Chang Cheng, Sun Di, Zhang Zhilei, He Lei, Wang Qiang, Shen Yingchao, Zhu Hengzhou, Fan Donghua
Jiangsu Provincial Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China.
Department of Oncology, Changshu Hospital Affiliated to Nanjing University of Chinese Medicine, Changshu, China.
Front Pharmacol. 2024 Nov 19;15:1474982. doi: 10.3389/fphar.2024.1474982. eCollection 2024.
Tumor metastasis to bone is a critical and painful stage in cancer progression, significantly affecting patients' quality of life. Traditional treatments for bone neuropathic pain often exhibit limited efficacy and undesirable side effects. Sophora flavescens, an herb used in traditional Chinese medicine, has shown potential analgesic and anti-cancer properties, but the existing evidence is fragmented and inconsistent.
In accordance with PRISMA guidelines, an extensive literature search was performed across PubMed, Web of Science, and Cochrane Library databases, Embase, Medline, CNKI, VIP, Wanfang Database, CBMdisc to identify relevant studies. The inclusion criteria focused on randomized controlled trials (RCTs) investigating the use of Sophora flavescens for bone neuropathic pain. Data related to pain intensity, mechanisms of action, and safety were extracted and analyzed using meta-analysis techniques. The quality of the studies was assessed using the Cochrane Risk of Bias tool.
Seven studies met the inclusion criteria, involving a total of 463 patients with bone neuropathic pain induced by tumor metastasis. The meta-analysis revealed a significant overall reduction in pain intensity for patients treated with Sophora flavescens compared to control groups (mean difference = 26.45, 95% CI: 13.89, 39.00, P < 0.0001). Specifically, the Karnofsky Performance Status (KPS) increase rate showed a combined risk ratio of 1.62 (95% CI: 1.32, 1.99, P < 0.0001), indicating improved performance status with treatment. Pain scores also significantly decreased (mean difference = 26.45, 95% CI: 13.89, 39.00, P < 0.0001) despite substantial heterogeneity among studies (I = 91%). Funnel plots suggested minimal publication bias, and sensitivity analyses confirmed the stability of these results. The included studies reported minimal adverse effects, indicating good tolerability of Sophora flavescens.
Sophora flavescens demonstrates significant potential as an adjunctive therapy for managing bone neuropathic pain induced by tumor metastasis, offering substantial pain relief with minimal adverse effects.
肿瘤骨转移是癌症进展中的一个关键且痛苦的阶段，严重影响患者的生活质量。传统的骨神经性疼痛治疗方法往往疗效有限且副作用不理想。苦参是一种用于传统中药的草药，已显示出潜在的镇痛和抗癌特性，但现有证据零散且不一致。
按照PRISMA指南，在PubMed、科学网、Cochrane图书馆数据库、Embase、Medline、中国知网、维普、万方数据库、中国生物医学文献数据库中进行广泛的文献检索，以识别相关研究。纳入标准侧重于调查苦参用于骨神经性疼痛的随机对照试验（RCT）。使用荟萃分析技术提取并分析与疼痛强度、作用机制和安全性相关的数据。使用Cochrane偏倚风险工具评估研究质量。
七项研究符合纳入标准，共涉及463例由肿瘤转移引起的骨神经性疼痛患者。荟萃分析显示，与对照组相比，苦参治疗的患者疼痛强度总体显著降低（平均差值 = 26.45，95%置信区间：13.89，39.00，P < 0.0001）。具体而言，卡氏功能状态量表（KPS）提高率的合并风险比为1.62（95%置信区间：1.32，1.99，P < 0.0001），表明治疗后功能状态有所改善。尽管研究之间存在很大异质性（I = 91%），疼痛评分也显著降低（平均差值 = 26.45，95%置信区间：13.89，39.00，P < 0.0001）。漏斗图表明发表偏倚最小，敏感性分析证实了这些结果的稳定性。纳入的研究报告的不良反应极少，表明苦参具有良好的耐受性。
苦参作为治疗肿瘤转移引起的骨神经性疼痛的辅助疗法具有显著潜力，能在产生最小副作用的情况下大幅缓解疼痛。
