the third and sixth menstruation cycle (odd ratio 0.5 [0.3; 0.9] and 0.3 [0.2; 0.5]) was lower in the acupressure group. At the third cycle hormonal contraceptive use was more common in the usual care group than in the acupressure group (odds ratio 0.5 [0.3;0.97]), but not statistically significant different at the sixth cycle (odds ratio 0.6 [0.3;1.1]). The number of sick leave days and body efficacy expectation (self-efficacy scale) did not differ between groups. On a scale from 0-6, mean satisfaction with the intervention at the third cycle was 3.7 (sd 1.3), recommendation of the intervention to others 4.3 (1.5), appropriateness of acupressure for menstrual pain 3.9 (1.4), and application of acupressure for other pain 4.3 (1.5). The intervention was safe and after the sixth cycle two third of the women (67.6%) still applied acupressure on all days with pain.

CONCLUSION:Smartphone app delivered self-acupressure resulted in a reduction of menstrual pain compared to usual care only. Effects were increasing over time and adherence was good. Future trials should include comparisons to other active treatment options.

AIM: This paper presents the findings of a study that assessed the effects of acupressure at the Sanyinjiao point on symptoms of primary dysmenorrhoea among adolescent girls. BACKGROUND: Dysmenorrhoea is the most common gynaecological disorder among adolescents. Traditional Chinese acupressure derived from acupuncture is a non-invasive technique. Despite renewed interest in the use of acupressure, relatively few studies have been undertaken to examine its effects on primary dysmenorrhoea. METHODS: An experimental study was conducted between December 2000 and August 2001. Participants were female students attending a technical college in Taiwan. None of the 69 participants had a prior history of gynaecological disease or secondary dysmenorrhoea, and all were rated higher than five for pain on a visual analogue scale from 0 to 10. The experimental group (n = 35) received acupressure at Sanyinjiao (above the ankle) while the control group (n = 34) rested for 20 min, while the control group underwent rest in the school health centre for 20 min without receiving acupressure. Fifty participants (30 experimental, 20 control) completed the 4-6-week follow-up session. Five instruments were used to collect pretest and post-test data at each session: (1) Visual Analogue Scale for pain; (2) the Short-Form McGill Pain Questionnaire; (3) the Menstrual Distress Questionnaire; (4) the Visual Analogue Scale for anxiety; and, for the experimental group only, (5) the Acupressure Self-Assessment Form. Data were analysed using the chi-square test, two-sample t-test and repeated measures two-way anova. RESULTS: Acupressure at Sanyinjiao during the initial session reduced the pain and anxiety typical of dysmenorrhoea. In the self-treatment follow-up session, acupressure at Sanyinjiao significantly reduced menstrual pain but not anxiety. Thirty-one (87%) of the 35 experimental participants reported that acupressure was helpful, and 33 (94%) were satisfied with acupressure in terms of its providing pain relief and psychological support during dysmenorrhoea. CONCLUSION: The findings suggest that acupressure at Sanyinjiao can be an effective, cost-free intervention for reducing pain and anxiety during dysmenorrhoea, and we recommend its use for self-care of primary dysmenorrhoea.

BACKGROUND: Complementary and alternative therapies may be adopted as nursing interventions to alleviate dysmenorrhea and improve productivity, creativity, work performance, and quality of life. OBJECTIVES: This study aimed to evaluate the efficacy of San Yin Jiao (SP6) acupressure as a non-pharmacologic nursing intervention for dysmenorrhea and identify its effects on temperature changes in two related acupoints as an explanatory mechanism of chi circulation. DESIGN: A non-equivalent control group pre and post-test design was employed to verify the effects of SP6 acupressure on skin temperature and dysmenorrhea. SETTING AND PARTICIPANTS: Young college women with primary dysmenorrhea were recruited from classrooms at two universities in Korea and 58 eligible participants were allotted to either a SP6 acupressure group or placebo group that received light touch on the SP6 acupoint. METHODS: The experimental group received acupressure treatment within the first 8h of menstruation, and severity of dysmenorrhea and skin temperature changes in the Zhongwan (CV2) and Qugu (CV12) acupoints were assessed prior to and 30 min, 1, 2, and 3h following treatment. RESULTS: There was a significant difference in severity of dysmenorrhea between the two groups immediately after (F=18.50, p=0.000) and for up to 2h (F=8.04, p=0.032) post treatment. Skin temperature was significantly elevated at 30 min after acupressure at the suprapubic CV2 acupoint in the experimental group compared to the control group. Temperature elevation was also noted at the epigastric CV12 acupoint post treatment but group differences were not significant, indicating that SP6 acupressure relieves dysmenorrhea primarily by temperature elevation in the CV2 pathway. CONCLUSIONS: Acupressure to the SP6 meridian can be an effective non-invasive nursing intervention for alleviation of primary dysmenorrhea, with effects lasting 2h post treatment.

