NIH Consensus Conference. Acupuncture.
NIH Consensus Conference. Acupuncture.
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1998
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目的为临床医生、患者和公众提供一个负责任的评估，评估针灸治疗各种疾病的使用和有效性。参与者一个非联邦，非倡导者，12名成员组成的小组，代表针灸，疼痛，心理学，精神病学，物理医学和康复，药物滥用，家庭医生，内科，卫生政策，流行病学，统计学，生理学，生物物理学领域，以及公众代表。此外，来自这些领域的25名专家向专家组和1200名会议观众提交了数据。在为期两天半的时间里，介绍和讨论分为三个阶段：（1）在为期两天的公开会议上，在与共识问题有关的领域工作的调查人员介绍情况;（2）在公开会议的公开讨论期间，与会者提出问题和发言;及（3）事务委员会在第二天余下时间及第三天上午进行闭门商议。这次会议是由替代医学办公室和医学应用研究办公室，美国国立卫生研究院，贝塞斯达，马里兰州组织和支持。证据通过MEDLINE、Allied and Alternative Medicine、EMBASE和MANTIS检索了1970年1月至1997年10月期间的文献，并手动检索了9种未被美国国家医学图书馆索引的期刊。一个广泛的参考书目2302提供给小组和会议的观众。专家发言人编写了他们自己的会议发言摘要，并引用了相关文献。科学证据优先于临床经验。专家组回答预先确定的问题，根据公开论坛和科学文献中提出的科学证据得出结论。小组编写了一份声明草稿，全文宣读并分发给专家和听众征求意见。此后，专家组解决了相互矛盾的建议，并在会议结束时发布了一份修订后的声明。专家组在会议结束后几周内完成了修订。声明草案在会议上发布后立即在万维网上公布，并在会议后几周内根据小组的最后修订稿进行了更新。该声明可在http://consensus.nih.gov. Conclusions针灸作为一种治疗干预在美国被广泛应用。虽然已经有许多关于其潜在有用性的研究，但由于设计、样本量和其他因素，这些研究中的许多研究提供了模棱两可的结果。这个问题进一步复杂化的内在困难，在使用适当的控制，如安慰剂和假针灸组。然而，已经出现了有希望的结果，例如，显示针灸在成人术后和化疗恶心和呕吐以及术后牙痛中的疗效。还有其他情况，如成瘾，中风康复，头痛，月经痉挛，网球肘，纤维肌痛，肌筋膜疼痛，骨关节炎，腰痛，腕管综合征和哮喘，其中针灸可能是有用的辅助治疗或可接受的替代方案或被列入综合管理计划。进一步的研究可能会发现针灸干预有用的其他领域。
OBJECTIVE To provide clinicians, patients, and the general public with a responsible assessment of the use and effectiveness of acupuncture to treat a variety of conditions. PARTICIPANTS A nonfederal, nonadvocate, 12-member panel representing the fields of acupuncture, pain, psychology, psychiatry, physical medicine and rehabilitation, drug abuse, family practice, internal medicine, health policy, epidemiology, statistics, physiology, biophysics, and the representatives of the public. In addition, 25 experts from these same fields presented data to the panel and a conference audience of 1200. Presentations and discussions were divided into 3 phases over 2 1/2 days: (1) presentations by investigators working in areas relevant to the consensus questions during a 2-day public session; (2) questions and statements from conference attendees during open discussion periods that were part of the public session; and (3) closed deliberations by the panel during the remainder of the second day and morning of the third. The conference was organized and supported by the Office of Alternative Medicine and the Office of Medical Applications of Research, National Institutes of Health, Bethesda, Md. EVIDENCE The literature, produced from January 1970 to October 1997, was searched through MEDLINE, Allied and Alternative Medicine, EMBASE, and MANTIS, as well as through a hand search of 9 journals that were not indexed by the National Library of Medicine. An extensive bibliography of 2302 references was provided to the panel and the conference audience. Expert speakers prepared abstracts of their own conference presentations with relevant citations from the literature. Scientific evidence was given precedence over clinical anecdotal experience. CONSENSUS PROCESS The panel, answering predefined questions, developed their conclusions based on the scientific evidence presented in the open forum and scientific literature. The panel composed a draft statement, which was read in its entirety and circulated to the experts and the audience for comment. Thereafter, the panel resolved conflicting recommendations and released a revised statement at the end of the conference. The panel finalized the revisions within a few weeks after the conference. The draft statement was made available on the World Wide Web immediately following its release at the conference and was updated with the panel's final revisions within a few weeks of the conference. The statement is available at http://consensus.nih.gov. CONCLUSIONS Acupuncture as a therapeutic intervention is widely practiced in the United States. Although there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations, such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.