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Cochrane Database of Systematic Reviews

Acupuntura para el dolor neuropático en adultos

Información

DOI:
https://doi.org/10.1002/14651858.CD012057.pub2Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 02 diciembre 2017see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Dolor y cuidados paliativos

Copyright:
  1. Copyright © 2019 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Contraer

Autores

  • Zi Yong Ju

    College of Acumox and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China

  • Ke Wang

    Correspondencia a: Research Lab of Surgery of Integrated Traditional and Western Medicine, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

    [email protected]

  • Hua Shun Cui

    Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

  • Yibo Yao

    Department of Anorectal Surgery, Longhua Hospital, Shanghai Traditional Chinese Medicine University, Shanghai, China

  • Shi Min Liu

    College of Acupuncture and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China

  • Jia Zhou

    Cardiothoracic Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

  • Tong Yu Chen

    Cardiothoracic Surgery, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China

  • Jun Xia

    Systematic Review Solutions Ltd, The Ingenuity Centre, The University of Nottingham, Nottingham, UK

Contributions of authors

Developing the protocol: ZYJ, KW, HSC, JX

Search: JX

Study screening: JZ, TYC

Data extraction: ZYJ, YY

Assessment of risk of bias: HSC, SML

Data analysis: HSC, ZYJ

Review writing: ZYJ, YY, SML

Final proof the manuscript: KW, JX

Update the review: KW, ZYJ

Sources of support

Internal sources

  • No sources of support supplied

External sources

  • The National Natural Science Foundation of China (NSFC, Grant Nos. 81202767), China.

    YYB was supported by NSFC grant. The contents of this systematic review are solely the responsibility of the authors and do not necessarily represent the official views of the NSFC.

  • Hai‐Pai Traditional Chinese Medicine Heritage Research Base ‐ Gu's general surgery (Shanghai Municipal Commission of Health and Family Planning (SMCHFP), Grant Nos. ZYSNXD‐CC‐APGC‐JD002), China.

    YYB was supported by SMCHFP grant. The contents of this systematic review are solely the responsibility of the authors and do not necessarily represent the official views of the SMCHFP.

Declarations of interest

ZYJ: none known; ZYJ is an acupuncture physician and uses acupuncture in clinical work managing patients with various diseases.

KW: none known; KW is a clinical medical researcher.

HSC: none known; HSC is an acupuncture physician and uses acupuncture in clinical work managing patients with various diseases.

YY: none known; YY is a specialist anorectal surgeon and manages patients with anorectal diseases.

SML: none known; SML is an acupuncture physician and uses acupuncture in clinical work managing patients with various diseases.

JZ: none known; JZ is a specialist cardiothoracic surgeon and manages patients with cardiothoracic diseases.

TYC: none known; TYC is a specialist cardiothoracic surgeon and manages patients with cardiothoracic diseases.

JX: none known.

Acknowledgements

Cochrane Review Group funding acknowledgement: this project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pain, Palliative and Supportive Care (PaPaS). The views and opinions expressed therein are those of the review authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

The protocol followed the agreed template for neuropathic pain, which was developed in collaboration with Cochrane Musculoskeletal and Cochrane Neuromuscular Diseases. The editorial process was managed by Cochrane Pain, Palliative and Supportive Care, with editorial feedback provided by Cochrane Neuromuscular Diseases.

Parts of this review were generated using Review Manager HAL 4.3 Beta. You can find more information about RevMan HAL here (RevMan HAL 2015).

Version history

Published

Title

Stage

Authors

Version

2017 Dec 02

Acupuncture for neuropathic pain in adults

Review

Zi Yong Ju, Ke Wang, Hua Shun Cui, Yibo Yao, Shi Min Liu, Jia Zhou, Tong Yu Chen, Jun Xia

https://doi.org/10.1002/14651858.CD012057.pub2

2016 Jan 29

Acupuncture for neuropathic pain in adults

Protocol

Zi Yong Ju, Ke Wang, Hua Shun Cui, Yibo Yao, Shi Min Liu, Jia Zhou, Tong Yu Chen, Jun Xia

https://doi.org/10.1002/14651858.CD012057

Differences between protocol and review

1. Types of interventions

We intended to include studies with at least eight weeks of treatment, as opposed to eight weeks of study duration. This was not clearly expressed in the published protocol, hence we clarified this in the current full review. Due to this change, the originally planned cut‐off time points for analysis (e.g. short‐, medium‐, and long‐term) were no longer applicable, and were removed.

We added the fourth comparison "acupuncture combined with other active therapy versus other active therapy" in this section. This was not clearly stated in the published protocol other than one sentence ("acupuncture either given alone or in combination with other therapies"). Therefore, we clarified the fourth comparison in the current full review for consistency between sections.

