Trinh K V, Graham N, Gross A R, Goldsmith C H, Wang E, Cameron I D, Kay T
McMaster University, DeGroote School of Medicine, Office of MD Admissions, 1200 Main Street West, MDCL-3112, Hamilton, Ontario, Canada L8N 3Z5.
Cochrane Database Syst Rev. 2006 Jul 19(3):CD004870. doi: 10.1002/14651858.CD004870.pub3.
Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Treatments for neck pain are varied, as are the perceptions of benefits. Acupuncture has been used as an alternative to more traditional treatments for musculoskeletal pain. This review summarizes the most current scientific evidence on the effectiveness of acupuncture for acute, subacute and chronic neck pain.
To determine the effects of acupuncture for individuals with neck pain.
We searched CENTRAL (2006, issue 1) and MEDLINE, EMBASE, MANTIS, CINAHL from their beginning to February 2006. We searched reference lists and the acupuncture database TCMLARS in China.
Any published trial using randomized (RCT) or quasi-randomized (quasi-RCT) assignment to the intervention groups, either in full text or abstract form, were included.
Two reviewers made independent decisions for each step of the review: article inclusion, data abstraction and assessment of trial methodological quality. Study quality was assessed using the Jadad criteria. Consensus was used to resolve disagreements. When clinical heterogeneity was absent, we combined studies using random-effects meta-analysis models.
We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale. For chronic mechanical neck disorders, there was moderate evidence that acupuncture was more effective for pain relief than some types of sham controls, measured immediately post-treatment. There was moderate evidence that acupuncture was more effective than inactive, sham treatments measured immediately post-treatment and at short-term follow-up (pooled standardized mean difference (SMD) -0.37, 95% confidence interval (CI) -0.61 to -0.12). There was limited evidence that acupuncture was more effective than massage at short-term follow-up. For chronic neck disorders with radicular symptoms, there was moderate evidence that acupuncture was more effective than a wait-list control at short-term follow-up.
AUTHORS' CONCLUSIONS: There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.
颈部疼痛是肌肉骨骼系统最常报告的三种病症之一。颈部疼痛的治疗方法多种多样，人们对其疗效的看法也各不相同。针灸已被用作治疗肌肉骨骼疼痛的一种替代传统疗法。本综述总结了关于针灸治疗急性、亚急性和慢性颈部疼痛有效性的最新科学证据。
确定针灸对颈部疼痛患者的疗效。
我们检索了Cochrane系统评价数据库（CENTRAL，2006年第1期）以及MEDLINE、EMBASE、MANTIS、CINAHL，检索时间从各数据库建库至2006年2月。我们还检索了参考文献列表以及中国的针灸数据库TCMLARS。
纳入任何已发表的试验，这些试验采用随机（RCT）或半随机（quasi - RCT）分组至干预组，全文或摘要形式均可。
两位评价者对综述的每个步骤独立做出决策：文章纳入、数据提取和试验方法学质量评估。使用Jadad标准评估研究质量。通过协商解决分歧。当不存在临床异质性时，我们使用随机效应荟萃分析模型合并研究。
我们未找到任何研究针灸对急性或亚急性疼痛疗效的试验，但找到了10项研究针灸治疗慢性颈部疼痛的试验。总体而言，方法学质量在Jadad量表上的平均分为2.3/5。对于慢性机械性颈部疾病，有中等证据表明，在治疗后即刻测量，针灸在缓解疼痛方面比某些类型的假对照更有效。有中等证据表明，在治疗后即刻和短期随访时，针灸比无活性的假治疗更有效（合并标准化均数差（SMD）-0.37，95%置信区间（CI）-0.61至-0.12）。在短期随访中，有有限证据表明针灸比按摩更有效。对于伴有神经根症状的慢性颈部疾病，有中等证据表明在短期随访中针灸比等待治疗组更有效。
有中等证据表明，在治疗结束时测量，针灸比某些假治疗能更好地缓解疼痛。有中等证据表明，接受针灸治疗的患者在短期随访时报告的疼痛程度低于等待治疗的患者。也有中等证据表明，针灸在治疗后缓解疼痛方面比无活性治疗更有效，且在短期随访中这种效果得以维持。
