Acupuncture and dry-needling for low back pain: An updated systematic review within the framework of the Cochrane Collaboration
Acupuncture and dry-needling for low back pain: An updated systematic review within the framework of the Cochrane Collaboration
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DOI：
10.1097/01.brs.0000158941.21571.01
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发表时间：
2005-04-15
期刊：
影响因子：
3
通讯作者：
Berman, B
中科院分区：
文献类型：
--
作者：
Furlan, AD;van Tulder, M;Berman, B
目标.目的观察针刺与干针治疗非特异性腰痛的临床疗效。腰痛通常是一种自限性疾病，随着时间的推移往往会自发改善。然而，对于许多人来说，背痛成为一种慢性或复发性的问题，为此采用了各种各样的治疗干预措施。搜索策略。我们在CENTRAL、MEDLINE和EMBASE中更新了1996年至2003年2月的检索结果。我们还检索了中国科克伦中心临床试验数据库和日本数据库，截止到2003年2月。针灸（包括针刺）或干针治疗成人非特异性急性/亚急性或慢性腰痛的随机对照试验。数据收集和分析。两名评审员独立评估方法学质量（使用科克伦回顾组推荐的标准）和提取数据。当报告的数据不允许统计汇总时，使用荟萃分析方法或证据水平将试验合并。纳入了35项随机临床试验：20项以英语发表，7项以日语发表，5项以中文发表，挪威语、波兰语和德语各1项。只有3项针灸治疗急性腰痛的试验。这些研究由于样本量小和方法学质量低而不能证明结论是正确的。对于慢性腰痛，有证据表明，与不治疗或假治疗相比，针灸可以缓解疼痛和改善功能。这些影响仅在会议结束后立即观察到，并在短期随访中观察到。也有证据表明，针灸，加上其他传统疗法，缓解疼痛，改善功能比传统疗法更好。然而，影响很小。干针似乎是一个有用的辅助治疗慢性腰痛的其他疗法。关于最有效的针灸技术没有明确的建议。这些数据不允许关于针灸治疗急性腰痛的有效性的确切结论。对于慢性腰痛，针灸在缓解疼痛和改善功能方面比治疗后立即和短期内不治疗或假治疗更有效。针灸并不比其他传统和“替代”疗法更有效。提示针刺和干针治疗慢性腰痛可能是其他治疗方法的有益补充。由于大多数研究的方法学质量较低，因此在这一领域显然需要更高质量的试验。
Objectives. To assess the effects of acupuncture and dry-needling for the treatment of nonspecific low back pain.Background. Low back pain is usually a self-limiting condition that tends to improve spontaneously over time. However, for many people, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed.Search strategy. We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003.Selection Criteria. Randomized controlled trials of acupuncture ( that involved needling) or dry-needling for adults with nonspecific acute/subacute or chronic low back pain.Data Collection and Analysis. Two reviewers independently assessed methodologic quality ( using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analysis methods or levels of evidence when the data reported did not allow statistical pooling.Results. Thirty-five randomized clinical trials were included: 20 were published in English, 7 in Japanese, 5 in Chinese, and 1 each in Norwegian, Polish, and German. There were only 3 trials of acupuncture for acute low back pain. These studies did not justify firm conclusions because of their small sample sizes and low methodologic quality. For chronic low back pain, there is evidence of pain relief and functional improvement for acupuncture compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and in short-term follow-up. There is also evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, the effects are onlysmall. Dry-needling appears to be a useful adjunct to other therapies for chronic low back pain. No clear recommendations could be made about the most effective acupuncture technique.Conclusions. The data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain. For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low back pain. Because most of the studies were of lower methodologic quality, there is a clear need for higher quality trials in this area.