2. Types of outcome measures

'Quality of life' was a planned outcome measure, but it was mistakenly omitted from the PICO section of the published protocol, even though it was listed as one of the seven 'Summary of findings' outcomes. We have rectified this error by adding 'Quality of life' to the outcome list.

3. Measures of treatment effect

We transferred the statement about the use of a random‐effects model from 'Measures of treatment effect' to 'Data synthesis' section.

4. Data synthesis

In the protocol we stated that we planned to analyse data for each painful condition in three tiers. However, in light of the evolving methodology, we adopted the GRADE approach to assess the quality of the body of evidence for each important outcome in line with current Cochrane guidelines.

5. Subgroup analysis and investigation of heterogeneity

We deleted the second planned subgroup analysis on 'different treatment durations' as we included all studies with more than eight weeks treatment duration making the original planned analysis redundant.

Notes

A restricted search in June 2019 did not identify any potentially relevant studies likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be re‐assessed for updating in two years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Adult; Humans; Middle Aged;

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.

Study flow diagram
Figuras y tablas -
Figure 1

Study flow diagram

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study
Figuras y tablas -
Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study

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Comparison 1 Acupuncture alone versus other active therapy, Outcome 1 Any pain‐related outcomes: no clinical response ‐ defined by original study.
Figuras y tablas -
Analysis 1.1

Comparison 1 Acupuncture alone versus other active therapy, Outcome 1 Any pain‐related outcomes: no clinical response ‐ defined by original study.

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Summary of findings for the main comparison. Acupuncture versus sham acupuncture for neuropathic pain in adults

Acupuncture versus sham acupuncture for neuropathic pain in adults

Patient or population: adults with neuropathic pain
Settings: hospital
Intervention: acupuncture

Comparison: sham acupuncture

Outcomes

Sham acupuncture

Acupuncture

Relative effect
MD (95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Participant‐reported pain intensity
VAS (0‐10, lower score = less pain)
Follow‐up: 10 weeks

Mean 6.2

Mean 5.8

The mean participant‐reported pain intensity in the intervention group was
0.40 lower
(1.83 lower to 1.03 higher)

45
(1 study)a in which 59 participants began treatment)

⊕⊝⊝⊝
very lowb,c

Acupuncture has no clinical significant beneficial effects on pain intensity compared to sham acupuncture.

Participant‐reported pain relief

substantial (at least 50% pain relief over baseline)

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participants experiencing any serious adverse event

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Quality of life
SF‐36 bodily pain score (0‐100, lower score = more disability)
Follow‐up: 10 weeks

Mean 27.7

Mean 37.7

The mean bodily pain component of quality of life in the intervention groups was 10 higher
(3.13 lower to 2313 higher)

45
(1 study)

⊕⊝⊝⊝
very lowb,c

Acupuncture has no beneficial effects on bodily pain compared to sham acupuncture.

CI: confidence interval; MD: mean difference; SF‐36: Short Form (36) Health Survey (SF‐36); VAS: visual analogue scale

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect;
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different;
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect;
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aGarrow 2014 recruited 59 participants initially; there were 14 withdrawals and only the 45 participants that completed treatment were included in the study's final results.
bDowngraded twice for study limitations (risk of bias) due to high risk of performance and attrition bias; high risk of bias confounded by small size of study.
cDowngraded once for imprecision due to wide 95% CI (the wide CIs were usually induced by small sample size and low incidence of events).

Figuras y tablas -
Summary of findings for the main comparison. Acupuncture versus sham acupuncture for neuropathic pain in adults
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Summary of findings 2. Acupuncture versus treatment as usual for neuropathic pain in adults

Acupuncture versus treatment as usual for neuropathic pain in adults

Patient or population: adults with neuropathic pain
Settings: hospital
Intervention: acupuncture

Comparison: treatment as usual

Outcomes

Sham acupuncture

Acupuncture

Relative effect

(Not applicable)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Participant‐reported pain intensity

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participant‐reported pain relief

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participants experiencing any serious adverse event

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Quality of life

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect;
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different;
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect;
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

Figuras y tablas -
Summary of findings 2. Acupuncture versus treatment as usual for neuropathic pain in adults
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Summary of findings 3. Acupuncture versus other active therapy for neuropathic pain in adults

Acupuncture versus other active therapy for neuropathic pain in adults

Patient or population: adults with neuropathic pain
Settings: hospital
Intervention: acupuncture

Comparison: other active therapy

Outcomes

Sham acupuncture

Acupuncture

Relative effect

(Not applicable)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Participant‐reported pain intensity

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participant‐reported pain relief

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participants experiencing any serious adverse event

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Quality of life

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect;
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different;
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect;
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

