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요통에 대한 침 및 건침술

Background

Although low‐back pain is usually a self‐limiting and benign disease that tends to improve spontaneously over time, a large variety of therapeutic interventions are available for its treatment.

Objectives

To assess the effects of acupuncture for the treatment of non‐specific low‐back pain and dry‐needling for myofascial pain syndrome in the low‐back region.

Search methods

We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003.

Selection criteria

Randomized trials of acupuncture (that involves needling) for adults with non‐specific (sub)acute or chronic low‐back pain, or dry‐needling for myofascial pain syndrome in the low‐back region.

Data collection and analysis

Two authors independently assessed methodological quality (using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta‐analyses methods or levels of evidence when the data reported did not allow statistical pooling.

Main results

Thirty‐five RCTs were included; 20 were published in English, seven in Japanese, five in Chinese and one each in Norwegian, Polish and German. There were only three trials of acupuncture for acute low‐back pain. They did not justify firm conclusions, because of small sample sizes and low methodological quality of the studies. For chronic low‐back pain there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and at short‐term follow‐up. There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry‐needling appears to be a useful adjunct to other therapies for chronic low‐back pain. No clear recommendations could be made about the most effective acupuncture technique.

Authors' conclusions

The data do not allow firm conclusions about the effectiveness of acupuncture for acute low‐back pain. For chronic low‐back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short‐term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry‐needling may be useful adjuncts to other therapies for chronic low‐back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

요통에 대한 침 및 건침술

이 체계적 문헌고찰은 2861 명의 환자들이 참여한 35개 무작위대조 연구를 포함하고 있다. 급성 요통의 침 또는 건침술 치료에 대한 어떤 권고도 할 수 없을 정도로, 근거는 불충분하다. 만성 요통의 경우, 침 치료는 치료를 받지 않거나 거짓 침 치료를 한 경우보다 치료 후 3개월 시점까지 통증을 줄이는데 더 효과적인 것으로 나타났다. 또한 만성 요통과 관련한 기능장애의 단기적 호전에는, 침 치료를 받을 경우 받지 않는 것에 비해 더 효과적인 것으로 나타났다. 침 치료가 기존의 다른 의학적 치료 및 '대체의학적' 치료보다 더 효과적이진 않았다. 기존의 의학적 치료와 침 치료를 함께 받는 경우, 기존 의학적 치료만 받는 것에 비해 더 잘 통증을 줄이고 기능장애를 회복시켰으나 둘 간 효과 차이는 그리 크지 않았다. 침 및 건침술은 만성 요통의 기존 치료법에 결합한 보조 요법으로 유용해 보인다.