针刺治疗癌性疼痛的系统评价及临床预初试验
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摘要
第一部分针刺治疗癌痛疗效的系统评价
目的：评价针刺治疗癌痛的疗效。方法：计算机检索Cochrane图书馆临床对照试验数据库（2008年第3期）、MEDLINE(1966～2008.6)、EMBASE(1974～2008.6)、PUBMED(1950～2008.6)、SCIENCEDIRECT(1995～2008.6)、CONTROLLED-TRIALS（1999～2008.6）、中文科技期刊全文数据库(VIP)（1989～2008.6）、中国学术期刊全文数据库（CNKI）（1994～2008.6）、中国生物医学文献数据库(CBM) (1978～2008.6),手工检索2007年1月至2008年6月发表的其它相关中文文献。由两名评价者独立对纳入文献进行质量评价并提取资料，如遇分歧，通过讨论解决。对纳入文献用RevMan5.0进行Meta分析，如果无法进行Meta分析，则进行定性分析。结果：8篇随机对照临床试验，共700例病人符合纳入标准，其中高质量研究1篇。由于绝大部分文献在试验设计、报道上存在明显缺陷，以及各试验间存在较大差异，不符合Meta分析条件，因而只进行了定性分析。结果显示，除一篇有关耳针疗法的高质量研究展示耳针组在镇痛效果上要显著优于安慰耳针组外，其它均为与非安慰对照组相比较且低质量的临床对照试验，但都提示针刺疗法有一定效果。结论：针刺治疗癌痛有效，但入选的绝大部分试验质量不高，降低了该结论的可靠性，还需更多设计严谨的高质量随机对照试验来证实。
第二部分临床研究
目的：观察针刺疗法对癌痛的镇痛效果及对癌痛患者生活质量、精神状态的影响。方法：将22例癌痛患者根据疼痛的轻、中、重不同程度分为3层，按照随机数字表把每一层病人随机分配到针刺组和安慰组。两组均可在研究期间维持基线期的镇痛药使用情况。研究期间用VAS疼痛量表评价疼痛缓解的临床疗效，并分别用QLQ-C30量表以及SCL-90量表评价癌痛患者的生活质量及精神状态。结果：针刺组及安慰组在第7天、第14天及第21天这3个时间点的VAS疼痛评分前后差值组间比较无显著性差异，且针刺组在以上3个时间点的前后差值组内比较亦无显著性差异。但安慰组在第14天及第21天的前后差值组内比较P<0.05,具有显著性差异。QLQ-C30量表评分结果显示，除在食欲丧失计分因子方面，针刺组与安慰组第7天的组间比较P<0.05,有显著差异外，其它因子评分方面的比较，无论是组间还是组内均无明显差异。SCL-90量表评分结果显示，除在强迫症状因子方面，针刺组在第7天的组内比较P<0.05,具有显著性差异外，其它因子评分方面的比较，无论是组间还是组内均无明显差异。结论：由于本初步研究的病例数较少，尚无法确定针刺对癌痛是否有效，亦无法证明其能否改善癌痛患者的生活质量和整体精神状态，但研究结果提示针刺可能会对癌痛患者的强迫症状有一定的改善作用，可是仍需更大规模的试验来证实。本试验对未来大规模的随机对照临床试验在设计上的思考：1、采取多中心合作的方式扩大研究病例数；2、增加对针刺治疗癌痛即时效果的观察；3、采用VAS与VRS-5相结合的疼痛评价方法。
The First Part: Systematic Evaluation of the Effect ofAcupuncture Therapy on Cancer Pain
Objectives: To evaluate the effect of acupuncture therapy on cancer pain.Methods:Computer database searches of clinica l controlled trials: Cochrane Library(Issue 3, 2008), MEDLINE (1966-June 2008), EMBASE (1974-June 2008),PUBMED (1950-June 2008), SCIENCEDIRECT (1995-June 2008), CONTROLLEDTRIALS(1999-June 2008), Chinese S&T Period icals Database (VIP; 1989-June2008), China Academic Journal Full-text Database (CNKI; 1994-June 2008), andChinese BioMed ica l Literature Database (CBM; 1978-June 2008). Manual searches ofother releva nt literature published between January 2007 and June 2008. Two separateevaluators assessed the quality of the included literature and extracted the usefulinformation. Disa greements were resolved though discussion. Meta-analysis of theincluded literature was done with RevMan5.0, and qualitative analysis was employedwhen meta-a nalysis was not appropriate.Results:Eight published randomizedcontrolled clinica l trials (RCTs), one of high quality, with a total of 700 patients, metthe inclusion criteria. Due to flaws in design and reporting that precluded theapplica tion of meta-a nalysis, only qualitative analysis was done on the majority of thepapers. The high-quality paper showed that ear needle therapy is significa ntlysuperior to placebo in pain alleviation. The other seven (low-q uality clinica l controlledtrials with non-placebo control groups) all showed that acupuncture therapy had somepositive effect. Conclusion:Acupuncture is effective for pain relief. However, the poorquality of the majority of the papers reduces the reliability of the conclusion. Morehigh quality RCTs are needed to verify the effects.
The Second Part: The Clinical Study
Objectives: To observe analgesic effect of acupuncture on carcinous pain and itseffect on the quality of patient's life and patient's mental status. Methods: 22 patients with carcinous pain were stratified into 3 levels, light, moderate and severe pain, andthen were assigned into acupuncture group and placebo group according to randomnumber table. Both groups can ma inta in the usage of analgesic drug of baseline levelduring the study period. Visua l analog scale (VAS) was employed during study periodto evaluate clinica l effect of acupuncture on pain alleviation, and QLQ-C30 scale andSCL-90 scale were used to evaluate improvement of quality of patient's life andpatient's mental status. ResultResults: No statistica lly significa nt difference was foundbetween acupuncture group and placebo group in VAS pain score measured at 7th,14th, 21st day of treatment, while within acupuncture group at the above 3 time points,no statistica lly significa nt differe nce was found in VAS score between pre- and posttreatment.Within placebo group, statistica lly significa nt difference was found in VASscore between pre- and post-treatment at 14th and 21st day (P<0.05). Result of QLQC30scale showed that no statistica lly significa nt difference was found in any otherscore factors both between the two groups and between pre- and post-treatment at 7thday of treatment within each of the two groups, with an exception of the score factorof "Loss of Appetite" between the two groups at 7th day of treatment (P<0.05). Resultof SCL-90 scale showed that no statistica lly significa nt difference was found in anyother score factors both between the two groups and between pre- and post-treatmentat 7th day of treatment within each of the two groups, with an exception of the scorefactor of "Compulsive Symptom" within acupuncture group at 7th day of treatment(P<0.05). Conclusion: Due to the limited number of study subjects, effect ofacupuncture on carcinous pain can not be determined, nor can it be proved thatacupuncture can improve patient life's quality and overa ll mental status. However,study result indica ted that acupuncture can, to some extent, improve compulsivesymptom for patients. Still, a large scale study is needed to confirm it. Considerationson the design of future large-scale randomized controlled clinica l trial: 1. Multi-centercooperation method should be employed to increase number of study subjects; 2.Observe more on the immed iate effect of acupuncture in treating carcinous pain; 3. Acombination of VAS and VRS-5 should be used for evaluation of pain.
