Acupuncture Trialists' Collaboration: meta-analysis of chronic pain trials

描述（由申请人提供）：针灸通常被认为是治疗慢性疼痛的方法，但其价值仍然存在争议。针灸临床试验合作组织成立于2006年，旨在为针灸治疗慢性疼痛的效果提供最佳证据。该合作从针灸治疗慢性疼痛的高质量随机试验中获得个体患者水平的数据，并对数据进行标准化，以便将其合并为单一数据集，然后进行分析，以解决针灸疗效和针灸研究设计方面的问题。NCCAM于2008年授予R21合作基金以支持其工作。针灸试验专家合作组织现在由31名国际医师、临床试验专家、生物统计学家、执业针灸师和其他专家组成，其中包括许多在针灸研究中最广为人知的名字。它在从其职权范围内的疼痛状况的试验者那里获得原始数据方面非常成功：骨关节炎，非特异性背部和颈部疼痛，慢性头痛和肩部疼痛。在符合纳入合作数据集的严格资格标准的31项试验中，从29项试验中获得了可用的个体患者数据。所有29项试验的数据都经过检查、重新标记并添加到合作数据库中，该数据库现在包括近1.8万名随机患者。对这些数据的初步分析已经完成。特别是，我们发现强有力的证据表明，对于包括的每种疼痛情况，针灸都优于无针灸控制和假针灸。我们还发现证据表明，针灸的效应大小取决于比较物，例如，与真正的针灸和非穿透性的假装置相比，真正的针灸和假技术之间的差异较小。因此，针灸试验者的合作有一个证明的跟踪记录，带来高影响的针灸研究成果。在此，我们建议使用额外的5年数据来更新我们的试验数据库及其分析。对合作的持续资助也将使我们能够将我们的分析扩展到针灸与药物治疗的比较，并解决与针灸有关的四个额外问题：针灸疗效的预测因素；针刺效果的时间过程；是否存在针灸“应答者”，在针灸治疗后有特殊的改善；不同从业者的结果是否不同。

DESCRIPTION (provided by applicant): Acupuncture is often considered for the treatment of chronic pain, but its value remains controversial. The Acupuncture Trialists' Collaboration was established in 2006 to provide best evidence on the effects of acupuncture on chronic pain. The collaboration obtains individual patient level data from high quality randomized trials of acupuncture for chronic pain, standardizes the data in order to combine it in a single data set, and then conducts analyses t to address questions concerning both acupuncture effectiveness and acupuncture study design. NCCAM awarded the collaboration R21 funding in support of its work in 2008. The Acupuncture Trialists' Collaboration now consists of an international group of 31 physicians, clinical trialists, biostatisticians, practicing acupuncturists and other specialists including many of the most widely recognized names in acupuncture research. It has been extremely successful in obtaining raw data from trialists in the pain conditions under its remit: osteoarthritis, non- specific back and neck pain, chronic headache, and shoulder pain. Of the 31 trials that met the stringent eligibility criteria for inclusion in the collaboration data set, usable individual patient data have been obtained from 29 trials. Data from all 29 trials have been checked, relabeled and added to the collaboration database, which now includes nearly 18,000 randomized patients. The initial analyses of these data are complete. In particular, we found strong evidence that acupuncture is superior both to no acupuncture control and to sham acupuncture for each of the pain conditions included. We also found evidence that the effect size of acupuncture depended on the comparator, for example, there were smaller differences between true acupuncture and sham techniques involving needle penetration, than between true acupuncture and a non-penetrating sham device. The Acupuncture Trialists' Collaboration therefore has a proven track record of bringing high-impact acupuncture research to fruition. Here we propose to update our database of trials, and analyses thereof, with an additional 5 years of data. Continuation funding for the collaboration will also allow us to extend our analyses to comparisons of acupuncture with drug therapy and to address four additional questions pertaining to acupuncture: predictors of acupuncture benefit; the time course of acupuncture effects; whether there are acupuncture 'responders' that have exceptional improvements after acupuncture therapy; whether outcomes vary between practitioners.