AIM AND OBJECTIVES: To examine a comparison between Hegu and Sanyinjiao matched points and Hegu, Zusanli single point on adolescent girls' menstrual distress, pain and anxiety perception. BACKGROUND: Primary dysmenorrhoea is a major cause of temporary disability, with a prevalence ranging from 60-93%, depending upon the population and study. No one has yet compared the effects of single point and multiple point acupressures. Design. A single blind randomised experimental study was used. METHODS: Adolescents (n = 134) randomly assigned to experimental groups Zusanli (n = 30), Hegu (n = 33) and Hegu-Sanyinjiao Matched Points (n = 36) received acupressure intervention protocol for 20 minutes, while the control group (n = 35) did not receive any acupressure intervention. Four instruments were used to collect data: (1) the Visual Analog Scale for Pain; (2) the Menstrual Distress Questionnaire Short Form; (3) the Short-Form McGill Pain Questionnaire and (4) the Visual Analog Scale for Anxiety. RESULTS: During the six-month follow-up, acupressure at matched points Hegu and Sanyinjiao reduced the pain, distress and anxiety typical of dysmenorrhoea. Acupressure at single point Hegu was found, effectively, to reduce menstrual pain during the follow-up period, but no significant difference for reducing menstrual distress and anxiety perception was found. Zusanli acupressure had no significant effects of reducing menstrual pain, distress and anxiety perception. CONCLUSION: This controlled trial provides preliminary evidence that six-month acupressure therapy provides female adolescents with dysmenorrhoea benefits. RELEVANCE TO CLINICAL PRACTICE: Acupressure is an effective and safe non-pharmacologic strategy for the treatment of primary dysmenorrhoea. We recommend the use of acupressure for self-care of primary dysmenorrhoea at Hegu and Sanyinjiao matched points and single point Hegu, as pressure placement at these points is easy for adolescent girls to learn and practice.

OBJECTIVES: The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide (NO) for women with primary dysmenorrhea. DESIGN: This was a randomized clinical trial comparing the effects of auricular acupressure by seed-pressure method and placebo adhesive patch. SETTING: Settings included colleges in northern and central Taiwan. SUBJECTS: Serum CA-125 testing was used as a screening test for primary dysmenorrhea (<35 mg/dL). The study included 36 college females randomized to acupressure group, 35 to control group. INTERVENTIONS: The acupressure group received auricular acupressure by seed-pressure method on liver (CO12), kidney (CO10), and endocrine (CO18) acupoints. The control group had a plain adhesive patch placed on the same acupoints with no seed attached. Acupressure protocol included massaging 15 times on each acupoint, 3 times a day, for a total of 20 days. OUTCOME MEASURES: Primary: Short-form Menstrual Distress Questionnaire (MDQs). Secondary: blood sample of NO. Assessments of MDQs and NO were performed at baseline and within the first 2 days of their next menses (after completion of 20 days of acupressure). RESULTS: In the acupressure group, the overall menstrual symptoms (95% confidence interval [CI] = -49.8 to -6.5, effect size [ES] = 0.43, p = 0.01) and two subscales, menstrual pain (95% CI = -16.4 -to -2.2, ES = 0.45, p = 0.01) and negative affects (95% CI = -11.9-2.0, ES = 0.38, p = 0.04), revealed that menstrual symptoms decreased significantly after auricular acupressure by the seed-pressure method. The ES for the MDQs were in favor of the auricular acupressure by seed-pressure method. NO level increased in the acupressure group, although this difference did not achieve statistical significance (p>0.05). CONCLUSIONS: This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual symptoms, and offers a noninvasive complementary therapy for women with primary dysmenorrhea.

PURPOSE:To examine the effect of auricular acupressure therapy on primary dysmenorrhea among female high school students in South Korea.

DESIGN:A randomized controlled trial was employed.

METHODS:The study sample consisted of 91 female high school students, with 45 participants in the experimental group and 46 in the control group in two regions of South Korea. The average age of the participants was 16.7 years, and the average age of menarche was 12.2 years. Auricular acupressure therapy including an auricular acupressure needle on skin paper tape was applied on an ear for 3 days during periods of extreme primary dysmenorrhea. The acupoint names were Jagung, Sinmun, Gyogam, and Naebunbi. For the placebo control group, only the skin paper tape without an auricular acupressure needle was applied on the same acupoints. Measures used were the Menstrual Distress Questionnaire to assess primary dysmenorrhea, and the visual analog scale to assess abdominal and back pain of participants.

FINDINGS:There were significant differences on abdominal pain (t = 24.594, p<.001), back pain (t = 22.661, p<.001), and primary dysmenorrhea (t = 32.187, p<.001) between the two groups. Auricular acupressure therapy decreased abdominal pain, back pain, and primary dysmenorrhea of female high school students in South Korea.

CONCLUSIONS:Auricular acupressure therapy was an effective intervention for alleviating abdominal pain, back pain, and primary dysmenorrhea of female high school students in South Korea. For feasibility of the auricular acupressure therapy in practice, it is needed to train and learn the exact positions of acupoints in ear.

CLINICAL RELEVANCE:Health providers should consider providing auricular acupressure therapy as an alternative method for reducing abdominal and back pain, and primary dysmenorrhea in female high school students in South Korea.