{"title":"针灸与安慰剂对纤维肌痛临床状态和潜在特异性效果的影响：对 11 项元分析的总体回顾。","authors":"Felipe Araya-Quintanilla, Robinson Ramirez-Vélez, Guillermo Mendez-Rebolledo, Iván Cuyul-Vásquez, Alexis Arce-Álvarez, Yasmin Ezzatvar, Héctor Gutiérrez-Espinoza","doi":"10.1177/1759720X241271775","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM).</p><p><strong>Objective: </strong>To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM.</p><p><strong>Design: </strong>Umbrella review of systematic reviews (SRs) and meta-analyses.</p><p><strong>Data sources and methods: </strong>An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, <i>p</i> < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, <i>p</i> = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, <i>p</i> = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, <i>p</i> < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21).</p><p><strong>Conclusion: </strong>Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture.</p><p><strong>Prospero registration number: </strong>CRD42023487315.</p>","PeriodicalId":23056,"journal":{"name":"Therapeutic Advances in Musculoskeletal Disease","volume":null,"pages":null},"PeriodicalIF":3.4000,"publicationDate":"2024-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11334136/pdf/","citationCount":"0","resultStr":"{\"title\":\"Effects of acupuncture versus placebo on clinical status and potential specific effects in Fibromyalgia: an umbrella review of 11 meta-analyses.\",\"authors\":\"Felipe Araya-Quintanilla, Robinson Ramirez-Vélez, Guillermo Mendez-Rebolledo, Iván Cuyul-Vásquez, Alexis Arce-Álvarez, Yasmin Ezzatvar, Héctor Gutiérrez-Espinoza\",\"doi\":\"10.1177/1759720X241271775\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. 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The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.</p><p><strong>Results: </strong>Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, <i>p</i> < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, <i>p</i> = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, <i>p</i> = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, <i>p</i> < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21).</p><p><strong>Conclusion: </strong>Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. 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引用次数: 0
摘要
背景：针灸的使用与患者的期望值有关，而治疗的相互作用效应在文献中仍是一个争论不休的话题。因此，针灸能否对纤维肌痛（FM）患者产生积极的临床效果仍不清楚：确定针灸与安慰剂在临床结果方面的有效性，并确定对纤维肌痛患者不归因于特定效应的总体效应：设计：对系统综述（SR）和荟萃分析进行总体回顾：我们在 MEDLINE（通过 PubMed）、Web of Science、CENTRAL、EMBASE、LILACS、CINAHL、PEDro 和 SPORTDiscus 数据库中进行了电子检索，检索时间从开始到 2023 年 12 月。我们选择了临床诊断为 FM 的研究，这些研究分析了针灸与安慰剂相比的效果。对疼痛强度、功能状态、疲劳、睡眠质量和抑郁症状进行了评估。疗效大小以平均差（MD）或标准平均差（SMD）计算。干预报告的质量采用建议分级评估、开发和评价方法进行评估：结果：共纳入 11 项研究，8399 名参与者。与安慰剂相比，针灸可降低疼痛强度（MD = -1.13 cm，95% CI -2.09~-0.17，P = 0.06）、睡眠质量（SMD = -0.25，95% CI -1.39~0.88，P = 0.06）和疲劳程度（SMD = 0.20，95% CI = 0.17~0.22，P 结论：针灸对疼痛强度和睡眠质量的改善具有统计学意义：针灸在降低 FM 女性患者的疼痛强度和疲劳程度方面具有显著的统计学差异。然而，证据的确定性较低至很低；其效果在临床上并不重要，而且超过50%的总体治疗效果并非归因于针灸的特殊效果：CRD42023487315。
Effects of acupuncture versus placebo on clinical status and potential specific effects in Fibromyalgia: an umbrella review of 11 meta-analyses.
Background: The use of acupuncture is related to patients' expectations, and the therapeutic interaction effect remains a topic of debate in the literature. Accordingly, it is still unclear whether acupuncture can generate positive clinical effects in patients with fibromyalgia (FM).
Objective: To determine the effectiveness of acupuncture versus placebo for clinical outcomes and determine the overall effect not attributed to specific effects in patients with FM.
Design: Umbrella review of systematic reviews (SRs) and meta-analyses.
Data sources and methods: An electronic search was performed in MEDLINE (via PubMed), Web of Science, CENTRAL, EMBASE, LILACS, CINAHL, PEDro, and SPORTDiscus databases from inception until December 2023. We selected studies with a clinical diagnosis of FM and that analyzed the effectiveness of acupuncture compared with a placebo. Pain intensity, functional status, fatigue, sleep quality, and depression symptoms were assessed. Effect sizes were calculated as the mean difference (MD) or standard mean difference (SMD). The quality of intervention reporting was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach.
Results: Eleven SRs with 8399 participants were included. Compared with placebo, acupuncture was associated with reductions in pain intensity (MD = -1.13 cm, 95% CI -2.09 to -0.17, p < 0.001), physical function (SMD = -0.63, 95% CI -1.67 to 0.41, p = 0.06), sleep quality (SMD = -0.25, 95% CI -1.39 to 0.88, p = 0.06), and fatigue (SMD = 0.20, 95% CI = 0.17 to 0.22, p < 0.001). The proportion not attributable to specific effects (PCE) of acupuncture was 58% for pain intensity (PCE = 0.58, 95% CI 0.45 to 0.71), 57% for physical function (PCE = 0.57, 95% CI -0.07 to 1.20), and 69% for fatigue (PCE = 0.69, 95% CI 0.18 to 1.21).
Conclusion: Acupuncture showed a statistically significant difference in decreased pain intensity and fatigue in women with FM. However, the certainty of evidence was low to very low; its effects are not clinically important, and more than 50% of the overall treatment effects were not attributed to the specific effects of acupuncture.
期刊介绍：
Therapeutic Advances in Musculoskeletal Disease delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of musculoskeletal disease.
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