Wang Rong, Li Xiuxia, Zhou Shenghu, Zhang Xiaogang, Yang Kehu, Li Xusheng
Department of Joint Surgery, Lanzhou General Hospital, Lanzhou Military Command, Lanzhou, China.
Gansu University of Chinese Medicine, Lanzhou, China.
Acupunct Med. 2017 Aug;35(4):241-250. doi: 10.1136/acupmed-2016-011176. Epub 2017 Jan 23.
To assess the efficacy of manual acupuncture (MA) in the treatment of myofascial pain syndrome (MPS).
We searched for randomised controlled trials (RCTs) comparing MA versus sham/placebo or no intervention in patients with MPS in the following databases from inception to January 2016: PubMed; Cochrane Library; Embase; Web of Science; and China Biology Medicine. Two reviewers independently screened the literature extracted data and assessed the quality of the included studies according to the risk of bias tool recommended by the Cochrane Handbook (V.5.1.0). Then, a meta-analysis was performed using RevMan 5.3 software.
Ten RCTs were combined in a meta-analysis of MA versus sham, which showed a favourable effect of MA on pain intensity after stimulation of myofascial trigger points (MTrPs; standardised mean difference (SMD) -0.90, 95% CI -1.48 to -0.32; p=0.002) but not traditional acupuncture points (p>0.05). Benefit was seen both after a single treatment (SMD -1.05, 95% CI -1.84 to -0.27; p=0.009) and course of eight sessions (weighted mean difference (WMD) -1.96, 95% CI -2.72 to -1.20; p<0.001). We also found a significant increase in pressure pain threshold following MA stimulation of MTrPs (WMD 1.00, 95% CI 0.32 to 1.67; p=0.004). Two of the included studies reported mild adverse events (soreness/haemorrhage) secondary to MA.
Through stimulation of MTrPs, MA might be efficacious in terms of pain relief and reduction of muscle irritability in MPS patients. Additional well-designed/reported studies are required to determine the optimal number of sessions for the treatment of MPS.
评估手针疗法（MA）治疗肌筋膜疼痛综合征（MPS）的疗效。
我们检索了从数据库建立至2016年1月的以下数据库中比较MA与假针刺/安慰剂或无干预措施治疗MPS患者的随机对照试验（RCT）：PubMed；Cochrane图书馆；Embase；科学网；以及中国生物医学数据库。两名评价者独立筛选文献、提取数据，并根据Cochrane手册（第5.1.0版）推荐的偏倚风险工具评估纳入研究的质量。然后，使用RevMan 5.3软件进行荟萃分析。
在一项MA与假针刺的荟萃分析中纳入了10项RCT，结果显示MA对肌筋膜触发点（MTrP）刺激后的疼痛强度有良好效果（标准化均数差（SMD）-0.90，95%可信区间-1.48至-0.32；p=0.002），但对传统穴位则无效果（p>0.05）。单次治疗后（SMD -1.05，95%可信区间-1.84至-0.27；p=0.009）以及8次疗程后（加权均数差（WMD）-1.96，95%可信区间-2.72至-1.20；p<0.001）均可见疗效。我们还发现，MA刺激MTrP后压力疼痛阈值显著升高（WMD 1.00，95%可信区间0.32至1.67；p=0.004）。纳入研究中的两项报告了MA继发的轻度不良事件（酸痛/出血）。
通过刺激MTrP，MA在缓解MPS患者疼痛和减轻肌肉兴奋性方面可能有效。需要更多设计良好/报告规范的研究来确定治疗MPS的最佳疗程数。
