Consortium for Health and Military Performance, Department of Military & Emergency Medicine, F. Edward Hébert School of Medicine, Uniformed Services University, Bethesda, Maryland, USA.
The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA.
Pain Med. 2019 Jul 1;20(7):1430-1448. doi: 10.1093/pm/pnz051.
Approximately 55-76% of Service members use dietary supplements for various reasons; although such use has become popular for a wide range of pain conditions, decisions to use supplements are often driven by information that is not evidence-based. This work evaluates whether the current research on dietary ingredients for chronic musculoskeletal pain provides sufficient evidence to inform decisions for practice and self-care, specifically for Special Operations Forces personnel.
A steering committee convened to develop research questions and factors required for decision-making. Key databases were searched through August 2016. Eligible systematic reviews and randomized controlled trials were assessed for methodological quality. Meta-analysis was applied where feasible. GRADE was used to determine confidence in the effect estimates. A decision table was constructed to make evidence-informed judgments across factors required for decision-making, and recommendations were made for practice and self-care use.
Nineteen dietary ingredients were included. Conditional evidence-based recommendations were made for the use of avocado soybean unsaponifiables, capsaicin, curcuma, ginger, glucosamine, melatonin, polyunsaturated fatty acids, and vitamin D. In these cases, desirable effects outweighed undesirable effects, but there was uncertainty about the trade-offs, either because the evidence was low quality or because benefits and downsides were closely balanced.
The evidence showed that certain dietary ingredients, when taken as part of a balanced diet and/or as a supplement (e.g., pill, tablet, capsule, cream), may alleviate musculoskeletal pain with no to minimal risk of harm. This finding emphasizes and reinforces the critical importance of shared decision-making between Operators and their health care providers.
约有 55-76%的军人出于各种原因使用膳食补充剂；尽管这种使用已经在各种疼痛状况中变得流行，但补充剂的使用决策通常是基于非循证信息做出的。这项工作评估了用于慢性肌肉骨骼疼痛的膳食成分的当前研究是否为实践和自我保健提供了足够的证据，特别是对于特种作战部队人员。
一个指导委员会召集来制定研究问题和决策所需的因素。主要数据库搜索至 2016 年 8 月。对合格的系统评价和随机对照试验进行了方法学质量评估。在可行的情况下进行了荟萃分析。GRADE 用于确定对效应估计的置信度。制作了一个决策表，以便在决策所需的因素上做出基于证据的判断，并为实践和自我保健的使用提出建议。
共纳入了 19 种膳食成分。对于鳄梨大豆不皂化物、辣椒素、姜黄、姜、葡萄糖胺、褪黑素、多不饱和脂肪酸和维生素 D 的使用，提出了有条件的循证推荐意见。在这些情况下，期望效果超过了不良效果，但由于证据质量低或由于收益和弊端大致平衡，权衡取舍存在不确定性。
证据表明，某些膳食成分在作为均衡饮食的一部分和/或作为补充剂（例如药丸、片剂、胶囊、乳膏）服用时，可能会缓解肌肉骨骼疼痛，而不会带来伤害的风险。这一发现强调并强化了操作人员与其医疗保健提供者之间进行共同决策的至关重要性。
