Giovanardi Carlo Maria, Gonzalez-Lorenzo Marien, Poini Alessandra, Marchi Eleonora, Culcasi Antonio, Ursini Francesco, Faldini Cesare, Di Martino Alberto, Mazzanti Umberto, Campesato Emanuela, Matrà Annunzio, Cevoli Sabina, Benedetti Maria Grazia
Italian Federation of Acupuncture Societies, Bologna, Italy.
Laboratorio di Metodologia delle Revisioni Sistematiche e Produzione di Linee Guida, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy.
Integr Med Res. 2023 Sep;12(3):100972. doi: 10.1016/j.imr.2023.100972. Epub 2023 Jul 7.
Conventional therapies (CTs), pharmacological (PH) and non-pharmacological (NPH), do not always achieve benefits in the treatment of chronic low back pain (CLBP). We assessed efficacy and safety of acupuncture for CLBP as alternative or addition to CT.
We included randomised controlled trials (RCTs) comparing acupuncture alone or in combination with CT to CT. We searched Medline, Cochrane Library, Embase up to May 2022. We assessed risk of bias with the original Cochrane tool and GRADE certainty of evidence. Results were pooled through meta-analysis.
Ten RCTs (2122 participants) were included comparing acupuncture versus CT and 4 RCTs (374 participants) were comparing acupuncture plus CT to CT alone. In terms of comparing acupuncture with NPH or PH, no differences were found for pain and disability. Comparing acupuncture with PH and NPH combined, pain and disability were reduced (SMD=-0.50, 95% CI -0.62 to -0.37; SMD=-0.71, 95% CI -1.17 to -0.24). Comparing acupuncture plus NPH with NPH alone, pain and disability were reduced (SMD=-0.70, 95% CI -0.94 to -0.46; SMD=-0.95, 95% CI -1.36 to -0.54). Comparing acupuncture plus PH with PH alone, pain and disability were reduced (MD=-0.21, 95% CI -433.28 to -10.42; MD=-3.1, 95% CI -4.87 to -1.83). Comparing acupuncture plus combined treatment versus combined treatment alone, no differences were found in pain, while disability was reduced (MD=-3.40 95% CI -5.17 to -1.63). No studies assessed adverse event. Certainty of evidence ranged from moderate to very low.
We are uncertain whether acupuncture is more effective and safer than CT. In the comparisons without estimates' imprecision, acupuncture showed promising results. Acupuncture could be an option based on patients' preferences.
传统疗法（CTs），包括药物治疗（PH）和非药物治疗（NPH），在慢性下腰痛（CLBP）的治疗中并不总是能取得良好效果。我们评估了针刺疗法作为CT的替代或补充治疗CLBP的疗效和安全性。
我们纳入了比较单独针刺疗法或针刺疗法与CT联合使用和单纯CT治疗的随机对照试验（RCTs）。检索了截至2022年5月的Medline、Cochrane图书馆、Embase数据库。我们使用原始的Cochrane工具评估偏倚风险，并采用GRADE证据确定性评估。通过荟萃分析汇总结果。
纳入了10项RCTs（2122名参与者）比较针刺疗法与CT，4项RCTs（374名参与者）比较针刺疗法加CT与单纯CT。在比较针刺疗法与NPH或PH时，疼痛和残疾方面未发现差异。比较针刺疗法与PH和NPH联合治疗时，疼痛和残疾程度降低（标准化均数差=-0.50，95%可信区间-0.62至-0.37；标准化均数差=-0.71，95%可信区间-1.17至-0.24）。比较针刺疗法加NPH与单纯NPH时，疼痛和残疾程度降低（标准化均数差=-0.70，95%可信区间-0.94至-0.46；标准化均数差=-0.95，95%可信区间-1.36至-0.54）。比较针刺疗法加PH与单纯PH时，疼痛和残疾程度降低（平均差=-0.21，95%可信区间-433.28至-10.42；平均差=-3.1，95%可信区间-4.87至-1.83）。比较针刺疗法加联合治疗与单纯联合治疗时，疼痛方面未发现差异，而残疾程度降低（平均差=-3.40，95%可信区间-5.17至-1.63）。没有研究评估不良事件。证据确定性从中度到极低。
我们不确定针刺疗法是否比CT更有效和更安全。在没有估计不精确性的比较中，针刺疗法显示出有希望的结果。针刺疗法可根据患者的偏好作为一种选择。