目的：评价针刺治疗癌痛的疗效。方法：计算机检索Cochrane图书馆临床对照试验数据库（2008年第3期）、MEDLINE(1966～2008.6)、EMBASE(1974～2008.6)、PUBMED(1950～2008.6)、SCIENCEDIRECT(1995～2008.6)、CONTROLLED-TRIALS（1999～2008.6）、中文科技期刊全文数据库(VIP)（1989～2008.6）、中国学术期刊全文数据库（CNKI）（1994～2008.6）、中国生物医学文献数据库(CBM) (1978～2008.6),手工检索2007年1月至2008年6月发表的其它相关中文文献。由两名评价者独立对纳入文献进行质量评价并提取资料，如遇分歧，通过讨论解决。对纳入文献用RevMan5.0进行Meta分析，如果无法进行Meta分析，则进行定性分析。结果：8篇随机对照临床试验，共700例病人符合纳入标准，其中高质量研究1篇。由于绝大部分文献在试验设计、报道上存在明显缺陷，以及各试验间存在较大差异，不符合Meta分析条件，因而只进行了定性分析。结果显示，除一篇有关耳针疗法的高质量研究展示耳针组在镇痛效果上要显著优于安慰耳针组外，其它均为与非安慰对照组相比较且低质量的临床对照试验，但都提示针刺疗法有一定效果。结论：针刺治疗癌痛有效，但入选的绝大部分试验质量不高，降低了该结论的可靠性，还需更多设计严谨的高质量随机对照试验来证实。
第二部分临床研究
目的：观察针刺疗法对癌痛的镇痛效果及对癌痛患者生活质量、精神状态的影响。方法：将22例癌痛患者根据疼痛的轻、中、重不同程度分为3层，按照随机数字表把每一层病人随机分配到针刺组和安慰组。两组均可在研究期间维持基线期的镇痛药使用情况。研究期间用VAS疼痛量表评价疼痛缓解的临床疗效，并分别用QLQ-C30量表以及SCL-90量表评价癌痛患者的生活质量及精神状态。结果：针刺组及安慰组在第7天、第14天及第21天这3个时间点的VAS疼痛评分前后差值组间比较无显著性差异，且针刺组在以上3个时间点的前后差值组内比较亦无显著性差异。但安慰组在第14天及第21天的前后差值组内比较P<0.05,具有显著性差异。QLQ-C30量表评分结果显示，除在食欲丧失计分因子方面，针刺组与安慰组第7天的组间比较P<0.05,有显著差异外，其它因子评分方面的比较，无论是组间还是组内均无明显差异。SCL-90量表评分结果显示，除在强迫症状因子方面，针刺组在第7天的组内比较P<0.05,具有显著性差异外，其它因子评分方面的比较，无论是组间还是组内均无明显差异。结论：由于本初步研究的病例数较少，尚无法确定针刺对癌痛是否有效，亦无法证明其能否改善癌痛患者的生活质量和整体精神状态，但研究结果提示针刺可能会对癌痛患者的强迫症状有一定的改善作用，可是仍需更大规模的试验来证实。本试验对未来大规模的随机对照临床试验在设计上的思考：1、采取多中心合作的方式扩大研究病例数；2、增加对针刺治疗癌痛即时效果的观察；3、采用VAS与VRS-5相结合的疼痛评价方法。
The First Part: Systematic Evaluation of the Effect ofAcupuncture Therapy on Cancer Pain
Objectives: To evaluate the effect of acupuncture therapy on cancer pain.Methods:Computer database searches of clinica l controlled trials: Cochrane Library(Issue 3, 2008), MEDLINE (1966-June 2008), EMBASE (1974-June 2008),PUBMED (1950-June 2008), SCIENCEDIRECT (1995-June 2008), CONTROLLEDTRIALS(1999-June 2008), Chinese S&T Period icals Database (VIP; 1989-June2008), China Academic Journal Full-text Database (CNKI; 1994-June 2008), andChinese BioMed ica l Literature Database (CBM; 1978-June 2008). Manual searches ofother releva nt literature published between January 2007 and June 2008. Two separateevaluators assessed the quality of the included literature and extracted the usefulinformation. Disa greements were resolved though discussion. Meta-analysis of theincluded literature was done with RevMan5.0, and qualitative analysis was employedwhen meta-a nalysis was not appropriate.Results:Eight published randomizedcontrolled clinica l trials (RCTs), one of high quality, with a total of 700 patients, metthe inclusion criteria. Due to flaws in design and reporting that precluded theapplica tion of meta-a nalysis, only qualitative analysis was done on the majority of thepapers. The high-quality paper showed that ear needle therapy is significa ntlysuperior to placebo in pain alleviation. The other seven (low-q uality clinica l controlledtrials with non-placebo control groups) all showed that acupuncture therapy had somepositive effect. Conclusion:Acupuncture is effective for pain relief. However, the poorquality of the majority of the papers reduces the reliability of the conclusion. Morehigh quality RCTs are needed to verify the effects.
The Second Part: The Clinical Study
Objectives: To observe analgesic effect of acupuncture on carcinous pain and itseffect on the quality of patient's life and patient's mental status. Methods: 22 patients with carcinous pain were stratified into 3 levels, light, moderate and severe pain, andthen were assigned into acupuncture group and placebo group according to randomnumber table. Both groups can ma inta in the usage of analgesic drug of baseline levelduring the study period. Visua l analog scale (VAS) was employed during study periodto evaluate clinica l effect of acupuncture on pain alleviation, and QLQ-C30 scale andSCL-90 scale were used to evaluate improvement of quality of patient's life andpatient's mental status. ResultResults: No statistica lly significa nt difference was foundbetween acupuncture group and placebo group in VAS pain score measured at 7th,14th, 21st day of treatment, while within acupuncture group at the above 3 time points,no statistica lly significa nt differe nce was found in VAS score between pre- and posttreatment.Within placebo group, statistica lly significa nt difference was found in VASscore between pre- and post-treatment at 14th and 21st day (P<0.05). Result of QLQC30scale showed that no statistica lly significa nt difference was found in any otherscore factors both between the two groups and between pre- and post-treatment at 7thday of treatment within each of the two groups, with an exception of the score factorof "Loss of Appetite" between the two groups at 7th day of treatment (P<0.05). Resultof SCL-90 scale showed that no statistica lly significa nt difference was found in anyother score factors both between the two groups and between pre- and post-treatmentat 7th day of treatment within each of the two groups, with an exception of the scorefactor of "Compulsive Symptom" within acupuncture group at 7th day of treatment(P<0.05). Conclusion: Due to the limited number of study subjects, effect ofacupuncture on carcinous pain can not be determined, nor can it be proved thatacupuncture can improve patient life's quality and overa ll mental status. However,study result indica ted that acupuncture can, to some extent, improve compulsivesymptom for patients. Still, a large scale study is needed to confirm it. Considerationson the design of future large-scale randomized controlled clinica l trial: 1. Multi-centercooperation method should be employed to increase number of study subjects; 2.Observe more on the immed iate effect of acupuncture in treating carcinous pain; 3. Acombination of VAS and VRS-5 should be used for evaluation of pain.
引文
[1]张吉.针灸镇痛机制与临床[M].人民卫生出版社,2007,第一版: 222-522.
[2]郑美珍，沈晓宇，等.针对农村晚期癌痛患者的药物治疗[J].中国实用乡村医生杂志,2007,12(14):29-33.
[3]林泽.针灸治疗癌痛举要[J].中医药学刊,2004,22(3):551-561.
[1]张吉.针灸镇痛机制与临床[M].人民卫生出版社,2007,第一版: 522.
[2]李其松，钱浩，等.癌症并发症及其处理.见:汤钊猷主编.现代肿瘤学[M].上海医科大学出版社,2000:556.
[3] Delia Schaffer, Timothy Florin, Craig Eagle, Ian Marschner,Gurkirpal Singh, Mendel Grobler, Chris Fenn, Manjula Schou andKathleen M Curnow. Risk of serious NSAID-related gastrointestinalevents during long-term exposure: a systematic review MJA 2006; 185(9): 501-506.
