Cui Yang, Zhou Xinyu, Li Quan, Wang Delong, Zhu Jiamin, Zeng Xiangxin, Han Qichen, Yang Rui, Xu Siyu, Zhang Dongxu, Meng Xiangyue, Zhang Shuo, Sun Zhongren, Yin Hongna
Heilongjiang University of Chinese Medicine, Harbin, China.
The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China.
Front Neurosci. 2023 Jan 10;16:1056102. doi: 10.3389/fnins.2022.1056102. eCollection 2022.
Postherpetic neuralgia (PHN) is a common, complex, and refractory type of neuropathic pain. Several systematic reviews support the efficacy of acupuncture and related treatments for PHN. Nevertheless, the efficacy of various acupuncture-related treatments for PHN remains debatable.
We aimed to assess the efficacy and safety of acupuncture-related treatments for PHN, identify the most effective acupuncture-related treatments, and expound on the current inadequacies and prospects in the applications of acupuncture-related therapies.
We searched PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, Google Scholar, four Chinese databases (China National Knowledge Infrastructure, China Biomedical, Chongqing VIP, and Wan Fang databases), clinical research registration platform (World Health Organization International Clinical Trial Registration platform, China Clinical Trial Registration Center) for relevant studies. We also examined previous meta-analyses; gray literature; and reference lists of the selected studies. We then evaluated the risk of bias in the included studies and performed a Bayesian multiple network meta-analysis.
We included 29 randomized controlled trials comprising 1,973 patients, of which five studies showed a high risk of bias. The pairwise meta-analysis results revealed that the efficacy of all acupuncture-related treatments for pain relief related to PHN was significantly better than antiepileptics. The network meta-analysis results showed that pricking and cupping plus antiepileptics were the most effective treatment, followed by electroacupuncture (EA) plus antiepileptics for pain relief in patients with PHN. EA plus antiepileptics ranked the best regarding reduced Pittsburgh Sleep Quality Index (PSQI) and Self-Rating Depression Scale (SDS) scores in patients with PHN. No results were found regarding the total response rate or quality of life in this study. Acupuncture-related treatments showed a lower incidence of adverse events than that of antiepileptics.
Acupuncture-related therapies are potential treatment options for PHN and are safe. Pricking and cupping plus antiepileptics, are the most effective acupuncture-related techniques for pain relief, while EA plus antiepileptics is the best acupuncture-related technique for improving PHN-related insomnia and depression symptoms. However, owing to the limitations of this study, these conclusions should be cautiously interpreted, and future high-quality studies are needed.
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226422, identifier CRD42021226422.
带状疱疹后神经痛（PHN）是一种常见、复杂且难治的神经性疼痛类型。多项系统评价支持针灸及相关治疗对PHN的疗效。然而，各种针灸相关治疗对PHN的疗效仍存在争议。
我们旨在评估针灸相关治疗对PHN的疗效和安全性，确定最有效的针灸相关治疗方法，并阐述针灸相关疗法应用中的当前不足和前景。
我们检索了PubMed、Cochrane对照试验中心注册库、Embase、科学网、谷歌学术、四个中文数据库（中国知网、中国生物医学数据库、重庆维普数据库和万方数据库）、临床研究注册平台（世界卫生组织国际临床试验注册平台、中国临床试验注册中心）以查找相关研究。我们还查阅了以往的荟萃分析；灰色文献；以及所选研究的参考文献列表。然后我们评估纳入研究的偏倚风险，并进行贝叶斯多重网络荟萃分析。
我们纳入了29项随机对照试验，共1973例患者，其中5项研究显示存在高偏倚风险。成对荟萃分析结果显示，所有针灸相关治疗对缓解PHN相关疼痛的疗效均显著优于抗癫痫药物。网络荟萃分析结果显示，刺络拔罐加抗癫痫药物是最有效的治疗方法，其次是电针（EA）加抗癫痫药物用于缓解PHN患者的疼痛。EA加抗癫痫药物在降低PHN患者匹兹堡睡眠质量指数（PSQI）和自评抑郁量表（SDS）评分方面排名最佳。本研究未发现关于总有效率或生活质量的结果。针灸相关治疗的不良事件发生率低于抗癫痫药物。
针灸相关疗法是PHN的潜在治疗选择且安全。刺络拔罐加抗癫痫药物是缓解疼痛最有效的针灸相关技术，而EA加抗癫痫药物是改善PHN相关失眠和抑郁症状的最佳针灸相关技术。然而，由于本研究的局限性，这些结论应谨慎解读，未来需要高质量的研究。
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021226422，标识符CRD42021226422。
