DOC

ACUPUNCTURE

By Willie Daniels,2014-07-06 05:30
11 views 0
ACUPUNCTURE

    ACUPUNCTURE

    WorldJ.AcuMoa?.Vo1.15,No.J,March.2005?53?

    LiteratureAnalysis

    ACUPUNCTUREFoRPRIMARYDYSMENORRHEA

    Ameta-analysis

    CHOUChin.shan(周金山)IIUBao-yan(刘保延)

    ChinaAcadentyofTraditionalChinese

    ZHANGLu(张璐)JINZhi.gao(晋志高)

    Medicine,Beijing1O0700,China

    ABSTRACTRecentliteraturesearchshowedthatupto1313wthereareatotalof9thesesaboutclinicaltreatmentofprimary

    dysmenorrheawithacupuncturetherapy,amongthem5clinicaltrialsarefromChinesejoornalsandtherest4fromforeignjo(.ir-

    nals.Majorityofthetrialshavesomemethodologicaland/orreportingshortcomings.Thefrequencyandintensityofdysmenorrhea

    aredividedintointermittentandcontinuoustypes.Resultsofquantitativerneta-analysiswithRevman4.1softwareshowedthatthe

    existingevidencesupportsthevalueofacupunctureforthetreatmentofdysmenorrhea.However,thequalityofevidenceisnotful-

    lyconvincing.Thereisanurgentneedforwell-planned,large-scaleandmultiple-centerstudiestoassesstheeffectivenessand

    cost-effectivenessofacupunctureunderreal-lifeconditions.

    KEYWORDSDysmenorrheaAcupuncturetherapyLiteratureanalysis

    Dysmenorrheaisreferredtopainfulmenstruation

    duetospasmoftheuterusintheperiodofmenstrua

    tion.Clinicalmanagementofdysmenorrheacotxli"~on

    lyconsistsofnonsteroidalantiinflammatorydrugs

    andoraladministrationofcontraceptivepills,bothof whichworkwellinreducinguterinemuscularactivi

    ty.However,thesetreatmentsareaccompaniedbya numberofsideeffects,makinganonpharmacological

    therapybepotentialvalueintreatingdysmenorrhea. Asaninterventionapproach,acupuncturetherapyhas ahistoryofover3,000yearsinChina.Thediagnosis andtreatmentdescribedinclassicalworksoftradi

    tionalChinesemedicine(TCM)aredeeplyinfluenced bythesystemsofmedicineandphilosophyofancient China.AccordingtothetheoryofFCM,animbal

    aneebetweenandrangofthetxxtypresentsase

    liesoffunctionaldisordersincludingpain,etc.. Acupuncturetreatsillnessesbyregulatingthebalance ofyinyang,andpromotingfreeflowofqi(vitalen

    ergy).Acupunctureisusuallyusedforclinicaltreat

    mentofdysmenorrhea,nevertheless,thereisstilla debateinthemedicalcycleaboutwhetheracupunc

    turehasaspecificanddefiniteeffectratherthanpsy

    chologicalactionSosystematicassessmentontheef

    ficacyofacupuncturetreatmentofdysmenorrhea seemstobeparticularlynecessary.

    Thearticlesaboutacupuncturetreatmentofdys

    menorrhealwerecollectedfromtheCochraneCon

    trolledTrialsRegister(CCRT)ontheCochraneli

    brary;ChinaInformationServiceSystemonTCM(

    国中医药信息网);ChinaNationalKnowledgeIn

    frastructure(www.cnki.net,CNKI中国期刊网);

    ChineseBiologyMedicineDisk(CBMdisk,中国生物

医学文献光盘);MEDLINE,Pubmed,EMBASE

    andBIOSISdatabases.

    Alloftherelatedjournalsandcollectionsofaca

    demicthesesofconferencesinChinafroml949to 2003weresearchedbyhand.Fhesejournalsandcol

    lectionsofacademicthesesincludedAcupunctureRe

    search,ChineseAcupunctureandMoxibustion,Jour

    nalofIntegratedTraditionalandWesternMedicine, etc.,collectionsofacademicthesisof4sessionsof nationalconferencesonacu--moxibustionandacupunc-

    tureanalgesia,etc.

