摘要
背景:近20年有不少研究报道运用针刺疗法治疗癌痛有效,但学术界对针刺治疗癌痛的效果仍有争议。目的:运用循证医学系统综述方法评价针刺治疗癌痛的疗效。检索策略:计算机检索Cochrane图书馆(2008年第3期)、医学文摘数据库(Excerpta Medica Database,EMBASE)、PubMed、Science Direct数据库、对照试验索引、重庆维普资讯中文科技期刊数据库、中国知网中国期刊全文数据库、中国生物医学文献数据库(CBMdisc),检索日期始于各数据库起始日期,截止至2008年6月30日。手工检索6种中文期刊(2007年1月～2008年6月)上发表的相关文献。纳入标准:收集比较各种针刺疗法与安慰剂、西药、中药对比治疗癌痛的随机对照试验(randomized controlled trial,RCT)。针刺和药物联用与各种药物比较的RCT也予以纳入。资料提取与分析:两名评价员独立选择试验并提取资料,如遇不一致,通过讨论解决。对纳入的文献采用Cochrane协作网提供的软件RevMan5.0进行meta分析,如果纳入文献无法进行meta分析,则进行定性分析。结果:7篇RCT共634例病人符合纳入标准,其中高质量研究1篇。由于绝大部分文献在试验设计和报告上存在明显缺陷,各试验间存在较大差异,不符合meta分析条件,因而只进行了定性分析。结果显示,除1篇有关耳针疗法的高质量研究报告耳针在镇痛效果上显著优于安慰耳针外,其他均是与非安慰对照且低质量的RCT,但都提示针刺疗法有一定效果。结论:针刺治疗癌痛有效,但入选的绝大部分试验质量不高,降低了该结论的可靠性,还需更多设计严谨的高质量RCT来证实。
Background： Although acupuncture is a well-established treatment for cancer pain and its effects have been widely reported in recent two decades, there is still controversy over whether its efficacy is better than placebo.
Objective： To evaluate the efficacy of acupuncture therapy on cancer pain.
Search strategy： Cochrane Central Register of Controlled Trials （The Cochrane Library, Issue 3, 2008）, EMBASE, PubMed, ScienceDirect database, Current Controlled Trials, Chongqin VIP database and CNKI database were searched, and the search date ended in June 2008. The authors also hand-searched six Chinese Journals related to the question.
Inclusion criteria： All randomized controlled trials （RCTs） comparing acupuncture therapy with placebo, Western drugs, Chinese herbal medicines, or comparing acupuncture therapy plus drug treatment with drug treatment.
Data extraction and analysis： Two separate evaluators assessed the quality of the included reports and extracted the useful information. Disagreements were resolved through discussion. Meta-analysis of the included trials was done with RevMan 5.0, and qualitative analysis was employed when meta-analysis was not appropriate.
Results： Seven published RCTs with a total of 634 patients met the inclusion criteria, and the quality of one of the included trials was high. Due to flaws in design and reporting, meta-analysis was precluded, and only qualitative analysis was done on the majority of the reports. The high-quality trial showed that auricular acupuncture therapy was significantly superior to placebo in pain alleviation. The other six low-quality trials with non-placebo showed that acupuncture therapy had some positive effects.
Conclusion： Acupuncture is effective for pain relief. However, the poor quality of the majority of the trials reduces the reliability of the conclusion. More high-quality RCTs are needed to verify the effects.
出处
《中西医结合学报》
CAS
2010年第6期501-509,共9页
Journal of Chinese Integrative Medicine
关键词
针刺镇痛
疼痛
癌
随机对照试验
系统综述
acupuncture analgesia
pain
carcinoma
randomized controlled trial
systematic review
