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，但其价值仍然存在争议。针灸试验者合作组织成立于2006年，旨在提供针灸对慢性疼痛影响的最佳证据。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，对数据进行分析，以便将其联合收割机组合在一个数据集中，然后进行分析，以解决有关针灸有效性和针灸研究设计的问题。NCCAM在2008年授予合作R21资金，以支持其工作。针灸试验者合作组织现在由31名医生、临床试验者、生物统计学家、执业针灸师和其他专家组成的国际小组组成，其中包括许多针灸研究中最广为人知的名字。它已经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，慢性头痛和肩部疼痛。在符合纳入协作数据集的严格合格标准的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18，000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，针灸上级无针灸对照和假针灸的每一个疼痛条件包括。我们还发现，针灸的效果大小取决于比较器的证据，例如，有真正的针灸和假技术之间的差异较小，涉及针穿透，比真正的针灸和非穿透假设备。因此，针灸试验者合作组织在实现高影响力的针灸研究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。继续资助的合作也将使我们能够扩展我们的分析，以比较针灸与药物治疗，并解决四个额外的问题有关针灸：针灸效益的预测因素;针灸效果的时间过程;是否有针灸“反应者”，有特殊的改善针灸治疗后;是否结果不同的从业者。 公共卫生相关性：针灸临床价值的评估和针灸研究的研究设计，关键取决于对先前研究数据的仔细综合。我们计划将联合收割机的原始数据，从所有大型，高质量的随机试验针灸慢性疼痛到一个单一的数据集，使个别患者的数据Meta分析。这将使我们能够解决有关针灸有效性和影响其有效性的因素的问题，例如给予的治疗次数。

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. PUBLIC HEALTH RELEVANCE: Both the assessment of the clinical value of acupuncture, and research design of acupuncture studies, depend critically on the careful synthesis of prior research data. We plan to combine raw data from all large, high-quality randomized trials of acupuncture for chronic pain into a single data set to enable individual patient data meta- analysis. This will allow us to address questions both about the effectiveness of acupuncture and factors, such as the number of treatments given, that impact its effectiveness.