无针耳穴针刺与医学针刺对慢性非特异性下腰痛老年患者疼痛及健康相关生活质量的影响：一项前瞻性临床试验

NADA Ear Acupuncture and Medical Acupuncture for Pain- and Health-Related Quality of Life among Older Patients with Chronic Nonspecific Low Back Pain: A Prospective Clinical Trial.

作者信息

Rybicka Monika, Gąsowski Jerzy, Przeklasa-Muszyńska Anna, Dobrogowski Jan, Wierzbicka Jagoda, Hui Ka-Kit, Ptasnik Sara, Kocot-Kępska Magdalena

机构信息

Department of Internal Medicine and Gerontology, Faculty of Medicine, Jagiellonian University Medical College, 31-008 Krakow, Poland.

Department of Medicine, Center for East-West Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.

出版信息

Brain Sci. 2024 Feb 23;14(3):205. doi: 10.3390/brainsci14030205.

BACKGROUND: The purpose of this study was to investigate the efficacy and safety of the NADA (National Acupuncture Detoxification Association)-standardized ear acupuncture protocol in comparison to medical acupuncture (MA) in the treatment of chronic nonspecific low back pain (LBP) in older adults. METHODS: This was a prospective, clinical, single center, open label, comparative study. A total of 60 older patients with chronic nonspecific LBP were enrolled in the study. The patients were divided into two groups. The MA group received treatment with medical acupuncture (MA), while the NADA group received NADA ear acupuncture once a day for 20 min, for a total of 10 sessions. The co-primary outcome measures were the reduction in pain intensity evaluated by the Numeric Rating Scale (NRS) compared to baseline and improvement in patients' quality of life (QOL) assessed in the SF-36 questionnaire before and after treatment; this was compared between the two groups. RESULTS: After two weeks of treatment, a significant reduction compared to baseline was observed in the NRS scores following treatment with medical acupuncture as well as after the utilization of NADA ear acupuncture protocol: NRS score for average pain experienced by the patients over the previous week (NRSa) MA: = 0.002; NADA: < 0.001, maximum NRS score in the past week (NRSm) MA: < 0.001; NADA: < 0.001, and NRS score at the time of examination (NRSe) MA: = 0.001; NADA: < 0.001. Reduction of the NRSa score compared to baseline was significantly greater in the NADA group ( = 0.034). Significant improvements in the QOL of patients according to the SF-36 questionnaire compared to baseline were observed in the MA group in the following domains: PF ( = 0.003), RP ( = 0.002), SF ( = 0.041), RE ( = 0.005), MH = 0.043), HT ( = 0.013), PCS ( = 0.004), and MCS ( = 0.025); and in the NADA group, in the following domains: PF ( = 0.004), RP ( = 0.048), BP ( = 0.001), VT ( = 0.035), RE ( = 0.006), MH ( < 0.001), HT ( = 0.003), PCS ( < 0.001), and MCS ( < 0.001). There were minor complications observed in 35% of patients (total of 20 participants); 31% (9 patients) in the MA group and 39% (11 patients) in the NADA group. These were minor and quickly resolved, including insertion point pain, minor bleeding after needle removal, and one instance of fainting. No patients in either group reported worsening of LBP. These complications occurred in 4.14% of MA sessions (12 times/290 sessions) and in 6.07% of NADA acupuncture sessions (16 times/280 sessions). CONCLUSION: The outcomes of this study suggest that both MA and NADA ear acupuncture could be a valuable and personalized component of a comprehensive approach to managing chronic nonspecific LBP in older patients. Incorporation of MA and NADA ear acupuncture into the clinical management of chronic nonspecific LBP in elderly patients has the potential to reduce pain intensity and improve the overall quality of life of affected individuals. However, further studies are needed to confirm our findings.

背景：本研究旨在比较国家针灸戒毒协会（NADA）标准化耳针方案与医学针灸（MA）治疗老年人慢性非特异性下腰痛（LBP）的疗效和安全性。方法：这是一项前瞻性、临床、单中心、开放标签的对照研究。共有60例患有慢性非特异性下腰痛的老年患者纳入研究。患者被分为两组。医学针灸组接受医学针灸（MA）治疗，而NADA组每天接受一次NADA耳针治疗，每次20分钟，共治疗10次。共同主要结局指标为与基线相比，采用数字评定量表（NRS）评估的疼痛强度降低情况，以及治疗前后采用SF - 36问卷评估的患者生活质量（QOL）改善情况；并在两组之间进行比较。结果：治疗两周后，医学针灸治疗以及采用NADA耳针方案治疗后，与基线相比NRS评分均显著降低：患者前一周平均疼痛的NRS评分（NRSa），医学针灸组： = 0.002；NADA组： < 0.001，过去一周的最大NRS评分（NRSm），医学针灸组： < 0.001；NADA组： < 0.001，以及检查时的NRS评分（NRSe），医学针灸组： = 0.001；NADA组： < 0.001。与基线相比，NADA组NRSa评分的降低幅度显著更大（ = 0.034）。根据SF - 36问卷，与基线相比，医学针灸组患者在以下领域的生活质量有显著改善：生理功能（PF， = 0.003）、生理职能（RP， = 0.002）、躯体疼痛（SF， = 0.041）、角色情感（RE， = 0.005）、精神健康（MH = 0.俯下身子去，用自己的语言，用自己的感受去贴近他们的生活。043）、健康变化（HT， = 0.013）、生理健康总分（PCS， = 0.004）和精神健康总分（MCS， = 0.025）；NADA组在以下领域：PF（ = 0.004）、RP（ = 0.048）、血压（BP， = 0.001）、活力（VT， = 0.035）、RE（ = 0.006）、MH（ < 0.001）、HT（ = 0.003）、PCS（ < 0.001）和MCS（ < 0.001）。35%的患者（共20名参与者）出现轻微并发症；医学针灸组31%（9例患者），NADA组39%（11例患者）。这些并发症轻微且很快缓解，包括进针点疼痛、拔针后少量出血以及1例昏厥。两组均无患者报告下腰痛加重。这些并发症在医学针灸治疗中发生率为4.14%（290次治疗中出现12次），在NADA耳针治疗中发生率为6.07%（280次治疗中出现16次）。结论：本研究结果表明，医学针灸和NADA耳针均可成为老年患者慢性非特异性下腰痛综合管理中有价值且个性化的组成部分。将医学针灸和NADA耳针纳入老年患者慢性非特异性下腰痛的临床管理，有可能降低疼痛强度并改善受影响个体的整体生活质量。然而，需要进一步研究来证实我们的发现。