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

描述(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。针灸试验者的合作成立于2006年，旨在为针灸治疗慢性疼痛的效果提供最佳证据。该合作从高质量的针灸治疗慢性疼痛的随机试验中获得个人患者水平的数据，对数据进行标准化，以便将其合并到单个数据集中，然后进行分析t以解决有关针灸有效性和针灸研究设计的问题。NCCAM在2008年授予了协作R21资金，以支持其工作。针灸试验专家的合作现在包括一个由31名医生、临床试验人员、生物统计学家、执业针灸医生和其他专家组成的国际小组，其中包括许多针灸研究领域最知名的名字。它非常成功地从试验者那里获得了其职权范围内疼痛状况的原始数据：骨关节炎、非特异性背部和颈部疼痛、慢性头痛和肩痛。在符合纳入协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患者个人数据。所有29项试验的数据都已被检查、重新标记并添加到协作数据库中，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，我们发现了强有力的证据表明，对于包括在内的每种疼痛情况，针灸都优于没有针灸控制的针灸和假针灸。我们还发现了针灸效果大小取决于比较器的证据，例如，真正的针灸和涉及针刺的假技术之间的差异比真正的针灸和非穿透的假设备之间的差异更小。因此，针灸试验者的合作在使高影响力的针灸研究取得成果方面有着良好的记录。在这里，我们建议更新我们的试验数据库及其分析，增加5年的数据。继续为合作提供资金还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另外四个问题：针灸益处的预测因素；针灸效果的时间进程；是否有针灸“响应者”在针灸治疗后有特殊改善；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.