    Allthepaperssearchedfromtheabovementioned journalsandliteraturewerecopiedbytwore

    searchers.Asthefirststep.wetriedtocollectallthe articlesonacupuncturetreatmentofrecurrentdys

    menorrheafromtheoriginaldataandcollectl9theses altogether.Amongthem,10wereexcludedbecause thetreatmentnotonlyinvolvedacupuncturetherapy butalsorecruitedotherremedies,Theremaining9 qualifiedtheseswereanalyzedindetailbyatleasttwo researchers(Table1).Whendi~greementsol2

?54?WorldJ.AcuMoxi.Vo1.15.No.J.March,2005

    curred.weresolvedthembydiscussion.Information aboutpatients,interventionmethods,outcomes,etc. werefilledintoapredesignedtable.Inaddition,we

    alsolistedthefirstauthorsorthecorrespondingan

    thorsoftheprimarystudiesasnecessary.Thequality ofreports/methodologicalqualityoftheincludedtrials wasassessedbyatleasttwoindependentresearchers

    usingJadad'Sscale(Jadad,etal,1996).Themain itemsofthescalewere:?randomallocation(1

    point:ifanadequatemethodtogeneratearandomse

    quencewasdescribed);?double-blindness(1point:

    iftherewasastatementthatbothpatientsandre

    searcherswereblindedandwhentheblindingproee

    durewasdescribedandadequate);?reportof

    dropouts/exclusions(1point:ifdropoutsandwith

    drawalsaswellasthereasonswerelistedindepen. dentlyineachtreatmentgroup).

    Table1Generalinformationabouttheincludedstudies Da?dPainalleviated

    RelatedclinicaIRCT2.1-0TENS(100HZ)/ShamTENS+analg~c. MY32P>O,0528.5scale(15),men5unkfxM

    ,

    criteriaDoublebliIldP0(400ms,t.i.d)( t990)symptonmquestkmnaite

    Note:Noonereportedside-effects.LiYe'trials(1998)includedsimpleprimarydy~aenorrhe

    a(excludedothergynecologicdiseases)

    Gr=group

    I'hemaximumscorewas5points.Studiesscor

    ing3ormorewereconsideredtobehighquality.The pointsachievedforeachoftheabovethreeitemswere listedinorderforeachstudyinthetabledescribing the"characteristicsoftheincludedstudies"(e.g.for atrialgettingfullpointsoneachitem,thesCOre wouldbe221).Asummaryofthescoresforallthe includedtrialsisalsoprovidedinTable1(Jadad'S scale).

    Atotalof880patientsofthe9studiesmetthe

includedcriteriaofmeta-analysis.Twostudiescol

    lectedfromChinesejournalsadoptedcriteriaofTCM (1994)toclassifydysmenorrhea,threeusedthelat

    estChinesenationalcriteria,andfourusedself-made criteria.Ofallthetrials,fivewerechemicaldrug- controlled.twowereherbalmedieine-controlledand twoused"Sham''acupunctureforwhichtheneedled pointswerebesidetherealacupointsorthesuperficial

    WorM.,.AcuMoxi.Vo1.15,No.j,M(drch,2005?55? non.acupoints.Theacupunctureinterventionsused variedconsiderably.Fivetrialsadoptedtraditional acupuncture,threeusedSham-TENS(transcuta

    neouselectricnervestimulation)andoneusedelec

    troacupuncture(EA).Symmetrybetweentreatment andcontrolgroupswasgoodinallthestudiesinclud

    ei.Insixstudies.thetheorybehindthechoiceof acupointswastraditionalChinesemedicine,three gaveotherreasons.Fiveusedbodyacupoints.two usedauricularpointsandtheotheroneusedperipher

    aldermatomes."Deqi",anirradiationfeelingsaidto indicatetheeffectivenessofneedling,wasreportedin mostofthestudiesespeciallybyChineseclinicalre

    searches.Alloftheninetrials.threeattemptedto blindpatients,andonlyoneblindedbothpatientsand theresearcherssuccessfully.Whilethestudies searchedfromChinesejournalsdidnotdescribethe concreteblindmethod.

    Themeandurationoftreatmentwas4months

    (rangingfrom3to12months).In8trialsthatafter

    completionofthetreatment,amean10months'(7 to12months)follow.upwasconducted.

    Themostcommonlyreportedoutcomeswere

    painintensity,durationandremission.Butinmany studiestheresultswerenotreportedindetail.Sub. jectivemood,qualityoflife,medicationuse,anddis

    abilitywerereportedinminorityofthetrials.Criteria madeinChinesestudieslaidenoughemphasisonthe acupoints.Majorityofthetrialshadmethodological and/orreportingshortcomings.Allocationconceal

    mentwasdescribedinonlyonetrailwhichuseda centraltelephonecallrandomizationscheme.Theme

    dianJadad's8corewas1.5(rangingfrom1to5) fromapossiblemaximumscoreof5(seeTable1). Reportofdropoutsandwithdrawalswassatisfactory inonlythreetrials.

    2RESULTS

    Thetrialswerehomogeneousinacupuncturever

    SUScontrolledgroup,buthighlyheterogeneousbe

    tweenacupunctureandmedicationgroupsregarding theinterventions;typesandtimingofoutcomemea

    sures.Inaddition,dataoftheseclinicalreportswere oftenpresentedinaninsufficientdetail.Weper. formedquantitativemeta?-analysisofacupuncturever.. SUScontrol(9studies)andacupunctureversusmedi. cation(9studies).Bothofthemobtainedpositivere. suits.ThefiguresandgraphsinCochraneReviews displaytheOddsRatioandtheWeightedMeanDif

    ferencebydefault(Fig1,2).

