Dimitrova Alexandra, Murchison Charles, Oken Barry
Department of Neurology, Oregon Health and Science University , Portland, OR.
J Altern Complement Med. 2017 Mar;23(3):164-179. doi: 10.1089/acm.2016.0155. Epub 2017 Jan 23.
Neuropathy and its associated pain pose great therapeutic challenges. While there has been a recent surge in acupuncture use and research, little remains known about its effects on nerve function. This review aims to assess the efficacy of acupuncture in the treatment of neuropathy of various etiologies.
The Medline, AMED, Cochrane, Scopus, CINAHL, and clintrials.gov databases were systematically searched from inception to July 2015. Randomized controlled trials (RCTs) assessing acupuncture's efficacy for poly- and mononeuropathy were reviewed. Parallel and crossover RCTs focused on acupuncture's efficacy were reviewed and screened for eligibility. The Scale for Assessing Scientific Quality of Investigations in Complementary and Alternative Medicine was used to assess RCT quality. RCTs with score of >9 and active control treatments such as sham acupuncture or medical therapy were included.
Fifteen studies were included: 13 original RCTs, a long-term follow-up, and a re-analysis of a prior RCT. The selected RCTs studied acupuncture for neuropathy caused by diabetes, Bell's palsy, carpal tunnel syndrome, human immunodeficiency virus (HIV), and idiopathic conditions. Acupuncture regimens, control conditions, and outcome measures differed among studies, and various methodological issues were identified. Still, the majority of RCTs showed benefit for acupuncture over control in the treatment of diabetic neuropathy, Bell's palsy, and carpal tunnel syndrome. Acupuncture is probably effective in the treatment of HIV-related neuropathy, and there is insufficient evidence for its benefits in idiopathic neuropathy. Acupuncture appears to improve nerve conduction study parameters in both sensory and motor nerves. Meta-analyses were conducted on all diabetic neuropathy and Bell's palsy individual subject data (six RCTs; a total of 680 subjects) using a summary estimate random effects model, which showed combined odds ratio of 4.23 (95% confidence interval 2.3-7.8; p < 0.001) favoring acupuncture over control for neuropathic symptoms.
Acupuncture is beneficial in some peripheral neuropathies, but more rigorously designed studies using sham-acupuncture control are needed to characterize its effect and optimal use better.
神经病变及其相关疼痛带来了巨大的治疗挑战。尽管近期针灸的使用和研究激增，但对于其对神经功能的影响仍知之甚少。本综述旨在评估针灸治疗各种病因所致神经病变的疗效。
对Medline、AMED、Cochrane、Scopus、CINAHL和clintrials.gov数据库从建库至2015年7月进行系统检索。对评估针灸治疗多发性和单发性神经病变疗效的随机对照试验（RCT）进行综述。对聚焦于针灸疗效的平行和交叉RCT进行综述并筛选其是否符合纳入标准。使用补充和替代医学研究科学质量评估量表来评估RCT的质量。纳入得分>9且有诸如假针灸或药物治疗等活性对照治疗的RCT。
纳入15项研究：13项原始RCT、1项长期随访研究以及1项对既往RCT的重新分析。所选RCT研究了针灸治疗由糖尿病、贝尔麻痹、腕管综合征、人类免疫缺陷病毒（HIV）以及特发性疾病引起的神经病变。各研究中的针灸方案、对照条件和结局指标有所不同，且发现了各种方法学问题。尽管如此，大多数RCT显示在治疗糖尿病性神经病变、贝尔麻痹和腕管综合征方面，针灸比对照更具优势。针灸可能对治疗HIV相关神经病变有效，而对于其在特发性神经病变中的益处，证据不足。针灸似乎能改善感觉神经和运动神经的神经传导研究参数。使用汇总估计随机效应模型对所有糖尿病性神经病变和贝尔麻痹的个体受试者数据（6项RCT；共680名受试者）进行荟萃分析，结果显示在神经病变症状方面，支持针灸优于对照的合并比值比为4.23（95%置信区间2.3 - 7.8；p < 0.001）。
针灸对某些周围神经病变有益，但需要使用假针灸对照进行更严格设计的研究，以更好地明确其效果和最佳应用方式。