[4] Lapeyre-Mestre M, de Castro AM, Bareille MP, Del Pozo JG,Requejo AA,Arias LM, Montastruc JL, Carvajal A. Non-steroidal antiinflammatorydrug-related hepatic damage in France and Spain:analysis from national spontaneous reporting systems. Fundam ClinPharmacol. 2006; 20(4):391-5.
[5]Chan FK.Primer: managing NSAID-induced ulcer complicationsbalancinggastrointestinal and cardiovascular risks. Nat Clin PractGastroenterol Hepatol. 2006; 3(10):563-73.
[6] Schneider V, Levesque LE, Zhang B, Hutchinson T, Brophy JM.Association of selective and conventional nonsteroidalantiinflammatory drugs with acute renal failure: A population-based,nested case-control analysis Am J Epidemiol. 2006; 164(9):881-9.Epub 2006 Sep 27.
[7]贺西征，卢乐萍，尹富敏，等.癌痛药物治疗现状的循证医学研究[J].中国临床康复,2008,8(6):2446-2447.
[8]Reid CM,Martin RM,Sterne JAC,Davies AN,Hanks GW.Oxycodone forCancer-Related Pain:Meta-analysis of Randomized ControlledTrials.ARCH INTERN MED,2006,4(166):837-843.
[9]Lee H,Schmidt K,Ernst E.Acupuncture for the relief of cancerrelatedpain:a systematic review.European Journal ofPain,2005(9):437-444.
[10]Jadad AR,Moore RA,Carroll D,Jenkinson C,Reynolds DJ,GavaghanDJ,McQuay HJ.Assessing the quality of reports of randomaziedclinical trials: is blinding necessary[J]?Control ClinTrials,1996;17(1):1-12.
[11]Moher D, Pham B, Jones A,et al.Does quality of reports ofrandomized trials affect estimates of intervention efficacyreported in meta-analyses. Lancet,1998, 352:609-613.
[12]Kjaergard LL,Villumsen J,Gluud C.Quality of randomized clinicaltrials affects estimates of intervention efficacy(abstract).In:ⅦCochrane Colloquium, Rome, 1999,57.
[13]Vickers A,Goyal N,Harland R,et al.Do certain countries produceonly positive results?A systematic review of controlledtrials.Control Clin Trials,1998,19:159-166.
[14] Egger M ,Smith GD ,Schneider M ,et a1.Bias in metaanalysisdetected by a simple ,graphical test .BMJ ,1997 ,315 :629.
[15]沈素娥.腕踝针加药物对癌症患者止痛效果临床观察[J].中国针灸，2000，3:143-144.
[16]陈良良，胡红琴，沈爱学，王俊岭，等.电刺激对癌痛患者的治疗作用[J].浙江中西医结合杂志，2002，12（8）：516.
[17]金哲秀.针灸两步法治疗大肠癌27例临床分析[J].上海中医药杂志，2003，37（5）：48-49.
[18]Mehling WE,Jacobs B,Acree M,Wilson L,Bostrom A,West J,AcquahJ,Burns B,Chapman J,Hecht FM,et al. Symptom Management with Massageand Acupuncture in Postoperative Cancer Patients: A RandomizedControlled Trial[J]. Journal of Pain and SymptomManagement,2007,33(3):258-266.
[19]卞镝，张宁苏，成泽东，陈以国，等.穴位注射加灸对癌痛患者外周血中β-内啡肽的影响[J].辽宁中医杂志，2004，31（3）：246-247.
[20]卞镝，成泽东，张宁苏，陈以国，等.穴位注射加灸对癌痛患者外周血中IL-2／IL-2R表达的影响[J].中国针灸，2004，24(9):641-644.
[21]卞镝，成泽东，张宁苏，陈以国，等.针灸对癌痛患者免疫机制的调节[J].辽宁中医杂志，2004，31（4）：334-335.
[22]McDonough SM,Liddle SD,Hunter R,Walsh DM,Glasgow P,GormleyG,Hurley D,Delitto A,Park J,Bradbury I,Baxter GD,et al.Exercise andmanual auricular acupuncture: a pilot assessor-blind randomisedcontrolled trial[J].BMC Musculoskelet Disord,2008,9-(31).
[23]钭志萍，雷永海，郑桂爱，洪波，等.足三里穴穴位注射对胃癌终末期镇痛作用观察[J].浙江中西医结合杂志，2004，19(9):538-539.
[24]肖建华，李力军，等.针刺缓解癌痛50例观察[J].针刺研究，1994，3：139-140.
[25]党文，杨介宾，等.针刺治疗胃癌痛的临床研究[J].针灸经络，1995，36（5）:277-280.
[26]丹宇，梁亚兵，陶冶，等.针刺对癌症疼痛镇痛作用的临床研究[J].中国针灸，1998，1:17-18.
[27]边荣华.针刺对癌症疼痛的镇痛作用观察[J].实用中医药杂志，1999，15（7）:28.
[28]孙亚林，于连荣，等.齐刺留针法治疗肝癌疼痛80例疗效观察[J].中国针灸，2000，4:211-212.
[29]章梅，夏天，吴少华，张仲海，张燕军，等.针刺和中药对癌症疼痛镇痛作用的临床研究[J].针刺研究，2000，25（1）:64-66.
[30] Alimi D,Rubino C, Pichard-Le′andri E, Fermand-Brule′S, DubreuilDubreuil-Lemaire ML,Hill C. Analgesic Effect of Auricular Acupuncturefor Cancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journalof Clinical Oncology,2003,21(22):4120 -4126.
[31]陈仲杰，郭宇鹏，吴中朝，等.以痛为腧针刺治疗癌性疼痛疗效观察[J].中国针灸，2008，28(4):251-253.
[32]胡侠，顾伟，周庆辉，凌昌全，等.腕踝针对肝癌疼痛的镇痛疗效及对神经肽类物质的影响[J].中西医结合肝病杂志，2005，15（3）：131-133.
[33]胡侠，凌昌全，周庆辉，等.腕踝针治疗中晚期肝癌疼痛的临床观察[J].中国针灸，2004，24(3):149-151.
[34]陈华，刘颖，等.针灸配合三阶梯镇痛治疗癌性疼痛31例疗效观察[J].中华实用中西医杂志，2002，2(9):1125-1126.
[35]刘秀艳.针灸与穴位注射药物治疗肝癌疼痛3O例[J].陕西中医，2007，2 8（9）：1225-1226.
[36]刘秀艳，董瑞萍，等.针灸与穴位注射药物治疗肝癌疼痛51例[J].陕西中医，2008，29（3）：347-348.
[37]孙国杰等.针灸学[M].上海科学技术出版社,1997,第一版:169.
[38]王牧民，黄静，裴志东，等.癌痛三阶梯止痛45例观察[J].中国肿瘤临床与康复，2001，8（1）：76.
[39]宿向东，王莉，等.中晚期癌症三阶梯止痛80例疗效观察[J].四川肿瘤防治，1998，11（3）：18-20.
[40]郭智荣，周朝娟，陈登玲，王美江，等.盐酸吗啡控释片治疗中、重度癌痛的疗效观察[J].中国肿瘤临床与康复，2001，8（4）：114-115.
[41]关铁军，金刚，李大为，等.盐酸吗啡控释片治疗中重度癌痛疗效的临床观察[J].实用肿瘤学杂志，2001，15（4）：285.
[42]丁莉.美菲康治疗中、重度癌痛的临床观察[J].中华医学研究与实践，2005，3（1）：48-49.
[43]赵善琳，韦燕，龚建忠，等.美菲康治疗晚期癌症疼痛70例临床观察[J].右江民族医学院学报，2007，4：537-538.
[44]中国科学院生理研究所.不同针刺参数对针麻临床效果的影响[J].针刺麻醉, 1978，1：109.
[45]王吉耀.循证医学与临床实践[M].科学出版社，2002，第一版：58.
