腰痛真假针刺设计循证医学研究与动态腧穴定位分析
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摘要
为探讨腧穴定位问题,检索PubMed 2010年1月1日至2017年10月27日采用真、假针刺对照治疗腰痛的综述和临床研究,得到6篇综述和12篇采用假针刺对照的随机对照试验。在8篇采用进皮假针刺设计的随机对照试验中,有6篇采用标准腧穴方案,真、假针刺疗效差异无统计学意义;有2篇采用个体化治疗,针刺捻转得气或采用触诊定位阿是穴,则真假针刺的疗效差异有统计学意义,说明进皮假针刺不是安慰治疗;动态腧穴定位和标准腧穴定位针刺对腰痛都有镇痛作用,动态腧穴定位可能效果更好。
To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017.Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for qi arrival or palpation for ashi point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.
To explore the positioning of acupoints, a research was done with PubMed for system reviews and clinical trials on treatment of low-back pain with sham-acupuncture controlled design from January 1, 2010 to October 27, 2017.Six system reviews and 12 sham-controlled acupuncture random trials were found. The statistical difference was not found in all the 6 trials with standard acupoint compared with the sham-acupuncture among the 8 penetrating skin sham-control trials. The statistical difference was found in the two trials with penetrating skin sham control, who was used individualized treatment, twirling for qi arrival or palpation for ashi point. It is considered that sham-acupuncture penetrating skin is not a placebo, and needling with standard or dynamic acupoint may reduce low-back pain, and dynamic acupoint positioning may be better than standard acupoint positioning.
引文
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[2]Itoh K,Katsumi Y,Hirota S,et al.Effects of trigger point acupuncture on chronic low back pain in elderly patients-a sham-controlled randomised trial[J].Acupunct Med,2006,24(1):5-12.
[3]冷三华.痛症经络逆向刺激疗法[M].北京:人民卫生出版社,2017.
[4]黄龙祥,黄幼民.针灸腧穴通考[M].北京:人民卫生出版社,2011:45.
[5]Wasan AD,Kong J,Pham LD,et al.The impact of placebo,psychopathology,and expectations on the response to acupuncture needling in patients with chronic low back pain[J].J Pain,2010,11(6):555-563.doi:10.1016/j.pain.2009.09.013.
[6]Haake M,Müller HH,Schade-Brittinger C,et al.German acupuncture Trials(GERAC)for chronic low back pain:randomized,multicenter,blinded,parallel-group trial with 3groups[J].Arch Intern Med,2007,167(17):1892-1898.
[7]Leibing E,Leonhardt U,K?ster G,et al.Acupuncture treatment of chronic low-back pain-a randomized,blinded,placebo-controlled trial with 9-month follow-up[J].Pain,2002,96(1-2):189-196.
[8]Brinkhaus B,Witt CM,Jena S,et al.Acupuncture in patients with chronic low back pain:a randomized controlled trial[J].Arch Intern Med,2006,166(4):450-457.
[9]Vas J,Aranda JM,Modesto M,et al.Acupuncture in patients with acute low back pain:a multicentrerandomised controlled clinical trial[J].Pain,2012,153(9):1883-1889.doi:10.1016/j.pain.2012.05.033.
[10]Rubinstein SM,Van Middelkoop M,Kuijpers T,et al.Asystematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain[J].Eur Spine J,2010,19(8):1213-1228.
[11]Hutchinson AJ,Ball S,Andrews JC,et al.The effectiveness of acupuncture in treating chronic non-specific low back pain:a systematic review of the literature[J].J OrthopSurg Res,2012,7:36.doi:10.1186/1749-799X-7-36.
[12]Lam M,Galvin R,Curry P.Effectiveness of acupuncture for nonspecific chronic low back pain:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2013,38(24):2124-2138.doi:10.1097/01.brs.0000435025.65564.b7.
[13]Lee JH,Choi TY,Lee MS,et al.Acupuncture for acute low back pain:a systematic review[J].Clin J Pain,2013,29(2):172-185.doi:10.1097/AJP.0b013e31824909f9.
[14]Liu L,Skinner M,McDonough S,et al.Acupuncture for low back pain:an overview of systematic reviews[J].Evid Based Complement Alternat Med,2015:328196.doi:10.1155/2015/328196.
[15]梁飞凡,陈威烨,陈博,等.针刺治疗下腰痛疗效的Meta分析[J].中国骨伤,2016,29(5):449-455.
[16]Qaseem A,Wilt TJ,McLean RM,et al.Clinical Guidelines Committee of the American College of Physicians.Noninvaasive treatments for acute,subacute,and chronic low back pain:a clinical practice guideline from the American College of Physicians[J].Ann Intern Med,2017,166(7):514-530.doi:10.7326/M16-2367.
[17]Andronis L,Kinghorn P,Qiao S,et al.Cost-effectiveness of non-invasive and non-pharmacological interventions for low back pain:a systematic literature review[J].Appl Health Econ Health Policy,2017,15(2):173-201.doi:10.1007/s40258-016-0268-8.
[18]Taylor P,Pezzullo L,Grant SJ,et al.Cost-effectiveness of acupuncture for chronic nonspecific low back pain[J].Pain Pract,2014,14(7):599-606.doi:10.1111/papr.12116.
[19]Kennedy S,Baxter GD,Kerr DP.Acupuncture for acute non-specific low back pain:a pilot randomised non-penetrating shamcontrolled trial[J].Complement Ther Med,2008,16(3):139-146.doi:10.1016/j.ctim.2007.03.001.
[20]Cho YJ,Song YK,Cha YY,et al.Acupuncture for chronic low back pain:a multicenter,randomized,patient-assessor blind,sham-controlled clinical trial[J].Spine(Phila Pa 1976),2013,38(7):549-557.doi:10.1097/BRS.0b013e318275e601.
[21]Hasegawa TM,Baptista AS,de Souza MC.Acupuncture for acute non-specific low back pain:a randomised,controlled,double-blind,placebo trial[J].Acupunct Med,2014,32(2):109-115.doi:10.1136/acupmed-2013-010333.
[22]Inoue M,Kitakoji H,IshizakiN,et al.Relief of low back pain immediately after acupuncture treatment-a randomised,placebo controlled trial[J].Acupunct Med,2006,24(3):103-108.