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2022, Vol. 26 ›› Issue (5): 813-820Network Meta-analysis of different acupuncture methods for the treatment of lumbar disc herniationWang Nan, Qian Yuzhang, Xie Lin
Abstract: OBJECTIVE: Acupuncture treatment for lumbar disc herniation has good results. However, there are many acupuncture methods. Pairwise comparisons have been mostly used in existing clinical studies, and there is a lack of direct comparisons of the therapeutic effects of several common acupuncture methods. Various acupuncture methods have been used for the treatment of lumbar disc herniation, among which abdominal, floating, warm, electroacupuncture, balance and conventional acupuncture are the most popular and have been widely used in clinical practice. Therefore, we evaluated the efficacy and safety of six acupuncture methods in the treatment of lumbar disc herniation with network Meta-analysis. METHODS: Seven databases including PubMed, EMbase, Cochrane Library, SinoMed, CNKI, WanFang and VIP were searched by computers. Two reviewers independently searched, screened and extracted the data, and randomized controlled trials regarding acupuncture for treating lumbar disc herniation were finally included. Quality of the literatures was assessed using the risk of bias tool in the Cochrane Handbook, and RevMan 5.3, Stata 14 and Gemtc 0.14.3 software were used for data analysis RESULTS: Forty-three randomized controlled trials involving 5 175 patients were finally included and the quality assessment of the literatures was acceptable. The results of network Meta-analysis showed that: (1) in terms of clinical efficiency, all the six acupuncture methods could achieve good curative effects, and the order of efficacy probability was ranked as follows: abdominal needle (0.97) > warm needle (0.47) > floating needle (0.44) > electroacupuncture (0.53) > balance needle (0.52) > conventional acupuncture (0.98). (2) In terms of reducing visual analog scale scores, the order of probability was: floating needle (0.4) > warm needle (0.4) > abdominal needle (0.26) > electroacupuncture (0.44) > balance needle (0.56) > conventional acupuncture (0.79). (3) In terms of safety, only eight of the included literatures mentioned adverse reactions, five of which had no obvious adverse reaction events, and three articles mentioned the occurrence of needle insertion point pain and subcutaneous hematoma, but no symptoms remained after treatment. CONCLUSION: Six acupuncture methods, including abdominal, floating, warm, electroacupuncture, balance and conventional acupuncture, all have good advantages in the treatment of lumbar disc herniation, with no obvious serious adverse reactions. Abdominal needle ranks first in overall clinical efficacy. Floating needle has the first possibility in reducing low back and leg pain. When a severe pain occurs, floating needle can be clinically prioritized. However, high-quality, multicenter, large-sample, randomized double-blind controlled trials are required to verify the reliability of this conclusion. Key words:acupuncture, abdominal needle, floating needle, warm needle, electroacupuncture, balance needle, lumbar disc herniation, network Meta-analysis |