Figuras y tablas -
Summary of findings 3. Acupuncture versus other active therapy for neuropathic pain in adults
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Summary of findings 4. Acupuncture combined with other active therapy versus other active therapy for neuropathic pain in adults

Acupuncture combined with other active therapy versus other active therapy for neuropathic pain in adults

Patient or population: adults with neuropathic pain
Settings: hospital
Intervention: acupuncture combined with other active therapy

Comparison: other active therapy alone

Outcomes

Other active therapy

Acupuncture combined with other active therapy

Relative effect
(MD (95% CI))

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Participant‐reported pain intensity
VAS (0‐10, lower score = less pain)
Follow‐up: 84 days

Mean 4.25

Mean 3.23

The mean participant‐reported pain intensity in the intervention groups was
1.02lower
(1.09 lower to 0.95 lower)

104
(1 study)

⊕⊝⊝⊝
very lowa.b

Acupuncture combined other active therapy has no clinical significant beneficial effects on pain intensity compared to other active therapy alone.

Participant‐reported pain relief

substantial (at least 50% pain relief over baseline)

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Participants experiencing any serious adverse event

‐

‐

‐

‐

‐

No studies reported this outcome so no evidence to support or refute benefits of intervention.

Quality of life
FACT/the GOG‐Ntx questionnaire scores (0 ‐ 100, lower score = better)
Follow‐up: 84 days

Mean 35.17

Mean 32.98

The mean bodily pain component of quality of life in the intervention groups was 2.19lower
(2.39 lower to 1.99 lower)

104
(1 study)

⊕⊕⊝⊝
lowa

Acupuncture combined other active therapy improved the quality of life compared to other active therapy alone.

CI: confidence interval; FACT/the GOG‐Ntx: Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group/Neurotoxicity; MD: mean difference; VAS: Visual Analogue Scale

GRADE Working Group grades of evidence
High quality: we are very confident that the true effect lies close to that of the estimate of the effect;
Moderate quality: we are moderately confident in the effect estimate; the true effect is likely to be close to the estimate of effect, but there is a possibility that it is substantially different;
Low quality: our confidence in the effect estimate is limited; the true effect may be substantially different from the estimate of the effect;
Very low quality: we have very little confidence in the effect estimate; the true effect is likely to be substantially different from the estimate of effect.

aDowngraded twice for study limitations (risk of bias) due to high risk of performance and detection bias.
bDowngraded once for imprecision due to wide 95% CI (the wide CIs were usually induced by small sample size and low incidence of events).

Figuras y tablas -
Summary of findings 4. Acupuncture combined with other active therapy versus other active therapy for neuropathic pain in adults
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Table 1. Acupuncture points used in included studies

Acupuncture points used

Study ID

Taixi (KI3); Hegu (LI4); Taichong (LR3); Sanyinjiao (SP6); Zusanli (ST36)

Garrow 2014

Shenmai (B62); Zulinqi (GB41); Zhaohai (K6); Lieque (L7); Neiguan (P6); Houxi (SI3); Waiguan (SJ5); Gongsun (SP4)

Han 2017a;
Zhao 2016

Feishu (BL13); Geshu (BL17); Feiyang (BL58); Zulinqi (GB41); Zhiyang (GV9); Shendao (GV11); Shenzhu (GV12); Dazhui (GV14); Taichong (LR3); Sanyinjiao (SP6); Xuehai (SP10); Tianshu (ST25); Zusanli (ST36); Xiangu (ST43)

Han 2017

The main points: Huantiao (GB30); Yanglingquan (GB34); Sanyinjiao (SP6); Zusanli (ST36);

The auxiliary points (selected 2‐3from following): Shenshu (BL23); Kunlun (BL60); Guanyuan (CV4); Qihai (CV6); Huantiao (GB30); Taixi (K3); Taichong (LIV3); Pishu (PL20)

Wang 2016

The main points: Ganshu (BL18); Pishu (BL20); Shenshu (BL23); Yishu; Feishu (BL58); Zusanli (ST36); Sanyinjiao (SP6), Taibai (SP3); Zutonggu; Qihai (CV6); Guanyuan (CV4); Fenglong(ST40) and Yanglingquan (GB34);

The auxiliary points: Jianyu (LI15); Quchi (LI11); Shousanli (LI10); Hegu (LI4); Biguan (ST31); Futu (ST32); Liangqiu (ST34); Xiangu (ST43) and Neiting (ST 44);

Added for blood stasis points: Geshu (BL17) and Xuehai (SP10);

Added for severe numbness of the hands and feet points: Bafeng(EX‐LE10) and Baxie (EX‐UE9).

Zhang 2010

Figuras y tablas -
Table 1. Acupuncture points used in included studies
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Table 2. Scales in this review

Outcomes

Scales

Description of scales

Relevant Studies

Participant‐reported pain intensity

Visual Analogue Scale (VAS)

The VAS is a visual analogue scale for pain intensity, in which 0 means no pain and 10 (or 100) means the worst pain ever experienced.