    Compllrison:02Acupunctumforprimarydysmenorrhca

    Outcoll~:OIAcupunctureVscontrol q?tI-reCO10R-.-_OR

    ?l?I.IaR1.'%t.'''cIFhI

    D1m14,321,32————??.

    9241If2.92.19lB.93l

    咖嘲146,4825,304?4?州^们?CI,'''1?V?-

    H相喀一射10,"4,11???,?W4酣?^.^^'r……I'I……J 知姗硼散,?so,6o^^4"?f?^'r'1'.?…'J

    I.'9,108,11e06^',,1??一N'J

    Uye1M97,lO021,30————?8413.8613.45.59l Uuch瑚怕叼20o0189,1_636,49————?17.

    B9.r5(3.64.121

    L|n豳哪g16,217,21-??』』0?,??c^?1'l一…?,r'0?r.J 撕妯舢m,?I1,64—————?"10.J,~225..751

    Tah53S,582193,2..1OOfle.

    5015,I9.13.931

    TmarbmrIycl~qtmce.,1.1Dat-0p|l0.e5 T尊瞳lol憎?.1ctz-8~0p.dD.便10o1

    .ij5'O

    ?_?啊叼t墉?O?州

    Fig1Acupunctureforprimarydysmenorrhea(acupuncturevscontro1)

?

    56?WorldJ.Acu.Ma?i.Vo1.15,Nf'.I,March,2lR)5

    Conl~so.:02Acupunctm'cforprimarydysmenorrhea

    0咖棚:02AcupunctureVschemicals _叫—舯矗叭d_m

    呻埔nM

    D?删1

晴?rain1

    H?-?^gB7 JI'iurmN

    I?.喇嘲

    Ulm

    ~hunmmg Lunclelm~905

    '蛔旧妯岬2 14I32

    .8,.8

    1O,11

    92,?

    9,1O

    97,1a0 1?I198 16,

    ?,?

    24,32

    25,3o

    2,11

    ?,?

    8,11

    ,3o

    I.9

    7,21

    .1I54

    触瑚,214,29B

    TutfqrHhmc瓤?—.-.df-8呻删

    Tut-OvIeffectz=3.15p=0~02

    ''—翻两—.doI-''

    12.9

    1O

    7.8

    12.4

    8.1

    11.8

    132

    11.9

    112

    OO.ol75l

    ?.lo_835.45l

    45.00(3.盯觯.37l

    4.6011.37,15.421 3.38o.39.32l

    13.86f3.45,55.59l 9.753..26.121

    6.加【1.2?,77l

    1O.4612,25,46,751 100.05.3Q1,68,15.001 ?_2

    ohendoab

    61O

    ?—?qW

    Figure2Acupunctureforprimarydysmenorrhea(acupuncturevschemicals)

    3DISCUSSIoN

    Overall,theexistingevidencesupportsthevalue

    ofacupunctureforthetreatmentofprimarydysmen orrhea.However,thequalityandamountofevidence

arenotfullyconvincing.Majorityofthetrialscom

    paringacupunctureversuscontrolindysmenorrhea patientswasinfavoroftrueacupuncture.Andcom

    parisonbetweenacupunctureandchemicalsormedici

    nalherbsindicatedapositiveresult.Butmosttrials weresmallinthesamplesizeandwereeitherinade

    quatelyreportedorhadmethodologicalflaws.More

    over,thetrialsvariedgreatlywithrespecttothepre

    cisenatureoftheacupunctureinterventionandthe n1th0({nfOIItcon1(,asSONSn1(,FI1.

    Fig3Funnelplot

    Anestimateofprecisiondescription'__——?__——funnel

    plot(Fig3)showedtheasymmetricalcharacteristic ofthestudiesincluded.Itsuggestedthatpublication biasorotherbiasesexisted.

    Thedoubleblindedmethodwasalmostimpo~si

    bleduringacupuncturetreatmentinourcountry.Pa

    tientsgenerallyknowthesenseofacupuncture"De

    qt.".MostofChinesepeopleexperiencedacupuncture treatment.Itwasdifficulttofindpatientswhonever receivedacupunctureasmanyresearchesdescribedin theirstudiesofEnglish.Concealmentofallocationto groupswasrarelydescribed,andreportofdropouts andwithdrawalswasoftenincomplete.Onlyone blindedtrialstestedthesuccessofblinding.Conse

    quently,atrialinwhichpatientsandresearchers werethblindedwasconsideredasdotJbleblind

    il?

    Assessingprimarydysmenorrheainaclinlcally meaningfulmannerisacomplexissue.Frequency,

Report this document

For any questions or suggestions please email
cust-service@docsford.com