Yao Chongjie, Cheng Yanbin, Zhu Qingguang, Lv Zhizhen, Kong Lingjun, Fang Min
Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
Research Institute of Tuina, Shanghai Academy of Traditional Chinese Medicine, Shanghai, China.
Evid Based Complement Alternat Med. 2021 Feb 5;2021:6678184. doi: 10.1155/2021/6678184. eCollection 2021.
This meta-analysis aimed to evaluate the effects of manual therapy (MT) on cancer pain, so as to provide clinical evidence for application.
Five English and Chinese databases were searched until February 29, 2020, for randomized controlled trials (RCTs) of MT for cancer pain. Articles published in the English or Chinese language were included. Two authors independently reviewed all articles and extracted the data, and any disagreements in the above process were discussed with other reviewers until the authors reached consensus. Review Manager 5.3 was used to calculate the effect size and 95% confidence intervals. This review was registered in PROSPERO, number CRD42020172053.
The intensity of cancer pain is our primary outcome measure, and compared with standard care, MT can significantly relieve the pain of patients with cancer (SMD, 0.63; 95% CI [0.18, 1.08]; =0.006 < 0.01); the effects of MT plus active activity were significantly different from AT alone (SMD, 0.79; 95% CI [0.28, 1.30]; =0.002 < 0.01); there was no statistical difference in the efficacy of MT and AT alone (SMD, -0.24; 95% CI [-1.09, 0.62]; =0.53 > 0.05). In other related symptoms, the above evidence cannot support that MT had a good effect on fatigue (SMD, 0.77; 95% CI [-0.09, 1.63]; =0.08 > 0.05), nausea (SMD, 0.24; 95% CI [-0.00, 0.48]; =0.05), anxiety (SMD, 0.76; 95 % CI [-0.32, 1.84]; =0.17 > 0.05), and depression (SMD, 0.67; 95 % CI [-0.28, 1.62]; =0.17 > 0.05); however, MT intervention can improve physical function ( = 271; SMD, 0.35; 95 % CI [-0.04, 0.74]; =0.04 < 0.05) and global well-being (SMD, 0.50; 95 % CI [0.02, 0.98]; =0.04 < 0.05). In addition, MT had a significant effect on pain relief (SMD, 0.52; 95% CI [0.03, 1.01]; =0.04 < 0.05) and improvement of physical function (SMD, 0.28; 95% CI [0.02, 0.53]; =0.03 < 0.05) even after a period of time after treatment.
MT was an effective intervention, which may have immediate effect on cancer pain and may improve physical function and global well-being. In the view of follow-up effects, MT had good effects for the reduction of pain and the recovery of physical function. However, because of limitations, the seemingly promising results should be interpreted with caution.
本荟萃分析旨在评估手法治疗（MT）对癌痛的影响，以便为其应用提供临床依据。
检索了五个英文和中文数据库至2020年2月29日，查找关于MT治疗癌痛的随机对照试验（RCT）。纳入以英文或中文发表的文章。两位作者独立审阅所有文章并提取数据，上述过程中的任何分歧都与其他审阅者讨论，直至作者达成共识。使用Review Manager 5.3计算效应量和95%置信区间。本综述已在PROSPERO注册，注册号为CRD42020172053。
癌痛强度是我们的主要结局指标，与标准护理相比，MT能显著缓解癌症患者的疼痛（标准化均数差[SMD]，0.63；95%置信区间[0.18, 1.08]；P = 0.006 < 0.01）；MT加主动活动的效果与单纯主动活动有显著差异（SMD，0.79；95%置信区间[0.28, 1.30]；P = 0.002 < 0.01）；MT与单纯主动活动的疗效无统计学差异（SMD，-0.24；95%置信区间[-1.09, 0.62]；P = 0.53 > 0.05）。在其他相关症状方面，上述证据不支持MT对疲劳（SMD，0.77；95%置信区间[-0.09, 1.63]；P = 0.08 > 0.05）、恶心（SMD，0.24；95%置信区间[-0.00, 0.48]；P = 0.05）、焦虑（SMD，0.76；95%置信区间[-0.32, 1.84]；P = 0.17 > 0.05）和抑郁（SMD，0.67；95%置信区间[-0.28, 1.62]；P = 0.17 > 0.05）有良好效果；然而，MT干预可改善身体功能（n = 271；SMD，0.35；95%置信区间[-0.04, 0.74]；P = 0.04 < 0.05）和总体幸福感（SMD，0.50；95%置信区间[0.02, 0.98]；P = 0.04 < 0.05）。此外，即使在治疗后的一段时间，MT对疼痛缓解（SMD，0.52；95%置信区间[0.03, 1.01]；P = 0.04 < 0.05）和身体功能改善（SMD，0.28；95%置信区间[0.02, 0.53]；P = 0.03 < 0.05）仍有显著效果。
MT是一种有效的干预措施，可能对癌痛有即时效果，并可能改善身体功能和总体幸福感。从随访效果来看，MT对减轻疼痛和身体功能恢复有良好效果。然而，由于存在局限性，这些看似有前景的结果应谨慎解读。
