【Cochrane简语概要】针灸治疗慢性非特异性腰痛

系统综述问题

针灸是否可以安全地减轻慢性非特异性LBP患者的疼痛，并改善其背部相关功能和生活质量？

研究背景

多数人都患有慢性腰痛（low-back pain，LBP）。其中有些人会选择针灸，以改善疼痛和其他症状。

检索日期

证据检索至2019年8月29日。

研究特征

我们评价了涉及8270名受试者的33项试验（37篇文章）。这些试验在欧洲，亚洲，北美和南美进行。研究比较了针灸与假针灸（安慰剂）、未治疗和常规护理间的差异。

关键结局

与假针灸相比，针灸似乎不能在治疗后立即明显地减轻疼痛。针灸治疗后，似乎并未立即改善背部特异性功能，或者短期内也不能提高生活质量。

与未治疗相比，针灸治疗后能立即缓解疼痛和改善功能。

与常规护理相比，针灸似乎并未显著减轻疼痛，但在治疗后似乎立即有效地改善了功能。针灸并不能改善短期内的生活质量。

针灸和假针灸之间，以及针灸和常规护理之间的不良事件的发生率可能是相似的。与针灸有关的不良反应是轻微或中度的。

证据质量

证据的质量从极低到中等不等。许多试验中，由于对针灸师或受试者的盲法存在问题，偏倚风险很高。这可能会影响受试者报告结局和研究者计算结局效果。一些结局基于少量样本，会导致结果的不一致和不精确。

（图片来源于u4k.net）

结论: 

我们发现在治疗后即刻缓解疼痛或在短期内改善生活质量方面，针灸可能不会比假干预发挥出更有重要的临床意义，并且与假干预相比，针灸能并未改善短期内的背部功能。但是，针灸在短期内比不治疗能更有效地改善疼痛和功能。以常规护理为对照的试验显示，临床上针灸可能并不能减轻疼痛，但该疗法可在治疗后立即改善功能，并在短期内改善躯体生活质量（而非精神生活质量）。考虑到大多数研究具有较高的偏倚风险，不一致且样本量较小导致不精确的风险，因此将证据降调整为中等至极低质量。使用针灸治疗慢性腰痛的临床决策，可能取决于提供能力，成本和患者的喜好。

译者：姜若文，黑龙江中医药大学；审校：张晓雯；编辑排版：张晓雯，北京中医药大学循证医学中心

相关文章链接

【Cochrane Plain Language Summary】Acupuncture for chronic non-specific low-back pain

Review question

Does acupuncture safely reduce pain and improve back-related function and quality of life for people with chronic nonspecific LBP?

Background

Most people have experienced chronic LBP. Some of them choose acupuncture to relieve their pain and other symptoms.

Search date

The evidence is current to 29 August 2019.

Study characteristics

We reviewed 33 trials (37 articles) with 8270 participants. The trials were carried out in Europe, Asia, North and South America. The studies compared acupuncture with sham (placebo), no treatment and usual care.

Key results

Compared with sham, acupuncture may not be more effective in reducing pain immediately after treatment. Acupuncture perhaps did not appear to improve back-specific function immediately after treatment, or may not enhance quality of life in the short term.

Acupuncture was better than no treatment for pain relief and functional improvement immediately after treatment.

Compared with usual care, acupuncture did not appear to significantly clinically reduce pain, but seemed more effective in improving function immediately after treatment. Acupuncture did not improve quality of life in the short-term.

The incidence of adverse events may be similar between acupuncture and sham, and between acupuncture and usual care. Adverse effects related to acupuncture were considered minor or moderate.

Certainty of the evidence

The certainty of the evidence ranged from very low to moderate. Many trials showed a high risk of bias due to problems with masking the acupuncturists or participants. This may affect the participants reported outcomes and trialists computed effects. Some outcomes were based on small samples, resulting in inconsistency and imprecision of results.

Authors' conclusions: 

We found that acupuncture may not play a more clinically meaningful role than sham in relieving pain immediately after treatment or in improving quality of life in the short term, and acupuncture possibly did not improve back function compared to sham in the immediate term. However, acupuncture was more effective than no treatment in improving pain and function in the immediate term. Trials with usual care as the control showed acupuncture may not reduce pain clinically, but the therapy may improve function immediately after sessions as well as physical but not mental quality of life in the short term. The evidence was downgraded to moderate to very low-certainty considering most of studies had high risk of bias, inconsistency, and small sample size introducing imprecision. The decision to use acupuncture to treat chronic low back pain might depend on the availability, cost and patient's preferences.

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