针刺激痛点治疗腰背肌筋膜疼痛综合征的Meta分析

Meta-analysis of Pain Point Stimulation with Needle on Myofascial Pain Syndrome in Low Back

目的系统评价针刺激痛点治疗腰背肌筋膜疼痛综合征(MPS)的有效性及安全性。方法通过检索中文数据库,包括中国知网(CNKI)、万方(Wanfang),英文数据库PubMed库,时间设定为2010年1月-2022年10月,检索针刺激痛点治疗MPS患者的随机对照试验(RCTs),由3位研究员根据纳排标准独立进行文献筛选、提取数据及评估文献质量风险,通过Review Manager 5.4软件分析腰背MPS患者针刺激痛点后的VAS疼痛、腰部功能、总有效率指标,并按照不同疗程(2周、3周、4周)及是否合并其他治疗进行亚组分析。结果最终纳入8篇RCTs,共计639名受试者。Meta分析结果显示,试验组(针刺激痛点)在VAS疼痛指标(MD=-1.84,95%CI:-2.39~-1.30,P<0.00001)、腰部功能评分(SMD=-1.34,95%CI:-2.40~-0.28,P=0.01)总有效率(RR=1.27,95%CI:1.16~1.39,P<0.00001)均优于对照组;亚组分析显示针刺激痛远期(4周)镇痛效果优于短期(2周、3周)治疗[MD(4周)2.71>MD(3周)2.09>MD(2周)0.97,P<0.00001],无论是否合并其他治疗,针刺激痛点在缓解疼痛(MD=-1.84,95%CI:-2.39~-1.30,P=0.001)方面的效果优于对照组。结论从目前发表的文献汇总分析,针刺激痛点治疗腰背肌筋膜疼痛综合征患者可有效缓解疼痛症状、改善腰部功能,无论配合其他治疗或单独干预,均可明显改善症状,效果优于传统的口服药物、推拿、电疗等,而皮下出血是针刺常见的不良反应。但本研究纳入的研究质量偏低,此结论还需要更多高质量的随机对照试验进一步验证。

Objective To systematically evaluate the efficacy and safety of pain point stimulation with needle on myofascial pain syndrome(MPS)in low back.Methods By searching the Chinese database,including China Knowledge Network Infrastructure,Wanfang,and the English database Pub Med,the time was set from January 2010 to October 2022.Randomized controlled trials(RCTs)of pain point stimulation with needle on myofascial pain syndrome were retrieved.Three researchers independently screened literature,extracted data and assessed the risk of literature quality according to the inclusion and exclusion criteria.The VAS pain,lumbar function and total effective rate of pain point stimulation with needle on myofascial pain syndrome were analyzed by Review Manager 5.4 software.Subgroup analysis was performed according to different courses of treatment(2 weeks,3 weeks,4 weeks)and whether other treatments were combined.Results Eight RCTs were finally included,a total of 639 subjects.The results of Meta-analysis showed that the VAS pain index(MD=-1.84,95%CI:-2.39 to-1.30,P<0.00001),lumbar function score(SMD=-1.34,95%CI:-2.40 to-0.28,P=0.01)and total effective rate(RR=1.27,95%CI:1.16 to 1.39,P<0.00001)in the experimental group were better than those in the control group.Subgroup analysis showed that the long-term(4 weeks)analgesic effect of pain point stimulation with needle was better than that of short-term(2 weeks,3 weeks)treatment[MD(4 weeks)2.71>MD(3 weeks)2.09>MD(2 weeks)0.97,P<0.00001].Regardless of whether other treatments were combined,the effect of pain point stimulation with needle on pain relief(MD=-1.84,95%CI:-2.39 to-1.30,P=0.001)was better than that of the control group.Conclusion According to the summary and analysis of the currently published literature,pain point stimulation with needle can effectively relieve the pain symptoms and improve the waist function in patients with myofascial pain syndrome in low back.Whether in combination with other treatments or alone intervention,it can significantly improve the symptoms,and the effect is better than traditional oral medicine,massage,electrotherapy,etc.,while subcutaneous hemorrhage is a common adverse reaction of acupuncture.However,the quality of the study is low,and this conclusion needs to be further verified by more high-quality randomized controlled trials.