Charité - University Medicine Berlin, corporate member of the Free University Berlin, Humboldt University of Berlin, and Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Foundation Chair of Clinical Naturopathy; Department of Internal Medicine, Division of Naturopathy, Immanuel Hospital Berlin; Department of Psychology, Faculty of Health, Witten/Herdecke University; KPW Garbsen, Center for Physiotherapy.
Dtsch Arztebl Int. 2018 Nov 23;115(47):785-792. doi: 10.3238/arztebl.2018.0785.
Leech therapy has been found to be effective in the treatment of a number of chronic musculoskeletal pain syndromes. Leeches are also often used empirically to treat chronic low back pain, but data from clinical trials have been lacking to date. We therefore conducted the first randomized trial of leech therapy for chronic low back pain.
Patients with chronic low back pain were randomized to receive either a single session of local treatment with 4-7 leeches or four weekly sessions of exercise therapy (1 hour each) led by a physical therapist. The primary endpoint was a change in average back pain intensity, as measured using a 100-mm visual analog scale (VAS), after 28 days. Secondary end- points included functional impairment (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire), quality of life (Short-Form Health Questionnaire [SF 36]), pain perception (pain perception scale = Schmerzempfindungsskala [SES]), depressivity (Center for Epidemiological Studies Depression Scale [CES-D]), and analgesic consumption (questionnaire/ diary). Trial visits took place before treatment and on days 28 ± 3 and 56 ± 5 after the start of treatment; the overall duration of the trial was 56 ± 5 days.
The mean low back pain score improved from 61.2 ± 15.6 before treatment to 33.1 ± 22.4 on day 28 in the leech ther- apy group (n = 25) and from 61.6 ± 14.8 to 59.8 ± 16.7 in the exercise therapy group (n = 19) (group difference -25.2; 95% con- fidence interval [-41.0; -9.45]; p = 0.0018). Significant benefits of leech therapy were also found at both time points with respect to physical impairment and function as well as physical quality of life. The patients' expectations from treatment were higher in the leech therapy group but did not significantly affect the findings.
A single session of leech therapy is more effective over the short term in lowering the intensity of pain over the short term and in improving physical function and quality of life over the intermediate term (4 weeks and 8 weeks, respectively). The limitations of this trial are the lack of blinding and the small number of patients. Leech therapy appears to be an effective treat- ment for chronic low back pain.
水蛭疗法已被证明在治疗多种慢性肌肉骨骼疼痛综合征方面有效。水蛭也常被经验性地用于治疗慢性腰痛，但迄今为止，临床试验的数据一直缺乏。因此，我们进行了首次水蛭疗法治疗慢性腰痛的随机试验。
将慢性腰痛患者随机分为两组，一组接受局部治疗，每次使用 4-7 只水蛭，另一组接受每周一次的物理治疗师指导的运动治疗（每次 1 小时），共 4 次。主要终点是治疗后 28 天平均腰痛强度的变化，使用 100mm 视觉模拟量表（VAS）测量。次要终点包括功能障碍（Roland-Morris 残疾问卷、汉诺威功能能力问卷）、生活质量（SF-36 简短健康问卷）、疼痛感知（疼痛感知量表=Schmerzempfindungsskala[SES]）、抑郁（流行病学研究中心抑郁量表[CES-D]）和镇痛药消耗（问卷/日记）。治疗前、治疗开始后第 28 ± 3 天和第 56 ± 5 天进行试验访视；整个试验持续 56 ± 5 天。
水蛭治疗组 25 例患者治疗前腰痛评分平均为 61.2 ± 15.6，治疗后第 28 天降至 33.1 ± 22.4（组间差异-25.2；95%置信区间[-41.0；-9.45]；p = 0.0018），运动治疗组 19 例患者治疗前腰痛评分平均为 61.6 ± 14.8，治疗后第 56 天降至 59.8 ± 16.7。水蛭治疗在治疗开始后的两个时间点均显著改善了身体功能和物理生活质量，也显著改善了物理损伤和功能。水蛭治疗组患者对治疗的期望较高，但并未显著影响研究结果。
单次水蛭治疗在短期内更有效，可降低短期疼痛强度，并改善中期（4 周和 8 周）的身体功能和生活质量。本试验的局限性在于缺乏盲法和患者数量较少。水蛭治疗似乎是治疗慢性腰痛的有效方法。
