Weiner Debra K, Ernst Edzard
Department of Medicine, Division of Geriatric Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213-3313, USA.
Clin J Pain. 2004 Jul-Aug;20(4):244-55. doi: 10.1097/00002508-200407000-00006.
To review common complementary and alternative treatment modalities for the treatment of persistent musculoskeletal pain in older adults.
A critical review of the literature on acupuncture and related modalities, herbal therapies, homeopathy, and spinal manipulation was carried out. Review included 678 cases within 21 randomized trials and 2 systematic reviews of herbal therapies: 798 cases within 2 systematic reviews of homeopathy; 1,059 cases within 1 systematic review of spinal manipulation for low back pain, and 419 cases within 4 randomized controlled trials for neck pain. The review of acupuncture and related modalities was based upon a paucity of well-controlled studies combined with our clinical experience.
Insufficient experimental evidence exists to recommend the use of traditional Chinese acupuncture over other modalities for older adults with persistent musculoskeletal pain. Promising preliminary evidence exists to support the use of percutaneous electrical nerve stimulation for persistent low back pain. While some herbals appear to have modest analgesic benefits, insufficient evidence exists to definitively recommend their use. Drug-herb interactions must also be considered. Some evidence exists to support the superiority of homeopathic remedies over placebo for treating osteoarthritis and rheumatoid arthritis. The benefits of spinal manipulation for persistent low back and neck pain have not been convincingly shown to outweigh its risks.
While the use of complementary and alternative modalities for the treatment of persistent musculoskeletal pain continues to increase, rigorous clinical trials examining their efficacy are needed before definitive recommendations regarding the application of these modalities can be made.
综述用于治疗老年人持续性肌肉骨骼疼痛的常见补充和替代治疗方式。
对关于针灸及相关疗法、草药疗法、顺势疗法和脊柱推拿的文献进行了批判性综述。综述纳入了21项随机试验中的678例病例以及2项草药疗法的系统评价：顺势疗法的2项系统评价中的798例病例；针对腰痛的脊柱推拿的1项系统评价中的1059例病例，以及针对颈部疼痛的4项随机对照试验中的419例病例。对针灸及相关疗法的综述基于缺乏充分对照研究以及我们的临床经验。
对于患有持续性肌肉骨骼疼痛的老年人，没有足够的实验证据推荐使用传统中医针灸而非其他疗法。有初步证据支持经皮电刺激神经疗法用于治疗持续性腰痛。虽然一些草药似乎有适度的镇痛效果，但没有足够证据明确推荐使用。还必须考虑药物与草药的相互作用。有一些证据支持顺势疗法药物在治疗骨关节炎和类风湿关节炎方面优于安慰剂。脊柱推拿治疗持续性腰痛和颈部疼痛的益处尚未令人信服地表明超过其风险。
虽然补充和替代疗法用于治疗持续性肌肉骨骼疼痛的情况持续增加，但在能够就这些疗法的应用做出明确推荐之前，需要进行严格的临床试验来检验其疗效。