Garrow 2014; Han 2017

Quality of life

Short Form (36) Health Survey (SF‐36)

The SF‐36 is a 36‐item, patient‐reported survey of patient health and consists of 8 scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0‐100 scale on the assumption that each question carries equal weight. The lower the score, the more disability. The 8 sections are: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning and mental health. Summary scores for the SF‐12, version 2 (SF‐12v2) health status measure are based on scoring coefficients derived for version 1 of the SF‐36. The higher score is better.

Garrow 2014;

Functional Assessment
of Cancer Therapy/Gynaecologic Oncology Group/Neurotoxicity (FACT/GOG‐Ntx) questionnaire

The FACT/GOG‐Ntx questionnaire is used to investigate patients' daily activities and evaluate the degree of neuropathy. The questionnaire includes 7 questions about physical well‐being, 7 questions about social/family well‐being, 6 questions about emotional well‐being, 7 questions about functional well‐being and 9 questions about additional concerns. Where in each question, 0 = not at all and 4 = very much, lower is better.

Han 2017

Figuras y tablas -
Table 2. Scales in this review
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Table 3. Single study data (continuous data)

Acupuncture versus sham acupuncture

Outcome

Specific measurement

Study

Manual acupuncture group

Sham acupuncture group

Effect measure

Statistical test

Mean

SD

Total

Mean

SD

Total

MD (95%CI)

P value

Pain intensity

VASa

Garrow 2014

5.8

2.6

24

6.2

2.3

21

‐0.40 (‐1.83 to 1.03)

0.58

Quality of life

SF‐36b: physical health score

Garrow 2014

31.9

9.2

24

32.1

9.8

21

‐0.20 (‐5.78 to 5.38)

0.94

SF‐36: mental health score

39.2

14

24

35.7

12.6

21

3.50 (‐4.17 to 11.27)

0.38

SF‐36: bodily pain score

37.7

27.4

24

27.7

16.9

21

10.00 (‐3.13 to 23.13)

0.14

Acupuncture + other active therapies versus other active therapies

Outcome

Specific measurement

Study

Acupuncture + other active therapies group

Other active therapies group

Effect measure

Statistical test

Mean

SD

Total

Mean

SD

Total

MD (95%CI)

P value

Pain intensity

VAS

Han 2017

3.23

0.17

52

4.25

0.197

52

‐1.02 (‐1.09 to ‐0.95)

< 0.00001

Quality of life

FACT/the GOG‐Ntxc

Han 2017

32.98

0.542

52

35.17

0.518

52

‐2.19 (‐2.39 to ‐1.99)

< 0.00001

MD: mean difference; SD: standard deviation
aVAS: Visual Analogue Scale (0‐10, lower is better)
bSF‐36: Short Form (36) Health Survey (0‐100, higher is better)
cFACT/the GOG‐Ntx: Functional Assessment of Cancer Therapy/Gynaecologic Oncology Group/ Neurotoxicity questionnaire (lower is better)

Figuras y tablas -
Table 3. Single study data (continuous data)
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Table 4. Single study data (dichotomous data)

Acupuncture versus sham acupuncture

Outcome

Study

Manual acupuncture group

Sham acupuncture group

Effect measure

Statistical test

Events

Total

Events

Total

RR (95%CI)

NNTB

P value

Withdraw from trial due to any cause

Garrow 2014

4

28

10

31

0.44 (0.16 to 1.25)

NNTB = 6

0.53

Adverse events: any cases

Garrow 2014

1

28

2

31

0.55 (0.05 to 5.78)

NNTB = 34

0.62

Acupuncture + other active therapies versus other active therapies

Outcome

Study

Acupuncture + other active therapies group

Other active therapies group

Effect measure

Statistical test

Events

Total

Events

Total

RR (95%CI)

NNT

P value

Any pain‐related outcomes: no clinical response

Wang 2016

4

30

10

30

0.40 (0.14 to 1.14)

NNTB = 5

0.09

Withdraw from trial due to any cause

Han 2017

3

52

3

52

1.00 (0.21 to 4.73)

NA

1.00

NA: not applicable; NNTB: number needed to treat for an additional beneficial outcome; RR: risk ratio

Figuras y tablas -
Table 4. Single study data (dichotomous data)
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Comparison 1. Acupuncture alone versus other active therapy

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Any pain‐related outcomes: no clinical response ‐ defined by original study Show forest plot

3

209

Risk Ratio (M‐H, Random, 95% CI)

0.25 [0.12, 0.51]
Figuras y tablas -
Comparison 1. Acupuncture alone versus other active therapy
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