[46]刘平，童瑶，等.中医药科学研究思路与方法[M].上海中医药大学出版社，2003，第一版:56.
[47]王杨，李卫，成小如，贾宣，等.随机模拟法验证非劣效临床试验样本量计算公式[J].中国卫生统计，2008，25（1）：26-28.
[48]许玲，魏品康，孙大志，Lixing Lao，等.中药治疗癌痛临床文献41篇的分析[J].世界华人消化杂志，2007,15（35）：3764-3769.
[1]胡侠，顾伟，周庆辉，凌昌全，等.腕踝针对肝癌疼痛的镇痛疗效及对神经肽类物质的影响[J].中西医结合肝病杂志，2005，15（3）：131-133.
[2]Alimi D,Rubino C, Pichard-Le′andri E, Fermand-Brule′S, Dubreuil -Lemaire ML,Hill C. Analgesic Effect of Auricular Acupuncture forCancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journal ofClinical Oncology,2003,21(22):4120-4126.
[3]张吉.针灸镇痛机制与临床[M].人民卫生出版社,2007,第一版: 222-522.
[4]陈仲杰，郭宇鹏，吴中朝，等.以痛为腧针刺治疗癌性疼痛疗效观察[J].中国针灸，2008，28(4):251-253.
[5]钭志萍，雷永海，郑桂爱，洪波，等.足三里穴穴位注射对胃癌终末期镇痛作用观察[J].浙江中西医结合杂志，2004，19(9):538-539.
[6]贾爱华，邵军，马振军，等.影响晚期癌症病人生活质量因素的探讨[J].首都医科大学学报，2004，25（3）：363-365.
[7]万冬桂，吴玉华，等.癌痛患者伴发抑郁的相关因素及中医治疗[J].中国中医药信息杂志，2004，11（5）：386-387.
[8] Lani Zimnerman,Kristine Turner Story,Fannie Caston Johansson,etal.Psychological Variables and Cancer Pain[J].Cancer Nursing,1996,19(1):44-53.
[9]陈虹，姜潮，刘启贵，等．晚期癌症患者焦虑抑郁及相关因素的研究[J]．中国临床心理学杂志，2002，10(2)：lO8-11O.
[10]付文彬，张波，等.癌痛的针灸治疗思路[J]．上海针灸杂志，1999，18（4）：32-33.
[11]党文，杨介宾，等.针刺治疗胃癌痛的临床研究[J].针灸经络，1995，36（5）:277-280.
[12]丹宇，梁亚兵，陶冶，等.针刺对癌症疼痛镇痛作用的临床研究[J].中国针灸，1998，1:17-18.
[13]边荣华.针刺对癌症疼痛的镇痛作用观察[J].实用中医药杂志，1999，15（7）:28.
[14]孙亚林，于连荣，等.齐刺留针法治疗肝癌疼痛80例疗效观察[J].中国针灸，2000，4:211-212.
[15]章梅，夏天，吴少华，张仲海，张燕军，等.针刺和中药对癌症疼痛镇痛作用的临床研究[J].针刺研究，2000，25（1）:64-66.
[16]肖建华，李力军，等.针刺缓解癌痛50例观察[J].针刺研究，1994，3：139-140.
[17]卞镝，张宁苏，成泽东，陈以国，等.穴位注射加灸对癌痛患者外周血中β-内啡肽的影响[J].辽宁中医杂志，2004，31(3): 246-247.
[18]孙燕.癌症疼痛的综合治疗[J].实用肿瘤内科杂志，1992，7(2)：120．
[19]孙国杰等.针灸学[M].上海科学技术出版社,1997,第一版:174.
[20]黄梅芳，俞昌德，等．安慰对照针灸方法的可信性测试[J]．中国针灸，2004，24(7)：507-509.
[21]刘慧林，张琰，李敬道，陈鹏，王麟鹏，等.针灸临床研究针刺安慰对照方法的设计与实践[J].中国循证医学杂志，2008，8（12）：1133-1135.
[22] Fisahman B，Pastemak S，Wallenstein SL,et a1．The memorial painassessment card[J].Cancer,1987,60：1151—1158.
[23] Enblom Anna, Hammar Mats, Steineck Gunnar, Borjeson Sussanne，etal.Can individuals identify if needling was performed with anacupuncture needle or a non-penetrating sham needle[J]．ComplementaryTherapies in Medicine，2008，16：288-294.
[1] ZhangHANG Ji. Analgesia Mechanism and Clinical Application of Acupuncture [M]. People’sHygiene Publishing House, 2007, First Edition: 522.
[2] Li QS, Qian H, etc. Cancer Complications and Its Management. See: TANG Zhao-you (chiefeditor). Modern Oncology [M]. Shanghai Medical University Publishing House, 2000: 556.
[3] Delia S, Timothy F, Craig E,,,et al. Risk of serious NSAID-related gastrointestinal eventsduring long-term exposure: a systematic review MJA 2006; 185 (9): 501-506.
[4] Lapeyre-Mestre M, de Castro AM, Bareille MP, et al.Non-steroidal anti-inflammatory drugrelatedhepatic damage in France and Spain: analysis from national spontaneous reporting systems.Fundam Clin Pharmacol. 2006; 20(4):391-5.
[5]Chan FK. Primer: managing NSAID-induced ulcer complications--balancing gastrointestinaland cardiovascular risks. Nat Clin Pract Gastroenterol Hepatol. 2006; 3(10):563-73.
[6] Schneider V, Levesque LE, Zhang B,et al. Association of selective and conventionalnonsteroidal antiinflammatory drugs with acute renal failure: A population-based, nested casecontrolanalysis Am J Epidemiol. 2006; 164(9):881-9. Epub 2006 Sep 27.
[7] He XZ, Lu LP, Yin FM, et al. Evidence-based research on drug treatment of carcinous pain [J].Chinese Journal of Clinical Rehabilitatio , 2008,8(6): 2446-2447.
[8]Reid CM,Martin RM,Sterne JAC,Davies AN,Hanks GW.Oxycodone for Cancer-RelatedPain:Meta-analysis of Randomized Controlled Trials.ARCH INTERN MED,2006,4(166):837-843.
[9]Lee H,Schmidt K,Ernst E.Acupuncture for the relief of cancer-related pain:a systematicreview.European Journal of Pain,2005(9):437-444.
[10]Jadad AR,Moore RA,Carroll D,Jenkinson C,Reynolds DJ,Gavaghan DJ,McQuay HJ.Assessingthe quality of reports of randomazied clinical trials: is blinding necessary[J]?Control ClinTrials,1996;17(1):1-12.
[11]Moher D, Pham B, Jones A,et al.Does quality of reports of randomized trials affect estimates ofintervention efficacy reported in meta-analyses. Lancet,1998, 352:609-613.
[12]Kjaergard LL,Villumsen J,Gluud C.Quality of randomized clinical trials affects estimates ofintervention efficacy(abstract).In:ⅦCochrane Colloquium, Rome, 1999,57.
[13]Vickers A,Goyal N, Harland R, et al. Do certain countries produce only positive results?Asystematicreview of controlled trials.Control Clin Trials, 1998,19 : 159-166.
[14] Egger M ,Smith GD ,Schneider M ,et a1.Bias in metaanalysis detected by a simple ,graphicaltest .BMJ ,1997 ,315 :629.
[15] Shen SS. Clinical Investigation on Analgesic Effect of Wrist-Ankle Needling in the Patientof Cancer [J]. Chinese Acupuncture & Moxibustion，2000，3:143-144.
[16] Chen LL, Hu HQ, Shen AX, Wang JL, et al. Therapeutic Effect of Electric Stimulationon Patients with Carcinous Pain [J].Zhe jiang Jouranl of Integrated Traditional Chinese andWestern Medicine,2002，12（8）：516.
