Acupuncture for neuropathic pain in adults

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

doi:10.1002/14651858.CD012057.pub2

Scolaris Content Display Scolaris Content Display

Contenido relacionado

Ir a:

Revisiones y protocolos relacionados
Guías
Temas

Revisiones y protocolos relacionados

Topics

Temas

Figure 1

Study flow diagram

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 2

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Figure 3

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

Analysis 1.1

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

Ir a la figura de la revisiónAbrir en una pestaña nueva

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 low^b,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 low^b,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).

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

Ir a la tabla de la revisión

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.

Summary of findings 2. Acupuncture versus treatment as usual for neuropathic pain in adults

Ir a la tabla de la revisión

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.

Summary of findings 3. Acupuncture versus other active therapy for neuropathic pain in adults

Ir a la tabla de la revisión

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 low^a.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)	⊕⊕⊝⊝ low^a	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).

Summary of findings 4. Acupuncture combined with other active therapy versus other active therapy for neuropathic pain in adults

Ir a la tabla de la revisión

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

Table 1. Acupuncture points used in included studies

Ir a la tabla de la revisión

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;
Quality of life	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

Table 2. Scales in this review

Ir a la tabla de la revisión

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
Outcome	Specific measurement	Study	Mean	SD	Total	Mean	SD	Total	MD (95%CI)	P value
Pain intensity	VAS^a	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‐36^b: 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
Outcome	Specific measurement	Study	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‐Ntx^c	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)

Table 3. Single study data (continuous data)

Ir a la tabla de la revisión

Table 4. Single study data (dichotomous data)

Acupuncture versus sham acupuncture
Outcome	Study	Manual acupuncture group		Sham acupuncture group		Effect measure		Statistical test
Outcome	Study	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
Outcome	Study	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

Table 4. Single study data (dichotomous data)

Ir a la tabla de la revisión

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]

Comparison 1. Acupuncture alone versus other active therapy

Ir a la tabla de la revisión

The Cochrane Library

Scolaris Language Selector Scolaris Language Selector

Idioma de la Revisión Cochrane

Idioma de la web

Scolaris Content Language Banner Portlet Scolaris Content Language Banner Portlet