A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
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DOI：
10.1001/archinternmed.2009.65
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发表时间：
2009-05-11
影响因子：
--
通讯作者：
Deyo, Richard A.
中科院分区：
文献类型：
--
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.
针灸是一种流行的补充和替代治疗慢性背痛。最近的欧洲试验表明，真实的针灸和假针灸具有类似的短期益处。本试验探讨了针刺位置和皮肤穿透对慢性腰痛患者针刺效果的重要性。638名慢性机械性腰痛的成年人被随机分为：个体化针灸，标准化针灸，模拟针灸或常规护理。由经验丰富的针灸师在7周内提供10次治疗。主要结局为背部相关功能障碍（罗兰残疾评分，范围：0 - 23）和症状困扰（0 - 10量表）。在基线和8、26和52周后评估结局。在第8周，个体化、标准化和模拟针灸组的平均功能障碍评分分别改善了4.4、4.5和4.4分，而接受常规治疗的患者改善了2.1分（P<0.001）。接受真实的或模拟针灸的参与者比接受常规护理的参与者更有可能在功能障碍量表上经历有临床意义的改善（60% vs. 39%，P<0.0001）。治疗组症状改善1.6 ~ 1.9分，常规护理组改善0.7分（P<0.0001）。一年后，治疗组的参与者比接受常规护理组的参与者更有可能经历有临床意义的功能障碍改善（分别为59%至65%对50%，P=0.02），但症状没有改善（P>0.05）。虽然针灸被发现对慢性腰痛有效，但为每个患者量身定制针刺部位和皮肤穿透似乎对获得治疗益处并不重要。这些发现对针灸的作用机制提出了质疑。目前还不清楚针灸或我们模拟的针灸方法是否提供生理上重要的刺激或代表安慰剂或非特异性作用。
Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. 638 adults with chronic mechanical low back pain were randomized to: individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland Disability score, range: 0 to 23) and symptom bothersomeness (0 to 10 scale). Outcomes were assessed at baseline and after 8, 26 and 52 weeks. At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P<0.001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs. 39%, P<0.0001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P<0.0001). After one year, participants in the treatment groups were more likely than those receiving usual care group to experience clinically meaningful improvements in dysfunction (59% to 65% versus 50%, respectively, P=0.02) but not in symptoms (P>0.05). Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture, or our simulated method of acupuncture, provide physiologically important stimulation or represent placebo or non-specific effects.
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影响因子：
2.5
作者：
Cherkin DC;Sherman KJ;Hogeboom CJ;Erro JH;Barlow WE;Deyo RA;Avins AL
通讯作者：
Avins AL
DOI：
10.1089/acm.1997.3.119
发表时间：
1997-01-01
期刊：
Journal of alternative and complementary medicine (New York, N.Y.)
影响因子：
--
作者：
Diehl, D L;Kaplan, G;Hurwitz, E L
通讯作者：
Hurwitz, E L
影响因子：
158.5
作者：
COBB, LA;THOMAS, GI;BRUCE, RA
通讯作者：
BRUCE, RA
影响因子：
3
作者：
PATRICK, DL;DEYO, RA;KELLER, RB
通讯作者：
KELLER, RB
影响因子：
3.3
作者：
Langevin, HM;Churchill, DL;Krag, MH
通讯作者：
Krag, MH