Cui Xuejun, Trinh Kien, Wang Yong-Jun
Research Institute of Spine Diseases, Shanghai Research Institute of Acupuncture and Meridian, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, No 725, South Wanping Rd, Shanghai, Shanghai, China, 200032.
Cochrane Database Syst Rev. 2010 Jan 20;2010(1):CD006556. doi: 10.1002/14651858.CD006556.pub2.
Chronic neck pain with radicular signs or symptoms is a common condition. Many patients use complementary and alternative medicine, including traditional Chinese medicine, to address their symptoms.
To assess the efficacy of Chinese herbal medicines in treating chronic neck pain with radicular signs or symptoms.
We electronically searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE, CINAHL and AMED (beginning to October 1, 2009), the Chinese Biomedical Database and related herbal medicine databases in Japan and South Korea (1979 to 2007). We also contacted content experts and handsearched a number of journals published in China.
We included randomized controlled trials with adults with a clinical diagnosis of cervical degenerative disc disease, cervical radiculopathy or myelopathy supported by appropriate radiological findings. The interventions were Chinese herbal medicines, defined as products derived from raw or refined plants or parts of plants, minerals and animals that are used for medicinal purposes in any form. The primary outcome was pain relief, measured with a visual analogue scale, numeric scale or other validated tool.
The data were independently extracted and recorded by two review authors on a pre-developed form. Risk of bias and clinical relevance were assessed separately by two review authors using the twelve criteria and the five questions recommended by the Cochrane Back Review Group. Disagreements were resolved by consensus.
All four included studies were in Chinese; two of which were unpublished. Effect sizes were not clinically relevant and there was low quality evidence for all outcomes due to study limitations and sparse data (single studies). Two trials (680 participants) found that Compound Qishe Tablets relieved pain better in the short-term than either placebo or Jingfukang; one trial (60 participants) found than an oral herbal formula of Huangqi ((Radix Astragali)18 g, Dangshen (Radix Codonopsis) 9 g, Sanqi (Radix Notoginseng) 9 g, Chuanxiong (Rhizoma Chuanxiong)12 g, Lujiao (Cornu Cervi Pantotrichum) 12 g, and Zhimu (Rhizoma Anemarrhenae)12 g) relieved pain better than Mobicox or Methycobal and one trial (360 participants) showed that a topical herbal medicine, Compound Extractum Nucis Vomicae, relieved pain better than Diclofenac Diethylamine Emulgel.
AUTHORS' CONCLUSIONS: There is low quality evidence that an oral herbal medication, Compound Qishe Tablet, reduced pain more than placebo or Jingfukang and a topical herbal medicine, Compound Extractum Nucis Vomicae, reduced pain more than Diclofenac Diethylamine Emulgel. Further research is very likely to change both the effect size and our confidence in the results.
伴有神经根症状的慢性颈部疼痛是一种常见病症。许多患者使用补充和替代医学，包括传统中医，来缓解症状。
评估中药治疗伴有神经根症状的慢性颈部疼痛的疗效。
我们通过电子方式检索了CENTRAL（《考克兰系统评价数据库》2009年第3期）、MEDLINE、EMBASE、CINAHL和AMED（截至2009年10月1日）、中国生物医学数据库以及日本和韩国的相关草药数据库（1979年至2007年）。我们还联系了内容专家，并手工检索了中国出版的一些期刊。
我们纳入了针对临床诊断为颈椎间盘退变疾病、神经根型颈椎病或脊髓病且有适当影像学检查结果支持的成年人的随机对照试验。干预措施为中药，定义为以任何形式用于药用目的的源自生药或精制植物、植物部分、矿物质和动物的产品。主要结局为疼痛缓解情况，采用视觉模拟量表、数字量表或其他经过验证的工具进行测量。
两位综述作者在预先制定的表格上独立提取并记录数据。两位综述作者分别使用考克兰背部综述小组推荐的十二条标准和五个问题评估偏倚风险和临床相关性。分歧通过协商解决。
纳入的四项研究均为中文研究；其中两项未发表。由于研究局限性和数据稀少（单项研究），效应量与临床无关，所有结局的证据质量均较低。两项试验（680名参与者）发现，复方七叶皂苷钠片在短期内缓解疼痛的效果优于安慰剂或颈复康；一项试验（60名参与者）发现，黄芪（18克）、党参（9克）、三七（9克）、川芎（12克）、鹿角（12克）和知母（12克）的口服草药配方缓解疼痛的效果优于莫比可或甲钴胺，一项试验（360名参与者）表明，外用草药复方马钱子提取物缓解疼痛的效果优于双氯芬酸二乙胺乳胶剂。
有低质量证据表明，口服草药复方七叶皂苷钠片比安慰剂或颈复康更能减轻疼痛，外用草药复方马钱子提取物比双氯芬酸二乙胺乳胶剂更能减轻疼痛。进一步的研究很可能会改变效应量以及我们对结果的信心。