[17]Jin ZX. Clinical Analysis of Two-Phase Acupuncture-Moxibustion Therapy for LargeIntestine Cancer in 27 Cases [J]. Shanghai Journal of Traditional Chinese Medicine，2003，3 7（5）：48-49.
[18]Mehling WE, Jacobs B, Acree M, et al. Symptom Management with Massage and Acupuncturein Postoperative Cancer Patients: A Randomized Controlled Trial[J]. Journal of Pain andSymptom Management,2007,33(3):258-266.
[19]Bian D, Cheng ZD, Zhang NS]，et al. Effect of Acupoint Injection and Moxibustion onβ-endorphin in peripheral blood of Patients with Carcinous Pain [J]. Liaoning Journal of TraditionalChinese Medicine，2004,31(3):246-247.
[20] Bian D, Cheng ZD, Zhang NS，et al. Effects of Acupoint—injection plus moxibustion onIL-2／IL-2R expression in peripheral blood in the patient with carcinous pain [J]. ChineseAcupuncture & Moxibustion，2004，24(9):641-644.
[21] Bian D, Cheng ZD, Zhang NS，et al. Regulation of Immunologic Mechanism ofAcupuncture on Patients with Carcinous Pain [J]. Liaoning Journal of Traditional ChineseMedicine，2004，31（4）：334-335.
[22]McDonough SM, Liddle SD, Hunter R, et al.Exercise and manual auricular acupuncture: apilot assessor-blind randomised controlled trial[J].BMC Musculoskelet Disord,2008,9-(31).
[23] Dou ZP,Lei YH, Zheng GA,et al. Observation on the Abirritation of Zusanli PointInjection on Late Gastric Carcinoma [J]. Zhejiang Jouranl of Integrated Traditional Chinese andWestern Medicine，2004，19(9):538-539.
[24]Xiao JH, LI LJ, et al. Observation of 50 Cases of Cancer Pain Relieved byAcupuncture[J].Acupuncture research,1994,3:139-140.
[25] Dang W, Yang JB, et al. Clinical Research of Acupuncture on Gastric Carcinoma Pain [J].Journal of Traditional Chinese Medicine，1995，36（5）:277-280.
[26] Yu D, Liang YB, Tao Y, et al. Clinical Reseach of Analgesic Effect of Acupuncture onCarcinous Pain [J]. Chinese Acupuncture & Moxibustion，1998，1:17-18.
[27]Bian RH. Observation on Analgesic Effect of Acupuncture on Carcinous Pain [J].Journal ofPractical Traditional Chinese Medicine,1999,15(7):28.
[28] Sun YL, Yu LR, et al. Observation on Therapeutic Effect of Needle-Retaining Method ofTriple Puncture in 80 Cases of Pain due to Hapetic Cancer [J]. Chinese Acupuncture &Moxibustion，2000，4:211-212.
[29]Zhang M，Xia T，Wu SH，Zhang ZH，Zhang YJ,et al. Analgesic Effect of Chinese Herbsand Acupuncture on Cancer Patients [J]. Acupuncture research,2000,25(1):64-66.
[30] Alimi D,Rubino C, Pichard-Le′andri E, et al.Analgesic Effect of Auricular Acupuncture forCancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journal of ClinicalOncology,2003,21(22):4120-4126.
[31] Chen ZJ,Guo YP,Wu ZC , et al. Observation on the therapeutic effect of acupuncture at painpoints on cancer pain [J]. Chinese Acupuncture & Moxibustion,2008,28(4):251-253.
[32]Hu Xia,Gu Wei, Zhou QH, et al. Analgesic Efficacy and Mechanism of Wrist-ankleAcupuncture on Pain Caused by Liver Cancer [J]. Chinese Journal of Integrated Traditional andWestern Medicine on Liver Diseases,2005,15（3）：131-133.
[33] Hu X, Ling CQ, Zhou QH, et al. Clinical observation on wrist-ankle acupuncture fortreatment of pain of middle-late liver cancer [J]. Chinese Acupuncture &Moxibustion,2004,24(3):149-151.
[34]Chen H, Liu Y, et al. Effective observations on treating cancerous pain byAcupuncture and Moxibustion and three levels analgesia [J]. Chinese Journal of the PracticalChinese with Modern Medicine,2002,2(9):1125-1126.
[35] Liu XY. 30 cases with liver cancer pain treated with acupuncture and drug injection at points[J]. Shanxi Journal of Traditional Chinese Medicine, 2007, 28 (9): 1225-1226.
[36] Liu XY, Dong RP, et al. 51 cases with liver cancer pain treated with acupuncture and druginjection at points [J]. Shanxi Journal of Traditional Chinese Medicine, 2008, 29 (3): 347-348.
[37] Sun GJ, et al. Acupuncture-moxibustion [M]. Shanghai Science and Technology PublishingHouse, 1997, First Edition: 169.
[38] Wang MM, Huang J, et al. Observation of three-step analgesic ladder for carcinous pain in 45cases [J]. Chinese Journal of Clinical Oncology and Rehabilitation，2001, 8 (1): 76.
[39] Su XD, Wang Li, et al. Observation of Treatment for Medium to Advanced Carcinous Painwith Three-step Analgesic Ladder in 80 Cases [J]. Sichuan Journal of Cancer Control, 1998, 11(3):18-20.
[40] Guo ZR, Zhou CJ, Chen DL, Wang MJ, et al. Observation of treatment for medium toadvanced carcinous pain with Morphine Hydrochloride Sustained- release Tablets [J]. ChineseJournal of Clinical Oncology and Rehabilitation, 2001, 8 (4): 114-115.
[41] Guan TJ, Jin G, Li DW, et al. Clinical Observation of treatment for medium toadvanced carcinous pain with Morphine Hydrochloride Sustained- release Tablets [J]. Journal ofPractical Oncology, 2001, 15 (4): 285.
[42]Ding Li. Clinical Observation of Treatment with Morphine on medium to advancedcarcinous pain [J]. Chinese Journal of Medical Research and Application,2005,3(1):48-49.
[43]Zhao SL, Wei Y, Gong JZ, et al. Clinical Observation of Treatment with Morphine onTerminal Carcinous Pain in 70 cases [J]. Journal of Youjiang Medical College for Nationalities,2007, 4: 537-538.
[44] Institute of Physiology, Chinese Academy of Sciences. Influence of Different Parameters onClinical Effect of Acupuncture [J]. acupuncture anaesthesia, 1978，1：109.
[45] Wang JY. Evidence-based Medicine and Clinical Practice [M]. Science Publishing House,2002, First Edition: 58.
[46] Liu P, Tong Y, et al. Thought and Method of Traditional Chinese Medicine ScientificResearch [M]. Shanghai University of Traditional Chinese Medicine Publishing House, 2003，FirstEdition:56.
[47] Yang W, Wei L, Xiao RC, Xuan J, et al. Sample Size Calculation in Noninferiority Trial byMonte Carlo Method [J]. Chinese Journal of Health Statistics, 2008, 25 (1): 26-28.
[48] Xu L, Wei PK, Sun DZ, Li Xing Lao，et al. Quality of reporting in 41 randomizedcontrolled clinicaI trials of Chinese medicine for cancer pain [J].World Chinese Journal ofDigestology,2007,15(35):3764-3769.
[2]郑美珍，沈晓宇，等.针对农村晚期癌痛患者的药物治疗[J].中国实用乡村医生杂志,2007,12(14):29-33.
[3]林泽.针灸治疗癌痛举要[J].中医药学刊,2004,22(3):551-561.
[1]张吉.针灸镇痛机制与临床[M].人民卫生出版社,2007,第一版: 522.
[2]李其松，钱浩，等.癌症并发症及其处理.见:汤钊猷主编.现代肿瘤学[M].上海医科大学出版社,2000:556.
