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Akupunktur dan 'dry‐needling' untuk sakit pinggang

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.

Akupunktur dan 'dry‐needling' untuk sakit pinggang

Tiga puluh lima kajian terkawal rawak (RCT) melibatkan 2861 pesakit telah disertakan dalam ulasan sistematik ini. Tidak terdapat bukti yang cukup untuk mengesyorkan akupunktur atau 'dry‐needling' untuk sakit pinggang akut. Untuk sakit pinggang kronik, keputusan menunjukkan bahawa akupunktur adalah lebih berkesan untuk menghilangkan sakit berbanding tiada rawatan sama sekali atau rawatan palsu dalam pemerhatian sehingga tiga bulan. Keputusan kajian‐kajian tersebut juga menunjukkan bahawa dalam jangka pendek, akupunktur adalah lebih berkesan untuk menambah baik fungsi untuk sakit pinggang kronik berbanding dengan pesakit yang tidak menerima apa‐apa rawatan. Akupunktur tidaklah lebih berkesan daripada rawatan‐rawatan konvensional dan alternatif lain. Apabila akupunktur ditambah kepada terapi konvensional lain, ia dapat menghilangkan sakit dan meningkatkan fungsi dengan lebih baik daripada terapi konvensional semata‐mata. Namun, kesannya adalah kecil sahaja. 'Dry‐needling' mungkin berguna sebagai tambahan kepada terapi lain untuk sakit belakang pinggang kronik.