Differences in patient-centered burdens and economic outcomes based on sociodemographic characteristics and social determinants of health: a scoping review.

Sequelae of pelvic inflammatory disease (SPID) refers to a series of long-term pathological changes and clinical manifestations resulting from delayed, inadequate, or incomplete treatment of pelvic inflammatory disease in women, leading to persistent or recurrent inflammation. Chronic pelvic pain (CPP) is one of the most prevalent sequlae, characterized by non-cyclical pelvic pain lasting more than 6 months. This pain is typically localized to the lower abdomen and lumbosacral region and is often described as a sensation of heaviness, soreness, or dull ache. It is frequently exacerbated by physical exertion, sexual intercourse, and perimenstrual periods, significantly diminishing patients’ quality of life. Currently, first-line treatment for CPP secondary to SPID predominantly comprises symptomatic interventions, including nonsteroidal anti-inflammatory drug (NSAID) analgesia, hormonal regulation, pelvic floor muscle training, and physical therapy. Standardized antibiotic use is recommended during acute exacerbations but are not routinely recommended in the chronic phase. For refractory pain, invasive treatments such as laparoscopic adhesiolysis and nerve blocks may be employed. However, long-term use of NSAIDs may lead to adverse effects such as gastrointestinal discomfort and hepatorenal impairment. Hormonal therapy has certain contraindications and poor long-term efficacy, while invasive treatments involve significant trauma and high costs. Moreover, none of these therapeutic approaches can fundamentally improve the histopathological state of pelvic tissues, resulting in disease recurrence and high relapse rates, which fail to meet clinical treatment demands., Acupuncture is a commonly used method in traditional Chinese medicine (TCM) clinical practice for the treatment of CPP., In 2021, a large-sample randomized controlled clinical trial suggested that 20 acupuncture sessions within 8 weeks could significantly improve clinical symptoms of moderate-to-severe CPP, with therapeutic effects maintained for 24 weeks post-treatment. Moxibustion exhibits therapeutic effects of warming meridians to dispel cold, promoting blood circulation to resolve stasis, and unblocking collaterals to relieve pain, thereby mitigating inflammatory responses and improving pelvic tissue adhesions. Relevant meta-analyses indicate that moxibustion-based therapies for SPID show significantly higher efficacy rates and pain relief outcomes compared to pharmacological treatments, with no significant differences in adverse reaction incidence., However, contemporary investigations suffer from a paucity of robust clinical evidence. Presently, no clinical guidelines, such as those promulgated by the European Association of Urology (EAU), the Society of Obstetricians and Gynaecologists of Canada (SOGC), and the American College of Obstetricians and Gynecologists (ACOG), advocate for the adoption of this therapeutic approach. Additionally, the efficacy differences between acupuncture and acupuncture combined with moxibustion in treating CPP require further investigation.