The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain.
The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain.
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DOI：
10.1097/j.pain.0000000000000747
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发表时间：
2017-05
期刊：
影响因子：
7.4
通讯作者：
Acupuncture Trialists' Collaboration
中科院分区：
文献类型：
--
作者：
MacPherson H;Vertosick EA;Foster NE;Lewith G;Linde K;Sherman KJ;Witt CM;Vickers AJ;Acupuncture Trialists' Collaboration
针灸治疗的效果在一个疗程后能持续多久还不确定。我们的目的是确定针灸后疼痛评分随时间的变化轨迹，使用来自针灸治疗慢性疼痛的高质量随机试验的大型个体患者数据集。可用的个体患者数据集包括29项试验和17,922名患者。慢性疼痛包括肌肉骨骼疼痛（腰背部、颈部和肩部）、膝关节骨关节炎和头痛/偏头痛。我们使用元分析技术来确定治疗后疼痛评分的轨迹。20项试验的长期随访数据，包括6376名患者。在比较针灸与无针灸对照（等候名单、常规护理等）的试验中，治疗结束后，效应值每3个月减少0.011 SD （95% CI: - 0.014至0.037,p = 0.4）。中心估计表明，相对于对照组，针灸治疗约90%的益处将持续12个月。在比较针灸与假手术的试验中，我们观察到每3个月效应大小减少0.025 SD (95% CI: 0.000至0.050,p = 0.050)，表明在12个月时减少了约50%。一个疗程的针灸治疗对慢性疼痛患者的效果在12个月内并没有明显下降。患者通常可以放心，治疗效果会持续下去。在考虑针灸效果的时间范围时，针灸的成本效益研究应该考虑我们的发现。进一步的研究应该衡量针灸的长期效果。
There is uncertainty regarding how long the effects of acupuncture treatment persist after a course of treatment. We aimed to determine the trajectory of pain scores over time following acupuncture, using a large individual patient dataset from high quality randomized trials of acupuncture for chronic pain. The available individual patient dataset included 29 trials and 17,922 patients. The chronic pain conditions included musculoskeletal pain (low back, neck and shoulder), osteoarthritis of the knee and headache/migraine. We used meta-analytic techniques to determine the trajectory of post-treatment pain scores. Data on longer-term follow-up were available for 20 trials, including 6376 patients. In trials comparing acupuncture to no acupuncture control (wait-list, usual care, etc), effect sizes diminished by a non-significant 0.011 SD per 3 months (95% CI: −0.014 to 0.037, p = 0.4) after treatment ended. The central estimate suggests that about 90% of the benefit of acupuncture relative to controls would be sustained at 12 months. For trials comparing acupuncture to sham, we observed a reduction in effect size of 0.025 SD per 3 months (95% CI: 0.000 to 0.050, p = 0.050), suggesting about a 50% diminution at 12 months. The effects of a course of acupuncture treatment for patients with chronic pain do not appear to decrease importantly over 12 months. Patients can generally be reassured that treatment effects persist. Studies of the cost-effectiveness of acupuncture should take our findings into account when considering the time horizon of acupuncture effects. Further research should measure longer term outcomes of acupuncture.