Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.
Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.
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DOI：
10.1016/j.jpain.2017.11.005
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发表时间：
2018-05
期刊：
影响因子：
--
通讯作者：
Acupuncture Trialists' Collaboration
中科院分区：
文献类型：
--
作者：
Vickers AJ;Vertosick EA;Lewith G;MacPherson H;Foster NE;Sherman KJ;Irnich D;Witt CM;Linde K;Acupuncture Trialists' Collaboration
尽管针灸在临床实践中广泛使用，但对于慢性疼痛的治疗仍然存在争议。我们的目标是更新个体患者数据荟萃分析，以确定针灸治疗四种慢性疼痛的效果大小。我们检索了 MEDLINE 和 Cochrane 对照试验中央注册中心截至 2015 年 12 月 31 日发表的随机试验。我们纳入了针灸与假针灸或无针灸对照治疗非特异性肌肉骨骼疼痛、骨关节炎、慢性头痛或肩痛的随机试验。仅当分配隐藏被明确确定为充分时才纳入试验。原始数据来自研究作者，并进入个体患者数据荟萃分析。主要结果指标是疼痛和功能。另外确定了 13 项试验，从 39 项试验中收到了总共 20,827 名患者的数据。对于每种疼痛情况，针刺均优于假手术和无针刺控制（均 p<0.001），与无针刺控制相比，组间差异接近 0.5 个标准差 (SD)，与假手术相比，组间差异接近 0.2 标准差 (SD)。我们还发现明确的证据表明，针灸的效果会随着时间的推移而持续存在，一年后的治疗效果仅小幅下降，约 15%。在二次分析中，我们发现试验结果与针灸治疗的特征之间没有明显的关联，但针灸的效应大小与对照组的类型相关，使用穿刺针进行假手术的假对照试验以及在对照组中进行高强度干预的试验的效应较小。我们的结论是，针灸对于治疗慢性疼痛是有效的，并且治疗效果会随着时间的推移而持续。虽然除了在正确的穴位位置进行针刺的具体效果外，其他因素也是治疗效果的重要因素，但针灸后疼痛的减轻不能仅用安慰剂效应来解释。不同试验中针灸效果大小的差异主要是由对照组接受的治疗差异造成的，而不是针灸治疗特征的差异造成的。
Despite wide use in clinical practice, acupuncture remains a controversial treatment for chronic pain. Our objective was to update an individual patient data meta-analysis to determine the effect size of acupuncture for four chronic pain conditions. We searched MEDLINE and the Cochrane Central Registry of Controlled Trials randomized trials published up until December 31, 2015. We included randomized trials of acupuncture needling versus either sham acupuncture or no acupuncture control for non-specific musculoskeletal pain, osteoarthritis, chronic headache, or shoulder pain. Trials were only included if allocation concealment was unambiguously determined to be adequate. Raw data were obtained from study authors and entered into an individual patient data meta-analysis. The main outcome measures were pain and function. An additional 13 trials were identified, with data received for a total of 20,827 patients from 39 trials. Acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001) with differences between groups close to 0.5 standard deviations (SD) for comparison with no acupuncture control and close to 0.2 SDs in comparison with sham. We also found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at one year. In secondary analyses, we found no obvious association between trial outcome and characteristics of acupuncture treatment, but effect sizes of acupuncture were associated with the type of control group, with smaller effects sizes for sham controlled trials that used a penetrating needle for sham, and for trials that had high intensity of intervention in the control arm. We conclude that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. While factors in addition to the specific effects of needling at correct acupuncture point locations are important contributors to the treatment effect, decreases in pain following acupuncture cannot be explained solely in terms of placebo effects. Variations in the effect size of acupuncture in different trials are driven predominately by differences in treatments received by the control group rather than by differences in the characteristics of acupuncture treatment.
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影响因子：
--
作者：
Cherkin, Daniel C.;Sherman, Karen J.;Avins, Andrew L.;Erro, Janet H.;Ichikawa, Laura;Barlow, William E.;Delaney, Kristin;Hawkes, Rene;Hamilton, Luisa;Pressman, Alice;Khalsa, Partap S.;Deyo, Richard A.
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Deyo, Richard A.
影响因子：
3.3
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影响因子：
7.4
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3
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通讯作者：
Song, Mi-Yeon
影响因子：
3.3
作者：
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通讯作者：
Benedetto, Chiara