[3] Delia Schaffer, Timothy Florin, Craig Eagle, Ian Marschner,Gurkirpal Singh, Mendel Grobler, Chris Fenn, Manjula Schou andKathleen M Curnow. Risk of serious NSAID-related gastrointestinalevents during long-term exposure: a systematic review MJA 2006; 185(9): 501-506.
[4] Lapeyre-Mestre M, de Castro AM, Bareille MP, Del Pozo JG,Requejo AA,Arias LM, Montastruc JL, Carvajal A. Non-steroidal antiinflammatorydrug-related hepatic damage in France and Spain:analysis from national spontaneous reporting systems. Fundam ClinPharmacol. 2006; 20(4):391-5.
[5]Chan FK.Primer: managing NSAID-induced ulcer complicationsbalancinggastrointestinal and cardiovascular risks. Nat Clin PractGastroenterol Hepatol. 2006; 3(10):563-73.
[6] Schneider V, Levesque LE, Zhang B, Hutchinson T, Brophy JM.Association of selective and conventional nonsteroidalantiinflammatory drugs with acute renal failure: A population-based,nested case-control analysis Am J Epidemiol. 2006; 164(9):881-9.Epub 2006 Sep 27.
[7]贺西征，卢乐萍，尹富敏，等.癌痛药物治疗现状的循证医学研究[J].中国临床康复,2008,8(6):2446-2447.
[8]Reid CM,Martin RM,Sterne JAC,Davies AN,Hanks GW.Oxycodone forCancer-Related Pain:Meta-analysis of Randomized ControlledTrials.ARCH INTERN MED,2006,4(166):837-843.
[9]Lee H,Schmidt K,Ernst E.Acupuncture for the relief of cancerrelatedpain:a systematic review.European Journal ofPain,2005(9):437-444.
[10]Jadad AR,Moore RA,Carroll D,Jenkinson C,Reynolds DJ,GavaghanDJ,McQuay HJ.Assessing the quality of reports of randomaziedclinical trials: is blinding necessary[J]?Control ClinTrials,1996;17(1):1-12.
[11]Moher D, Pham B, Jones A,et al.Does quality of reports ofrandomized trials affect estimates of intervention efficacyreported in meta-analyses. Lancet,1998, 352:609-613.
[12]Kjaergard LL,Villumsen J,Gluud C.Quality of randomized clinicaltrials affects estimates of intervention efficacy(abstract).In:ⅦCochrane Colloquium, Rome, 1999,57.
[13]Vickers A,Goyal N,Harland R,et al.Do certain countries produceonly positive results?A systematic review of controlledtrials.Control Clin Trials,1998,19:159-166.
[14] Egger M ,Smith GD ,Schneider M ,et a1.Bias in metaanalysisdetected by a simple ,graphical test .BMJ ,1997 ,315 :629.
[15]沈素娥.腕踝针加药物对癌症患者止痛效果临床观察[J].中国针灸，2000，3:143-144.
[16]陈良良，胡红琴，沈爱学，王俊岭，等.电刺激对癌痛患者的治疗作用[J].浙江中西医结合杂志，2002，12（8）：516.
[17]金哲秀.针灸两步法治疗大肠癌27例临床分析[J].上海中医药杂志，2003，37（5）：48-49.
[18]Mehling WE,Jacobs B,Acree M,Wilson L,Bostrom A,West J,AcquahJ,Burns B,Chapman J,Hecht FM,et al. Symptom Management with Massageand Acupuncture in Postoperative Cancer Patients: A RandomizedControlled Trial[J]. Journal of Pain and SymptomManagement,2007,33(3):258-266.
[19]卞镝，张宁苏，成泽东，陈以国，等.穴位注射加灸对癌痛患者外周血中β-内啡肽的影响[J].辽宁中医杂志，2004，31（3）：246-247.
[20]卞镝，成泽东，张宁苏，陈以国，等.穴位注射加灸对癌痛患者外周血中IL-2／IL-2R表达的影响[J].中国针灸，2004，24(9):641-644.
[21]卞镝，成泽东，张宁苏，陈以国，等.针灸对癌痛患者免疫机制的调节[J].辽宁中医杂志，2004，31（4）：334-335.
[22]McDonough SM,Liddle SD,Hunter R,Walsh DM,Glasgow P,GormleyG,Hurley D,Delitto A,Park J,Bradbury I,Baxter GD,et al.Exercise andmanual auricular acupuncture: a pilot assessor-blind randomisedcontrolled trial[J].BMC Musculoskelet Disord,2008,9-(31).
[23]钭志萍，雷永海，郑桂爱，洪波，等.足三里穴穴位注射对胃癌终末期镇痛作用观察[J].浙江中西医结合杂志，2004，19(9):538-539.
[24]肖建华，李力军，等.针刺缓解癌痛50例观察[J].针刺研究，1994，3：139-140.
[25]党文，杨介宾，等.针刺治疗胃癌痛的临床研究[J].针灸经络，1995，36（5）:277-280.
[26]丹宇，梁亚兵，陶冶，等.针刺对癌症疼痛镇痛作用的临床研究[J].中国针灸，1998，1:17-18.
[27]边荣华.针刺对癌症疼痛的镇痛作用观察[J].实用中医药杂志，1999，15（7）:28.
[28]孙亚林，于连荣，等.齐刺留针法治疗肝癌疼痛80例疗效观察[J].中国针灸，2000，4:211-212.
[29]章梅，夏天，吴少华，张仲海，张燕军，等.针刺和中药对癌症疼痛镇痛作用的临床研究[J].针刺研究，2000，25（1）:64-66.
[30] Alimi D,Rubino C, Pichard-Le′andri E, Fermand-Brule′S, DubreuilDubreuil-Lemaire ML,Hill C. Analgesic Effect of Auricular Acupuncturefor Cancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journalof Clinical Oncology,2003,21(22):4120 -4126.
[31]陈仲杰，郭宇鹏，吴中朝，等.以痛为腧针刺治疗癌性疼痛疗效观察[J].中国针灸，2008，28(4):251-253.
[32]胡侠，顾伟，周庆辉，凌昌全，等.腕踝针对肝癌疼痛的镇痛疗效及对神经肽类物质的影响[J].中西医结合肝病杂志，2005，15（3）：131-133.
[33]胡侠，凌昌全，周庆辉，等.腕踝针治疗中晚期肝癌疼痛的临床观察[J].中国针灸，2004，24(3):149-151.
[34]陈华，刘颖，等.针灸配合三阶梯镇痛治疗癌性疼痛31例疗效观察[J].中华实用中西医杂志，2002，2(9):1125-1126.
[35]刘秀艳.针灸与穴位注射药物治疗肝癌疼痛3O例[J].陕西中医，2007，2 8（9）：1225-1226.
[36]刘秀艳，董瑞萍，等.针灸与穴位注射药物治疗肝癌疼痛51例[J].陕西中医，2008，29（3）：347-348.
[37]孙国杰等.针灸学[M].上海科学技术出版社,1997,第一版:169.
[38]王牧民，黄静，裴志东，等.癌痛三阶梯止痛45例观察[J].中国肿瘤临床与康复，2001，8（1）：76.
[39]宿向东，王莉，等.中晚期癌症三阶梯止痛80例疗效观察[J].四川肿瘤防治，1998，11（3）：18-20.
[40]郭智荣，周朝娟，陈登玲，王美江，等.盐酸吗啡控释片治疗中、重度癌痛的疗效观察[J].中国肿瘤临床与康复，2001，8（4）：114-115.
[41]关铁军，金刚，李大为，等.盐酸吗啡控释片治疗中重度癌痛疗效的临床观察[J].实用肿瘤学杂志，2001，15（4）：285.
[42]丁莉.美菲康治疗中、重度癌痛的临床观察[J].中华医学研究与实践，2005，3（1）：48-49.
