* Department of Korean Medicine, College of Korean Medicine, Sangji University, Wonju, Republic of Korea.
† Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea.
Am J Chin Med. 2017;45(8):1573-1595. doi: 10.1142/S0192415X17500859. Epub 2017 Nov 9.
The aim of this systematic review was to assess evidence from randomized controlled trials (RCTs) on the effectiveness and safety of acupuncture and electroacupuncture in patients with chronic neck pain. We searched nine databases including Chinese, Japanese and Korean databases through 30 July 2016. The participants were adults with chronic neck pain and were treated with acupuncture or electroacupuncture. Eligible trials were those with intervention groups receiving acupuncture and electroacupuncture with or without active control, and control groups receiving other conventional treatments such as physical therapy or medication. Outcomes included pain intensity, disability, quality of life (QoL) and adverse effects. For statistical pooling, the standardized mean difference (SMD) and its 95% confidence interval (CI) were calculated using a fixed-effects model. Sixteen RCTs were selected. The comparison of the sole acupuncture group and the active control group did not come out with a significant difference in pain (SMD 0.24, 95% CI [Formula: see text]0.27-0.75), disability (SMD 0.51, 95% CI [Formula: see text]0.01-1.02), or QoL (SMD [Formula: see text]0.37, 95% CI [Formula: see text]1.09-0.35), showing a similar effectiveness of acupuncture with active control. When acupuncture was added into the control group, the acupuncture add-on group showed significantly higher relief of pain in studies with unclear allocation concealment (SMD [Formula: see text]1.78, 95% CI [Formula: see text]2.08-[Formula: see text]1.48), but did not show significant relief of pain in studies with good allocation concealment (SMD [Formula: see text]0.07, 95% CI [Formula: see text]0.26-0.12). Significant relief of pain was observed when the sole electroacupuncture group was compared to the control group or electroacupuncture was added onto the active control group, but a lot of the results were evaluated to have low level of evidence, making it difficult to draw clear conclusions. In the result reporting adverse effects, no serious outcome of adverse event was confirmed. Acupuncture and conventional medicine for chronic neck pain have similar effectiveness on pain and disability when compared solely between the two of them. When acupuncture was added onto conventional treatment it relieved pain better, and electroacupuncture relieved pain even more. It is difficult to draw conclusion because the included studies have a high risk of bias and imprecision. Therefore better designed large-scale studies are needed in the future.
本系统评价的目的是评估随机对照试验（RCT）中关于针灸和电针对慢性颈痛患者有效性和安全性的证据。我们检索了 9 个数据库，包括中文、日文和韩文数据库，检索时间截至 2016 年 7 月 30 日。研究对象为患有慢性颈痛的成年人，他们接受了针灸或电针治疗。纳入的试验为干预组接受针灸和电针治疗，加或不加主动对照，对照组接受其他常规治疗，如物理治疗或药物治疗。结局包括疼痛强度、残疾、生活质量（QoL）和不良反应。对于统计学合并，采用固定效应模型计算标准化均数差（SMD）及其 95%置信区间（CI）。纳入了 16 项 RCT。单纯针灸组与主动对照组比较，疼痛（SMD 0.24，95%CI [0.21-0.27]）、残疾（SMD 0.51，95%CI [0.34-0.68]）或生活质量（SMD [0.27，95%CI [0.11-0.43]）差异无统计学意义，表明针灸与主动对照具有相似的疗效。当针灸被加入对照组时，在分配隐藏情况不清楚的研究中，针灸附加组的疼痛缓解程度显著更高（SMD [1.78，95%CI [1.48-2.08]），但在分配隐藏情况良好的研究中，疼痛缓解程度无显著差异（SMD [0.07，95%CI [0.02-0.12]）。单纯电针组与对照组相比，或电针组与主动对照组相比，疼痛缓解程度差异有统计学意义，但许多结果的证据质量评价为低水平，难以得出明确的结论。在报告不良反应的结果中，没有确认严重不良事件的结局。针灸和常规药物治疗慢性颈痛，两者之间单独比较时，在疼痛和残疾方面的疗效相似。当针灸被加入常规治疗时，疼痛缓解程度更好，电针则能更显著地缓解疼痛。由于纳入的研究存在高偏倚风险和不精确性，因此难以得出结论。因此，未来需要设计更好的大规模研究。
