Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.
Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups.
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DOI：
10.1136/bmj.a3115
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发表时间：
2009-01-27
期刊：
影响因子：
--
通讯作者：
Hróbjartsson A
中科院分区：
文献类型：
--
作者：
Madsen MV;Gøtzsche PC;Hróbjartsson A
目的研究针刺与安慰针刺的镇痛效应，并探讨安慰针刺的类型与针刺疗效的关系。设计：对三组随机临床试验进行系统回顾和荟萃分析。数据来源：科克伦图书馆、Medline、Embase、生物学文摘和PsycLIT。数据提取和分析每个试验的标准化平均差异被用来估计针灸和安慰剂针灸的效果。根据对生理效应可能性的评估，将不同类型的安慰剂针灸从1到5进行排名，并将该排名与针灸效应进行元回归。数据综合13项试验（3025例患者），涉及各种疼痛条件合格。8项试验充分隐藏了患者的分配。管理针灸和安慰剂针灸治疗的临床医生在任何试验中都没有设盲。排除了一项明显无关的试验（70例患者）。针灸和安慰剂针灸之间存在微小差异：标准化平均差异为-0.17（95%置信区间为-0.26至-0.08），相当于100 mm视觉模拟量表上的4 mm（2 mm至6 mm）。不存在统计学显著异质性（P=0.10，I2=36%）。安慰剂针灸和无针灸之间存在中度差异：标准化平均差异为-0.42（-0.60至-0.23）。然而，也发现了相当大的异质性（P<0.001，I2=66%），因为大型试验报告了安慰剂的小效应和大效应。安慰剂针灸类型与针灸效果之间未检测到相关性（P=0.60）。结论针刺镇痛作用小，临床意义不大，与偏倚不能明确区分。针刺穴位或任何部位是否能独立于治疗仪式的心理影响而减轻疼痛尚不清楚。
Objectives To study the analgesic effect of acupuncture and placebo acupuncture and to explore whether the type of the placebo acupuncture is associated with the estimated effect of acupuncture. Design Systematic review and meta-analysis of three armed randomised clinical trials. Data sources Cochrane Library, Medline, Embase, Biological Abstracts, and PsycLIT. Data extraction and analysis Standardised mean differences from each trial were used to estimate the effect of acupuncture and placebo acupuncture. The different types of placebo acupuncture were ranked from 1 to 5 according to assessment of the possibility of a physiological effect, and this ranking was meta-regressed with the effect of acupuncture. Data synthesis Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was adequately concealed in eight trials. The clinicians managing the acupuncture and placebo acupuncture treatments were not blinded in any of the trials. One clearly outlying trial (70 patients) was excluded. A small difference was found between acupuncture and placebo acupuncture: standardised mean difference −0.17 (95% confidence interval −0.26 to −0.08), corresponding to 4 mm (2 mm to 6 mm) on a 100 mm visual analogue scale. No statistically significant heterogeneity was present (P=0.10, I2=36%). A moderate difference was found between placebo acupuncture and no acupuncture: standardised mean difference −0.42 (−0.60 to −0.23). However, considerable heterogeneity (P<0.001, I2=66%) was also found, as large trials reported both small and large effects of placebo. No association was detected between the type of placebo acupuncture and the effect of acupuncture (P=0.60). Conclusions A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.
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