不同针灸疗法治疗颈痛的疗效比较。

BACKGROUND: Neck pain is a common musculoskeletal symptom that has negative effects on quality of life and work productivity. Acupuncture has been widely used for neck pain, and a number of randomized controlled trials (RCTs) and systematic reviews (SRs) have evaluated its effectiveness. However, previous studies have obtained inconsistent results regarding the effects of acupuncture for neck pain, and there is no SR for the comparative efficacy and safety of various types of acupuncture. Therefore, we herein conducted a SR and network meta-analysis to compare and rank different types of acupuncture with respect to their effectiveness in treating neck pain. METHODS: We searched 9 electronic databases for relevant RCTs published from their inception to July 1, 2021. Pairwise meta-analyses and network meta-analysis were performed with R software using the frequentist framework. Change of pain intensity was assessed as the primary outcome, and change of pain-related disability and efficacy rate were assessed as secondary outcomes. The Cochrane risk of bias tool and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) instrument were used to evaluate the quality of the included RCTs and the certainty of the evidence. RESULTS: A total of 65 RCTs involving 5266 participants and 9 interventions were included. Three network meta-analyses were constructed for the following: pain intensity (42 RCTs, 3158 participants), pain-related disability (21 RCTs, 1581 participants), and efficacy rate (40 RCTs, 3512 participants). The results indicated that fire acupuncture, electroacupuncture, and warm acupuncture were more effective than manual acupuncture in terms of pain intensity reduction and efficacy rate, and that electroacupuncture decreased pain-related disability more effectively than manual acupuncture. Fire acupuncture ranked first among the 9 interventions. The overall q of evidence was very low according to the GRADE assessment. The reported adverse events were not serious. CONCLUSION: Fire acupuncture, warm acupuncture, acupoint catgut embedding, and electroacupuncture ranked higher than other interventions (usual care, sham acupuncture, no treatment) in reducing the pain and disability index scores and the efficacy rate. However, the included trials were evaluated as being of low quality; thus, we recommend additional well-designed RCTs with larger sample sizes to confirm these findings. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42021235274.

背景：颈部疼痛是一种常见的肌肉骨骼症状，会对生活质量和工作生产力产生负面影响。针灸已广泛用于治疗颈部疼痛，许多随机对照试验（RCT）和系统评价（SR）已经评估了其疗效。然而，先前的研究对于针灸治疗颈部疼痛的效果得出了不一致的结果，并且没有关于各种类型的针灸的比较疗效和安全性的 SR。因此，我们进行了这项 SR 和网络荟萃分析，以比较和排名不同类型的针灸治疗颈部疼痛的疗效。

方法：我们从建库到 2021 年 7 月 1 日检索了 9 个电子数据库，以寻找相关的 RCT。使用 R 软件基于经典框架进行了成对的荟萃分析和网络荟萃分析。疼痛强度的变化被评估为主要结局，疼痛相关残疾和疗效率的变化被评估为次要结局。使用 Cochrane 偏倚风险工具和推荐评估、制定与评估（GRADE）工具来评估纳入 RCT 的质量和证据的确定性。

结果：共纳入 65 项 RCT，涉及 5266 名参与者和 9 种干预措施。构建了 3 个网络荟萃分析，分别用于：疼痛强度（42 项 RCT，3158 名参与者）、疼痛相关残疾（21 项 RCT，1581 名参与者）和疗效率（40 项 RCT，3512 名参与者）。结果表明，火针、电针和温针在减轻疼痛强度和疗效方面比手动针灸更有效，电针在减轻疼痛相关残疾方面比手动针灸更有效。火针在 9 种干预措施中排名第一。根据 GRADE 评估，整体证据质量非常低。报告的不良事件并不严重。

结论：火针、温针、穴位埋线和电针在降低疼痛和残疾指数评分及疗效方面优于其他干预措施（常规护理、假针灸、不治疗）。然而，纳入的试验被评估为质量较低；因此，我们建议进行更多设计良好的 RCT，以扩大样本量，以证实这些发现。

系统评价注册：PROSPERO，CRD42021235274。