[43]赵善琳，韦燕，龚建忠，等.美菲康治疗晚期癌症疼痛70例临床观察[J].右江民族医学院学报，2007，4：537-538.
[44]中国科学院生理研究所.不同针刺参数对针麻临床效果的影响[J].针刺麻醉, 1978，1：109.
[45]王吉耀.循证医学与临床实践[M].科学出版社，2002，第一版：58.
[46]刘平，童瑶，等.中医药科学研究思路与方法[M].上海中医药大学出版社，2003，第一版:56.
[47]王杨，李卫，成小如，贾宣，等.随机模拟法验证非劣效临床试验样本量计算公式[J].中国卫生统计，2008，25（1）：26-28.
[48]许玲，魏品康，孙大志，Lixing Lao，等.中药治疗癌痛临床文献41篇的分析[J].世界华人消化杂志，2007,15（35）：3764-3769.
[1]胡侠，顾伟，周庆辉，凌昌全，等.腕踝针对肝癌疼痛的镇痛疗效及对神经肽类物质的影响[J].中西医结合肝病杂志，2005，15（3）：131-133.
[2]Alimi D,Rubino C, Pichard-Le′andri E, Fermand-Brule′S, Dubreuil -Lemaire ML,Hill C. Analgesic Effect of Auricular Acupuncture forCancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journal ofClinical Oncology,2003,21(22):4120-4126.
[3]张吉.针灸镇痛机制与临床[M].人民卫生出版社,2007,第一版: 222-522.
[4]陈仲杰，郭宇鹏，吴中朝，等.以痛为腧针刺治疗癌性疼痛疗效观察[J].中国针灸，2008，28(4):251-253.
[5]钭志萍，雷永海，郑桂爱，洪波，等.足三里穴穴位注射对胃癌终末期镇痛作用观察[J].浙江中西医结合杂志，2004，19(9):538-539.
[6]贾爱华，邵军，马振军，等.影响晚期癌症病人生活质量因素的探讨[J].首都医科大学学报，2004，25（3）：363-365.
[7]万冬桂，吴玉华，等.癌痛患者伴发抑郁的相关因素及中医治疗[J].中国中医药信息杂志，2004，11（5）：386-387.
[8] Lani Zimnerman,Kristine Turner Story,Fannie Caston Johansson,etal.Psychological Variables and Cancer Pain[J].Cancer Nursing,1996,19(1):44-53.
[9]陈虹，姜潮，刘启贵，等．晚期癌症患者焦虑抑郁及相关因素的研究[J]．中国临床心理学杂志，2002，10(2)：lO8-11O.
[10]付文彬，张波，等.癌痛的针灸治疗思路[J]．上海针灸杂志，1999，18（4）：32-33.
[11]党文，杨介宾，等.针刺治疗胃癌痛的临床研究[J].针灸经络，1995，36（5）:277-280.
[12]丹宇，梁亚兵，陶冶，等.针刺对癌症疼痛镇痛作用的临床研究[J].中国针灸，1998，1:17-18.
[13]边荣华.针刺对癌症疼痛的镇痛作用观察[J].实用中医药杂志，1999，15（7）:28.
[14]孙亚林，于连荣，等.齐刺留针法治疗肝癌疼痛80例疗效观察[J].中国针灸，2000，4:211-212.
[15]章梅，夏天，吴少华，张仲海，张燕军，等.针刺和中药对癌症疼痛镇痛作用的临床研究[J].针刺研究，2000，25（1）:64-66.
[16]肖建华，李力军，等.针刺缓解癌痛50例观察[J].针刺研究，1994，3：139-140.
[17]卞镝，张宁苏，成泽东，陈以国，等.穴位注射加灸对癌痛患者外周血中β-内啡肽的影响[J].辽宁中医杂志，2004，31(3): 246-247.
[18]孙燕.癌症疼痛的综合治疗[J].实用肿瘤内科杂志，1992，7(2)：120．
[19]孙国杰等.针灸学[M].上海科学技术出版社,1997,第一版:174.
[20]黄梅芳，俞昌德，等．安慰对照针灸方法的可信性测试[J]．中国针灸，2004，24(7)：507-509.
[21]刘慧林，张琰，李敬道，陈鹏，王麟鹏，等.针灸临床研究针刺安慰对照方法的设计与实践[J].中国循证医学杂志，2008，8（12）：1133-1135.
[22] Fisahman B，Pastemak S，Wallenstein SL,et a1．The memorial painassessment card[J].Cancer,1987,60：1151—1158.
[23] Enblom Anna, Hammar Mats, Steineck Gunnar, Borjeson Sussanne，etal.Can individuals identify if needling was performed with anacupuncture needle or a non-penetrating sham needle[J]．ComplementaryTherapies in Medicine，2008，16：288-294.
[1] ZhangHANG Ji. Analgesia Mechanism and Clinical Application of Acupuncture [M]. People’sHygiene Publishing House, 2007, First Edition: 522.
[2] Li QS, Qian H, etc. Cancer Complications and Its Management. See: TANG Zhao-you (chiefeditor). Modern Oncology [M]. Shanghai Medical University Publishing House, 2000: 556.
[3] Delia S, Timothy F, Craig E,,,et al. Risk of serious NSAID-related gastrointestinal eventsduring long-term exposure: a systematic review MJA 2006; 185 (9): 501-506.
[4] Lapeyre-Mestre M, de Castro AM, Bareille MP, et al.Non-steroidal anti-inflammatory drugrelatedhepatic damage in France and Spain: analysis from national spontaneous reporting systems.Fundam Clin Pharmacol. 2006; 20(4):391-5.
[5]Chan FK. Primer: managing NSAID-induced ulcer complications--balancing gastrointestinaland cardiovascular risks. Nat Clin Pract Gastroenterol Hepatol. 2006; 3(10):563-73.
[6] Schneider V, Levesque LE, Zhang B,et al. Association of selective and conventionalnonsteroidal antiinflammatory drugs with acute renal failure: A population-based, nested casecontrolanalysis Am J Epidemiol. 2006; 164(9):881-9. Epub 2006 Sep 27.
[7] He XZ, Lu LP, Yin FM, et al. Evidence-based research on drug treatment of carcinous pain [J].Chinese Journal of Clinical Rehabilitatio , 2008,8(6): 2446-2447.
[8]Reid CM,Martin RM,Sterne JAC,Davies AN,Hanks GW.Oxycodone for Cancer-RelatedPain:Meta-analysis of Randomized Controlled Trials.ARCH INTERN MED,2006,4(166):837-843.
[9]Lee H,Schmidt K,Ernst E.Acupuncture for the relief of cancer-related pain:a systematicreview.European Journal of Pain,2005(9):437-444.
[10]Jadad AR,Moore RA,Carroll D,Jenkinson C,Reynolds DJ,Gavaghan DJ,McQuay HJ.Assessingthe quality of reports of randomazied clinical trials: is blinding necessary[J]?Control ClinTrials,1996;17(1):1-12.
[11]Moher D, Pham B, Jones A,et al.Does quality of reports of randomized trials affect estimates ofintervention efficacy reported in meta-analyses. Lancet,1998, 352:609-613.
[12]Kjaergard LL,Villumsen J,Gluud C.Quality of randomized clinical trials affects estimates ofintervention efficacy(abstract).In:ⅦCochrane Colloquium, Rome, 1999,57.
[13]Vickers A,Goyal N, Harland R, et al. Do certain countries produce only positive results?Asystematicreview of controlled trials.Control Clin Trials, 1998,19 : 159-166.
[14] Egger M ,Smith GD ,Schneider M ,et a1.Bias in metaanalysis detected by a simple ,graphicaltest .BMJ ,1997 ,315 :629.
