Plunkett Anthony, Beltran Thomas, Haley Chelsey, Kurihara Connie, McCoart Amy, Chen Louis, Wilkinson Indy, Cohen Steven P
*Womack Army Medical Center §Henry M Jackson Foundation, Defense and Veterans Pain Management Center, Fort Bragg, NC †Department of Math and Science, Lincoln Memorial University, Harrogate, TN ‡Walter Reed National Military Medical Center ∥Uniformed Services University of the Health Sciences, Bethesda ¶Johns Hopkins School of Medicine, Baltimore, MD.
Clin J Pain. 2017 Oct;33(10):939-943. doi: 10.1097/AJP.0000000000000518.
Acupuncture is characterized as an alternative or complementary medicine with a low complication rate and minimal side effects. There is a lack of robust evidence that shows acupuncture is an effective treatment for chronic pain. The purpose of this study was to determine which (if any) characteristics can predict successful response to acupuncture in chronic pain patients treated at military treatment facilities.
Data from 222 patients who received treatment for a chronic pain condition were collected from 2 medical centers. The patients underwent at least 4 acupuncture treatments and had an average pain score of 4 or higher on a 0- to 10-point numerical rating scale or visual analog scale in the week before treatment initiation. A successful outcome was defined to be a 2-point or greater reduction on the numerical rating scale or visual analog scale 12 weeks postinitial treatment.
The overall treatment success rate was 42.3%. Multivariate logistic regression found a higher baseline pain rating and the use of stimulation needles to be associated with a positive outcome (odds ratio [OR]=1.26; 95% confidence interval [CI], 1.03-1.55; P=0.02 and OR=2.73; 95% CI, 1.39-5.32; P=0.03, respectively). Only the presence of one or more psychological comorbidities was found to be associated with treatment failure (OR=0.67; 95% CI, 0.49-0.92; P=0.01).
The use of electrical stimulation and higher baseline pain score were associated with a positive treatment outcome, while the presence of a psychological comorbidity diminished the likelihood of treatment success. Practitioners should consider using electrical stimulation more frequently, and addressing psychopathology before or concurrent to treatment, when initiating acupuncture.
针灸被视为一种替代医学或补充医学,并发症发生率低且副作用极小。目前缺乏有力证据表明针灸是治疗慢性疼痛的有效方法。本研究的目的是确定在军事治疗机构接受治疗的慢性疼痛患者中,哪些特征(如果有的话)能够预测对针灸治疗的成功反应。
从2个医疗中心收集了222例接受慢性疼痛治疗患者的数据。这些患者接受了至少4次针灸治疗,且在开始治疗前一周,在0至10分的数字评分量表或视觉模拟量表上的平均疼痛评分达到4分或更高。成功的治疗结果定义为初始治疗后12周,数字评分量表或视觉模拟量表上的评分降低2分或更多。
总体治疗成功率为42.3%。多因素逻辑回归分析发现,较高的基线疼痛评分和使用刺激针与积极的治疗结果相关(优势比[OR]=1.26;95%置信区间[CI],1.03 - 1.55;P = 0.02以及OR = 2.73;95% CI,1.39 - 5.32;P = 0.03)。仅发现存在一种或多种心理合并症与治疗失败相关(OR = 0.67;95% CI,0.49 - 0.92;P = 0.01)。
电刺激的使用和较高的基线疼痛评分与积极的治疗结果相关,而心理合并症的存在则降低了治疗成功的可能性。从业者在开始针灸治疗时,应考虑更频繁地使用电刺激,并在治疗前或治疗同时解决心理病理学问题。