Wang Yang, Li Wang, Peng Weina, Zhou Jing, Liu Zhishun
Acupuncture Department, Guang'anmen Hospital, China Academy of Chinese Medical Sciences Acupuncture Department, Beijing Hospital of Massage, Beijing, China.
Medicine (Baltimore). 2018 Aug;97(34):e11986. doi: 10.1097/MD.0000000000011986.
Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN.
The Cochrane Skin Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the gray literature were searched. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture, or comparing acupuncture with another active therapy versus the same active therapy were included.
Seven RCTs comparing acupuncture versus pharmacologic therapy were included. Meta-analysis was conducted for acupuncture's effect on PHN evaluating by pain intensity. Results from 2 RCTs showed that compared with pharmacologic therapy, acupuncture was better in decreasing the pain intensity measured by visual analog scale score (mean difference: 1.80, 95% confidence interval 1.72-1.87; P < .001). The limitations of the study are as follows: only trials comparing acupuncture versus pharmacologic therapy were included and all of the included trials were performed in China.
There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.
在中国,针灸被广泛用于治疗带状疱疹后神经痛(PHN),但其疗效尚不清楚。我们旨在评估针灸治疗PHN的疗效和安全性。
检索Cochrane皮肤组试验注册库、Cochrane对照试验中心注册库、MEDLINE、Embase、中国生物医学文献数据库、中国知网以及灰色文献。纳入比较单纯针灸与不治疗/另一种积极治疗/假针灸的随机对照试验(RCT),或比较针灸联合另一种积极治疗与单纯该积极治疗的RCT。
纳入7项比较针灸与药物治疗的RCT。对针灸治疗PHN的疗效进行荟萃分析,以疼痛强度作为评估指标。2项RCT的结果显示,与药物治疗相比,针灸在降低视觉模拟量表评分所测得的疼痛强度方面效果更好(平均差值:1.80,95%置信区间1.72 - 1.87;P<0.001)。本研究的局限性如下:仅纳入了比较针灸与药物治疗的试验,且所有纳入试验均在中国进行。
没有足够证据表明针灸在改善整体印象或生活质量方面优于药物治疗。未报告针灸的不良反应。总体而言,针灸对PHN患者是安全的,且可能在缓解疼痛方面有效。鉴于纳入研究质量较低,结果并不确凿,需要更多高质量的大规模RCT。