Han Kyou-Hwan, Cho Ki Haeng, Han Caroline, Cui Shanqin, Lin Lily, Baek Ho-Yu, Kim Jaejong
SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA.
SBU Research Institute of Integrative Medicine, South Baylo University, 2727 West 6th Street, Los Angeles, CA 90057, USA.
Complement Ther Med. 2022 Dec;71:102872. doi: 10.1016/j.ctim.2022.102872. Epub 2022 Aug 17.
Sciatica results from primary or secondary damage to the sciatic nerve in the lumbar or gluteal region. The first option for sciatica is analgesics, but their therapeutic effect and safety in long-term use are questionable. On the other hand, acupuncture has recently been recognized as a complementary and alternative medicine (CAM) to conventional medicine, and studies on its effectiveness and safety have been actively conducted.
To systematically compare acupuncture with analgesics in terms of effect, safety, and durability in the treatment of sciatica METHODS: This review was performed in accordance with Cochrane Handbook for Systematic Reviews of Interventions Version 6.2. Four databases were searched for this review: Wangfang, the Korean Traditional Knowledge Portal (KTKP), PubMed, and EBSCOhost. The primary outcome measures in the review were total effective rate (TER), visual analog scale (VAS) score and pain threshold, and the secondary ones were adverse effects (AEs) and relapse rates. Risk ratio (RR) for TER and mean difference (MD) for VAS score and pain threshold were used as statistics for the meta-analysis of effectiveness, along with associated 95 % confidence intervals (CIs) and P-values. AEs and relapse rates were used for the safety and durability of the interventions. Version 2 of the Cochrane risk-of-bias assessment tool for randomized trials (RoB 2) was used for the methodological quality of randomized controlled trials (RCTs) included in the review.
The synthesized TER of 28 RCTs involving 2707 participants was significantly higher in the acupuncture group compared to the analgesic group (RR [95 % CI] = 1.20 [1.16, 1.24], P < 0.001). The synthesized VAS score of 7 RCTs involving 589 participants was significantly reduced in the acupuncture group compared to the analgesic group (MD [95 % CI] = - 1.78 [- 2.44, - 1.12], P < 0.001). In 5 RCTs involving 311 participants, the synthesized pain threshold was significantly elevated in the acupuncture group compared to the analgesic group (MD [95 % CI] = 0.93 [0.64, 1.22], P < 0.001). Additionally, adverse effects (AEs) and relapse rates of RCTs in the review were lower in the acupuncture group compared to the analgesic group.
In this systematic review, acupuncture treatment was significantly effective and safe compared to analgesics in sciatica. In the future, studies with a rigorous study design are required to increase the validity of the effectiveness and safety of acupuncture treatment for sciatica.
坐骨神经痛是由腰椎或臀部区域的坐骨神经原发性或继发性损伤引起的。坐骨神经痛的首选治疗方法是使用镇痛药，但其长期治疗效果和安全性存在疑问。另一方面，针灸最近已被公认为是传统医学的补充和替代医学（CAM），并且对其有效性和安全性的研究也在积极开展。
系统比较针灸与镇痛药在治疗坐骨神经痛方面的疗效、安全性和持久性。
本综述按照《Cochrane系统评价干预措施手册》第6.2版进行。本综述检索了四个数据库：万方、韩国传统知识门户（KTKP）、PubMed和EBSCOhost。综述的主要结局指标是总有效率（TER）、视觉模拟量表（VAS）评分和疼痛阈值，次要指标是不良反应（AE）和复发率。TER的风险比（RR）以及VAS评分和疼痛阈值的平均差（MD）用作有效性Meta分析的统计量，并伴有相关的95%置信区间（CI）和P值。AE和复发率用于评估干预措施的安全性和持久性。本综述纳入的随机对照试验（RCT）的方法学质量使用Cochrane随机试验偏倚风险评估工具第2版（RoB 2）进行评估。
28项涉及2707名参与者的RCT的综合TER显示，针灸组显著高于镇痛药组（RR [95%CI]=1.20 [1.16, 1.24]，P<0.001）。7项涉及589名参与者的RCT的综合VAS评分显示，针灸组与镇痛药组相比显著降低（MD [95%CI]=-1.78 [-2.44, -1.12]，P<0.001）。在5项涉及311名参与者的RCT中，针灸组与镇痛药组相比，综合疼痛阈值显著升高（MD [95%CI]=0.93 [0.64, 1.22]，P<0.001）。此外，本综述中RCT的针灸组不良反应（AE）和复发率低于镇痛药组。
在本系统评价中，与镇痛药相比，针灸治疗坐骨神经痛显著有效且安全。未来，需要采用严格研究设计的研究来提高针灸治疗坐骨神经痛有效性和安全性的可信度。
