Acupuncture for chronic pain: individual patient data meta-analysis.
Acupuncture for chronic pain: individual patient data meta-analysis.
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DOI：
10.1001/archinternmed.2012.3654
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发表时间：
2012-10-22
影响因子：
--
通讯作者：
Linde, Klaus
中科院分区：
文献类型：
--
作者：
Vickers, Andrew J.;Cronin, Angel M.;Maschino, Alexandra C.;Lewith, George;MacPherson, Hugh;Foster, Nadine E.;Sherman, Karen J.;Witt, Claudia M.;Linde, Klaus
尽管针灸被广泛用于治疗慢性疼痛，但其价值仍存在相当大的争议。我们的目标是确定针灸对四种慢性疼痛情况的效果大小：背部和颈部疼痛，骨关节炎，慢性头痛和肩痛。我们进行了一项系统的综述，以确定针灸治疗慢性疼痛的随机试验，其中明确确定分配隐藏是足够的。使用31项合格试验中的29项数据进行了个体患者数据荟萃分析，总共分析了17,922名患者。在包括所有合格试验的初步分析中，针灸在每种疼痛情况下都优于假针灸和非针灸对照(均P<；0.001)。在排除了一组强烈支持针灸的外围试验后，不同疼痛条件下的效果大小相似。针刺组疼痛减轻，腰颈痛、骨关节炎、慢性头痛评分标准差分别为0.23(95%C.I.0.13，0.33)、0.16(95%C.I.0.07，0.25)和0.15(95%C.I.0.07，0.24)；与未针刺对照组比较，其效应大小分别为0.55(95%C.I.0.51，0.58)、0.57(95%C.I.0.50，0.64)和0.42(95%C.I.0.37，0.46)。这些结果对各种敏感性分析是稳健的，包括那些与发表偏见有关的分析。针灸对治疗慢性疼痛是有效的，因此是一个合理的转诊选择。真针灸和假针灸之间的显著差异表明，针灸不仅仅是一种安慰剂。然而，这些差异相对较小，这表明除了针刺的具体效果外，其他因素也是针灸疗效的重要贡献因素。
Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain. We conducted a systematic review to identify randomized trials of acupuncture for chronic pain where allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible trials, with a total of 17,922 patients analyzed. In the primary analysis including all eligible trials, acupuncture was superior to both sham and no acupuncture control for each pain condition (all p<0.001). After exclusion of an outlying set of trials that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores 0.23 (95% C.I. 0.13, 0.33), 0.16 (95% C.I. 0.07, 0.25) and 0.15 (95% C.I. 0.07, 0.24) standard deviations lower than sham controls for back and neck pain, osteoarthritis, and chronic headache respectively; the effect sizes in comparison to no acupuncture controls were 0.55 (95% C.I. 0.51, 0.58), 0.57 (95% C.I. 0.50, 0.64) and 0.42 (95% C.I. 0.37, 0.46). These results were robust to a variety of sensitivity analyses, including those related to publication bias. Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
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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.
通讯作者：
Deyo, Richard A.
影响因子：
2.1
作者：
CHRISTENSEN, BV;IUHL, IU;RASMUSSEN, HF
通讯作者：
RASMUSSEN, HF
影响因子：
2.3
作者：
BERRY, H;FERNANDES, L;HAMILTON, EBD
通讯作者：
HAMILTON, EBD
影响因子：
7.4
作者：
de Hoyos, JAG;Martín, MDA;Moreno, MJG
通讯作者：
Moreno, MJG
影响因子：
5.5
作者：
Berman, BM;Singh, BB;Hochberg, M
通讯作者：
Hochberg, M