[15] Shen SS. Clinical Investigation on Analgesic Effect of Wrist-Ankle Needling in the Patientof Cancer [J]. Chinese Acupuncture & Moxibustion，2000，3:143-144.
[16] Chen LL, Hu HQ, Shen AX, Wang JL, et al. Therapeutic Effect of Electric Stimulationon Patients with Carcinous Pain [J].Zhe jiang Jouranl of Integrated Traditional Chinese andWestern Medicine,2002，12（8）：516.
[17]Jin ZX. Clinical Analysis of Two-Phase Acupuncture-Moxibustion Therapy for LargeIntestine Cancer in 27 Cases [J]. Shanghai Journal of Traditional Chinese Medicine，2003，3 7（5）：48-49.
[18]Mehling WE, Jacobs B, Acree M, et al. Symptom Management with Massage and Acupuncturein Postoperative Cancer Patients: A Randomized Controlled Trial[J]. Journal of Pain andSymptom Management,2007,33(3):258-266.
[19]Bian D, Cheng ZD, Zhang NS]，et al. Effect of Acupoint Injection and Moxibustion onβ-endorphin in peripheral blood of Patients with Carcinous Pain [J]. Liaoning Journal of TraditionalChinese Medicine，2004,31(3):246-247.
[20] Bian D, Cheng ZD, Zhang NS，et al. Effects of Acupoint—injection plus moxibustion onIL-2／IL-2R expression in peripheral blood in the patient with carcinous pain [J]. ChineseAcupuncture & Moxibustion，2004，24(9):641-644.
[21] Bian D, Cheng ZD, Zhang NS，et al. Regulation of Immunologic Mechanism ofAcupuncture on Patients with Carcinous Pain [J]. Liaoning Journal of Traditional ChineseMedicine，2004，31（4）：334-335.
[22]McDonough SM, Liddle SD, Hunter R, et al.Exercise and manual auricular acupuncture: apilot assessor-blind randomised controlled trial[J].BMC Musculoskelet Disord,2008,9-(31).
[23] Dou ZP,Lei YH, Zheng GA,et al. Observation on the Abirritation of Zusanli PointInjection on Late Gastric Carcinoma [J]. Zhejiang Jouranl of Integrated Traditional Chinese andWestern Medicine，2004，19(9):538-539.
[24]Xiao JH, LI LJ, et al. Observation of 50 Cases of Cancer Pain Relieved byAcupuncture[J].Acupuncture research,1994,3:139-140.
[25] Dang W, Yang JB, et al. Clinical Research of Acupuncture on Gastric Carcinoma Pain [J].Journal of Traditional Chinese Medicine，1995，36（5）:277-280.
[26] Yu D, Liang YB, Tao Y, et al. Clinical Reseach of Analgesic Effect of Acupuncture onCarcinous Pain [J]. Chinese Acupuncture & Moxibustion，1998，1:17-18.
[27]Bian RH. Observation on Analgesic Effect of Acupuncture on Carcinous Pain [J].Journal ofPractical Traditional Chinese Medicine,1999,15(7):28.
[28] Sun YL, Yu LR, et al. Observation on Therapeutic Effect of Needle-Retaining Method ofTriple Puncture in 80 Cases of Pain due to Hapetic Cancer [J]. Chinese Acupuncture &Moxibustion，2000，4:211-212.
[29]Zhang M，Xia T，Wu SH，Zhang ZH，Zhang YJ,et al. Analgesic Effect of Chinese Herbsand Acupuncture on Cancer Patients [J]. Acupuncture research,2000,25(1):64-66.
[30] Alimi D,Rubino C, Pichard-Le′andri E, et al.Analgesic Effect of Auricular Acupuncture forCancer Pain:A Randomized, Blinded, Controlled Trial[J]. Journal of ClinicalOncology,2003,21(22):4120-4126.
[31] Chen ZJ,Guo YP,Wu ZC , et al. Observation on the therapeutic effect of acupuncture at painpoints on cancer pain [J]. Chinese Acupuncture & Moxibustion,2008,28(4):251-253.
[32]Hu Xia,Gu Wei, Zhou QH, et al. Analgesic Efficacy and Mechanism of Wrist-ankleAcupuncture on Pain Caused by Liver Cancer [J]. Chinese Journal of Integrated Traditional andWestern Medicine on Liver Diseases,2005,15（3）：131-133.
[33] Hu X, Ling CQ, Zhou QH, et al. Clinical observation on wrist-ankle acupuncture fortreatment of pain of middle-late liver cancer [J]. Chinese Acupuncture &Moxibustion,2004,24(3):149-151.
[34]Chen H, Liu Y, et al. Effective observations on treating cancerous pain byAcupuncture and Moxibustion and three levels analgesia [J]. Chinese Journal of the PracticalChinese with Modern Medicine,2002,2(9):1125-1126.
[35] Liu XY. 30 cases with liver cancer pain treated with acupuncture and drug injection at points[J]. Shanxi Journal of Traditional Chinese Medicine, 2007, 28 (9): 1225-1226.
[36] Liu XY, Dong RP, et al. 51 cases with liver cancer pain treated with acupuncture and druginjection at points [J]. Shanxi Journal of Traditional Chinese Medicine, 2008, 29 (3): 347-348.
[37] Sun GJ, et al. Acupuncture-moxibustion [M]. Shanghai Science and Technology PublishingHouse, 1997, First Edition: 169.
[38] Wang MM, Huang J, et al. Observation of three-step analgesic ladder for carcinous pain in 45cases [J]. Chinese Journal of Clinical Oncology and Rehabilitation，2001, 8 (1): 76.
[39] Su XD, Wang Li, et al. Observation of Treatment for Medium to Advanced Carcinous Painwith Three-step Analgesic Ladder in 80 Cases [J]. Sichuan Journal of Cancer Control, 1998, 11(3):18-20.
[40] Guo ZR, Zhou CJ, Chen DL, Wang MJ, et al. Observation of treatment for medium toadvanced carcinous pain with Morphine Hydrochloride Sustained- release Tablets [J]. ChineseJournal of Clinical Oncology and Rehabilitation, 2001, 8 (4): 114-115.
[41] Guan TJ, Jin G, Li DW, et al. Clinical Observation of treatment for medium toadvanced carcinous pain with Morphine Hydrochloride Sustained- release Tablets [J]. Journal ofPractical Oncology, 2001, 15 (4): 285.
[42]Ding Li. Clinical Observation of Treatment with Morphine on medium to advancedcarcinous pain [J]. Chinese Journal of Medical Research and Application,2005,3(1):48-49.
[43]Zhao SL, Wei Y, Gong JZ, et al. Clinical Observation of Treatment with Morphine onTerminal Carcinous Pain in 70 cases [J]. Journal of Youjiang Medical College for Nationalities,2007, 4: 537-538.
[44] Institute of Physiology, Chinese Academy of Sciences. Influence of Different Parameters onClinical Effect of Acupuncture [J]. acupuncture anaesthesia, 1978，1：109.
[45] Wang JY. Evidence-based Medicine and Clinical Practice [M]. Science Publishing House,2002, First Edition: 58.
[46] Liu P, Tong Y, et al. Thought and Method of Traditional Chinese Medicine ScientificResearch [M]. Shanghai University of Traditional Chinese Medicine Publishing House, 2003，FirstEdition:56.
[47] Yang W, Wei L, Xiao RC, Xuan J, et al. Sample Size Calculation in Noninferiority Trial byMonte Carlo Method [J]. Chinese Journal of Health Statistics, 2008, 25 (1): 26-28.
[48] Xu L, Wei PK, Sun DZ, Li Xing Lao，et al. Quality of reporting in 41 randomizedcontrolled clinicaI trials of Chinese medicine for cancer pain [J].World Chinese Journal ofDigestology,2007,15(35):3764-3769.