Gamus Dorit
Harefuah. 2015 Jan;154(1):9-15, 70.
This article assesses the evidence for effectiveness, adverse effects and cost-effectiveness of complementary therapies, as reflected in publications in high impact factor medical journals during the years 2012-2014. The search detected 13 randomized controlled studies (RCTs) and 14 meta-analyses, which collectively assessed results of 191 RCTs involving the participation of several thousand patients. Pain was the major focus of acupuncture research in both clinical and fMRI studies, which demonstrated that the effect of acupuncture is beyond the placebo effect. In addition, RCTs supported the use of acupuncture as an adjunctive therapy in chronic obstructive pulmonary disease and in moderate to severe depression. A promising trend was reported for the ameliorating effect of acupuncture in gout. Spinal manipulations may be helpful in cervical pain and yoga may be a useful treatment option for chronic neck pain, chronic low back pain and for pain-related disability. Beneficial effects of adding hypnosis and massage therapy to the treatment of fibromyalgia patients were also documented. Tai-chi may reduce balance impairment in mild-to-moderate Parkinson's disease and improve symptoms in patients with osteoarthritis. Products containing cranberry are associated with protective effects in some subgroups of patients with recurrent urinary tract infections. Chinese herbs may assist in glycemic control of diabetes patients and improve survival rate of patients with non-small cell lung cancer. Some of the complementary therapies were found to be cost-effective. Physicians should be aware of the possible adverse effects of these treatments and of possible drug-herb interactions. Further larger scale trials are justified.
本文评估了2012年至2014年间发表在高影响因子医学期刊上的补充疗法的有效性、不良反应和成本效益的证据。检索发现了13项随机对照试验(RCT)和14项荟萃分析,它们共同评估了涉及数千名患者参与的191项RCT的结果。疼痛是针灸临床研究和功能磁共振成像研究的主要焦点,这表明针灸的效果超出了安慰剂效应。此外,随机对照试验支持将针灸作为慢性阻塞性肺疾病和中度至重度抑郁症的辅助治疗方法。有报道称针灸对痛风有改善作用,这是一个有前景的趋势。脊柱推拿可能有助于缓解颈部疼痛,瑜伽可能是治疗慢性颈部疼痛、慢性下背部疼痛和疼痛相关残疾的有效选择。也有文献记载,在纤维肌痛患者的治疗中加入催眠和按摩疗法有有益效果。太极拳可能会减少轻度至中度帕金森病患者的平衡障碍,并改善骨关节炎患者的症状。含有蔓越莓的产品对复发性尿路感染患者的某些亚组有保护作用。中药可能有助于糖尿病患者的血糖控制,并提高非小细胞肺癌患者的生存率。一些补充疗法被发现具有成本效益。医生应该意识到这些治疗可能产生的不良反应以及可能的药物与草药相互作用。有必要进行进一步的大规模试验。