Acupuncture and dry-needling for low back pain: An updated systematic review within the framework of the Cochrane Collaboration

被引:261
作者
Furlan, AD
van Tulder, M
Cherkin, D
Tsukayama, H
Lao, LX
Koes, B
Berman, B
机构
[1] Inst Work & Hlth, Toronto, ON M5G 2E9, Canada
[2] Vrije Univ Amsterdam Med Ctr, Amsterdam, Netherlands
[3] Grp Hlth Ctr Hlth Studies, Seattle, WA USA
[4] Tsukuba Coll Technol Clin, Tsukuba, Ibaraki, Japan
[5] Univ Maryland, Sch Med, Complementary Med Program, Baltimore, MD 21201 USA
[6] Erasmus Univ, Rotterdam, Netherlands
关键词
systematic review; meta-analysis; Cochrane Collaboration; acupuncture; low back pain;
D O I
10.1097/01.brs.0000158941.21571.01
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Objectives. To assess the effects of acupuncture and dry-needling for the treatment of nonspecific low back pain. Background. Low back pain is usually a self-limiting condition that tends to improve spontaneously over time. However, for many people, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed. Search strategy. We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003. Selection Criteria. Randomized controlled trials of acupuncture ( that involved needling) or dry-needling for adults with nonspecific acute/subacute or chronic low back pain. Data Collection and Analysis. Two reviewers independently assessed methodologic quality ( using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analysis methods or levels of evidence when the data reported did not allow statistical pooling. Results. Thirty-five randomized clinical trials were included: 20 were published in English, 7 in Japanese, 5 in Chinese, and 1 each in Norwegian, Polish, and German. There were only 3 trials of acupuncture for acute low back pain. These studies did not justify firm conclusions because of their small sample sizes and low methodologic quality. For chronic low back pain, there is evidence of pain relief and functional improvement for acupuncture compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and in short-term follow-up. There is also evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, the effects are onlysmall. Dry-needling appears to be a useful adjunct to other therapies for chronic low back pain. No clear recommendations could be made about the most effective acupuncture technique. Conclusions. The data do not allow firm conclusions regarding the effectiveness of acupuncture for acute low back pain. For chronic low back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low back pain. Because most of the studies were of lower methodologic quality, there is a clear need for higher quality trials in this area.
引用
收藏
页码:944 / 963
页数:20
相关论文
共 61 条
[1]
[Anonymous], 1998, SHANGHAI J ACUPUNCTU
[2]
[Anonymous], 2001, J JAPAN SOC ACUPUNTU
[3]
[Anonymous], 1997, CHINESE ACUPUNCTURE
[4]
[Anonymous], 1983, MYOFASCIAL PAIN DYSF
[5]
[Anonymous], 2001, J JAPAN SOC ACUPUNCT
[6]
[Anonymous], 2001, J JAPAN SOC ACUPUNCT
[7]
[Anonymous], 2000, J JAPAN SOC ACUPUNTC
[8]
[Anonymous], 1979, J JAPAN ACUPUNCTURE
[9]
Acupuncture for chronic low back pain:: A randomized placebo-controlled study with long-term follow-up [J].
Carlsson, CPO ;
Sjölund, BH .
CLINICAL JOURNAL OF PAIN, 2001, 17 (04) :296-305
[10]
Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: A double-blind randomized controlled study [J].
Ceccherelli, F ;
Rigoni, MT ;
Gagliardi, G ;
Ruzzante, L .
CLINICAL JOURNAL OF PAIN, 2002, 18 (03) :149-153