Zhang Jiewen, Guo Zining, Wang Liying, Lin Run, Xiao Bijuan, Liu Wenhao, Xu Nenggui, Cui Shaoyang
Department of Rehabilitation, Shenzhen Hospital (Fu Tian) of Guangzhou University of Chinese Medicine, Shenzhen, China, Guangzhou, People's Republic of China.
South China Research Center for Acupuncture and Moxibustion, Guangzhou University of Chinese Medicine, Guangzhou, People's Republic of China.
J Pain Res. 2025 Sep 7;18:4651-4671. doi: 10.2147/JPR.S549214. eCollection 2025.
Acupuncture shows potential as a treatment for sciatica, but the credibility and consistency of supporting evidence remain unclear, warranting critical and comprehensive evaluation. This overview is aims to assess the reliability, adequacy, and limitations of current evidence on acupuncture for sciatica using a multidimensional approach and further examine its efficacy through a secondary meta-analysis.
Systematic reviews and meta-analyses (SRs/MAs) meeting PICOS criteria were identified from eight databases by two independent reviewers. Evidence reliability was assessed using AMSTAR-2, ROBIS, PRISMA-A, and the GROOVE tool across four domains: methodological quality, bias risk, reporting accuracy, and study overlap. Duplicate randomized controlled trials (RCTs) were excluded based on the Corrected Covered Area (CCA) analysis, and a secondary meta-analysis was conducted. Sensitivity analyses and funnel plots assessed robustness and publication bias.
Seven SRs/MAs were included. AMSTAR-2 revealed significant methodological flaws, particularly due to a lack of protocol pre-registration. ROBIS assessments showed a high risk of bias, with most studies relying on single-database searches and lacking comprehensive strategies. PRISMA-A indicated generally low reporting quality, especially regarding descriptions of acupuncture sensation. The GROOVE tool yielded a CCA of 7.23%, reflecting moderate study overlap. The secondary meta-analysis showed that acupuncture significantly improved treatment effectiveness (RR = 1.23; 95% CI: 1.20-1.26; = 0.008), reduced pain intensity, and increased pain threshold. Sensitivity analyses confirmed the robustness of results, while funnel plots suggested some publication bias. Acupuncture was generally considered safe across studies.
Although current evidence is limited by methodological flaws, publication bias, and poor reporting quality, acupuncture shows promising clinical potential for sciatica. High-quality, rigorously designed studies are needed to confirm its efficacy.
针灸显示出作为坐骨神经痛治疗方法的潜力，但支持证据的可信度和一致性仍不明确，需要进行批判性和全面的评估。本综述旨在采用多维度方法评估当前针灸治疗坐骨神经痛证据的可靠性、充分性和局限性，并通过二次荟萃分析进一步检验其疗效。
由两名独立评审员从八个数据库中识别出符合PICOS标准的系统评价和荟萃分析（SRs/MAs）。使用AMSTAR-2、ROBIS、PRISMA-A和GROOVE工具从方法学质量、偏倚风险、报告准确性和研究重叠四个领域评估证据可靠性。基于校正覆盖面积（CCA）分析排除重复的随机对照试验（RCTs），并进行二次荟萃分析。敏感性分析和漏斗图评估结果的稳健性和发表偏倚。
纳入了七项SRs/MAs。AMSTAR-2显示出显著的方法学缺陷，特别是由于缺乏方案预注册。ROBIS评估显示偏倚风险高，大多数研究依赖单一数据库搜索且缺乏全面策略。PRISMA-A表明报告质量普遍较低，尤其是关于针刺感觉的描述。GROOVE工具得出的CCA为7.23%，反映出研究重叠程度中等。二次荟萃分析表明，针灸显著提高了治疗效果（RR = 1.23；95%CI：1.20 - 1.26；P = 0.008），降低了疼痛强度，提高了痛阈。敏感性分析证实了结果的稳健性，而漏斗图表明存在一些发表偏倚。在各项研究中，针灸总体上被认为是安全的。
尽管当前证据受到方法学缺陷、发表偏倚和报告质量差的限制，但针灸对坐骨神经痛显示出有前景的临床潜力。需要高质量、设计严谨的研究来证实其疗效。
