中药外敷联合三步阶梯镇痛治疗癌性骨痛的系统回顾与meta分析

Q3 Medicine

Digital Chinese Medicine Pub Date : 2025-03-01 DOI:10.1016/j.dcmed.2025.03.006

Fei Wang , Guihua Lai , Fang Zhou , Duorui Nie , Xiongtao Cheng , Yue Wang , Jianxiong Cao

{"title":"中药外敷联合三步阶梯镇痛治疗癌性骨痛的系统回顾与meta分析","authors":"Fei Wang , Guihua Lai , Fang Zhou , Duorui Nie , Xiongtao Cheng , Yue Wang , Jianxiong Cao","doi":"10.1016/j.dcmed.2025.03.006","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><div>To systematically evaluate the overall efficacy of external application of traditional Chinese medicine (EA-TCM) in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain (CIBP).</div></div><div><h3>Methods</h3><div>We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems. It included four Chinese databases [Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP) ], six English databases (Scopus, Embase, Web of Science, PubMed, Cochrane Library, and OpenGrey), and two registration systems (Chinese Clinical Trial Registry and ClinicalTrials.gov). The timeframe for the literature search extended from the inception of each database to December 31, 2023. Meta-analysis was performed using RevMan (v5.4.1), and the outcome indicators (pain relief rate, analgesic duration, quality of life, pain intensity, breakthrough pain frequency, and adverse reactions) were graded using GRADE profiler (v3.6).</div></div><div><h3>Results</h3><div>According to the established inclusion and exclusion criteria, a total of 43 studies was deemed eligible, involving 3 142 participants with CIBP. The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone, the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate [risk ratio (RR) = 1.32, 95% confidence interval (CI): 1.24 to 1.41, <em>P</em> < 0.000 01], analgesic duration [mean difference (MD) = 1.33, 95% CI: 0.97 to 1.69, <em>P</em> < 0.000 01], and quality of life (MD = 5.66, 95% CI: 4.88 to 6.44, <em>P</em> < 0.000 01). Furthermore, the combined therapy significantly reduced pain intensity (MD = – 1.00, 95% CI: – 1.19 to – 0.80, <em>P</em> < 0.000 01), breakthrough pain frequency (MD = – 0.43, 95% CI: – 0.51 to – 0.36, <em>P</em> < 0.000 01), and adverse reactions (RR = 0.60, 95% CI: 0.53 to 0.68, <em>P</em> < 0.000 01) in CIBP patients. Based on the GRADE assessment, the level of evidence varied from low to moderate.</div></div><div><h3>Conclusion</h3><div>EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life. Additionally, the EA-TCM can effectively reduce the incidence of adverse reactions associated with three-step analgesic therapy.</div></div>","PeriodicalId":33578,"journal":{"name":"Digital Chinese Medicine","volume":"8 1","pages":"Pages 59-75"},"PeriodicalIF":0.0000,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"External application of traditional Chinese medicine in combination with three-step analgesic ladder therapy for cancer-induced bone pain: a systematic review and meta-analysis\",\"authors\":\"Fei Wang , Guihua Lai , Fang Zhou , Duorui Nie , Xiongtao Cheng , Yue Wang , Jianxiong Cao\",\"doi\":\"10.1016/j.dcmed.2025.03.006\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><div>To systematically evaluate the overall efficacy of external application of traditional Chinese medicine (EA-TCM) in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain (CIBP).</div></div><div><h3>Methods</h3><div>We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems. It included four Chinese databases [Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP) ], six English databases (Scopus, Embase, Web of Science, PubMed, Cochrane Library, and OpenGrey), and two registration systems (Chinese Clinical Trial Registry and ClinicalTrials.gov). The timeframe for the literature search extended from the inception of each database to December 31, 2023. Meta-analysis was performed using RevMan (v5.4.1), and the outcome indicators (pain relief rate, analgesic duration, quality of life, pain intensity, breakthrough pain frequency, and adverse reactions) were graded using GRADE profiler (v3.6).</div></div><div><h3>Results</h3><div>According to the established inclusion and exclusion criteria, a total of 43 studies was deemed eligible, involving 3 142 participants with CIBP. The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone, the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate [risk ratio (RR) = 1.32, 95% confidence interval (CI): 1.24 to 1.41, <em>P</em> < 0.000 01], analgesic duration [mean difference (MD) = 1.33, 95% CI: 0.97 to 1.69, <em>P</em> < 0.000 01], and quality of life (MD = 5.66, 95% CI: 4.88 to 6.44, <em>P</em> < 0.000 01). Furthermore, the combined therapy significantly reduced pain intensity (MD = – 1.00, 95% CI: – 1.19 to – 0.80, <em>P</em> < 0.000 01), breakthrough pain frequency (MD = – 0.43, 95% CI: – 0.51 to – 0.36, <em>P</em> < 0.000 01), and adverse reactions (RR = 0.60, 95% CI: 0.53 to 0.68, <em>P</em> < 0.000 01) in CIBP patients. Based on the GRADE assessment, the level of evidence varied from low to moderate.</div></div><div><h3>Conclusion</h3><div>EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life. Additionally, the EA-TCM can effectively reduce the incidence of adverse reactions associated with three-step analgesic therapy.</div></div>\",\"PeriodicalId\":33578,\"journal\":{\"name\":\"Digital Chinese Medicine\",\"volume\":\"8 1\",\"pages\":\"Pages 59-75\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Digital Chinese Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2589377725000242\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Digital Chinese Medicine","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2589377725000242","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}

引用次数: 0

摘要

目的系统评价中药外用联合口服三步阶梯镇痛治疗癌性骨痛（CIBP）的整体疗效。方法在10个数据库和2个注册系统中检索EA-TCM联合三步镇痛阶梯疗法治疗CIBP的随机对照试验文献。包括4个中文数据库[中国生物医学文献数据库（SinoMed）、中国知网（CNKI）、万方数据库和中国科技期刊数据库（VIP）]， 6个英文数据库（Scopus、Embase、Web of Science、PubMed、Cochrane Library和OpenGrey），以及2个注册系统（Chinese ClinicalTrial Registry和ClinicalTrials.gov）。文献检索的时间范围从每个数据库建立之初延伸至2023年12月31日。采用RevMan （v5.4.1）软件进行meta分析，采用GRADE profiler （v3.6）软件对结局指标（疼痛缓解率、镇痛持续时间、生活质量、疼痛强度、突破疼痛频率、不良反应）进行评分。结果根据建立的纳入和排除标准，共纳入43项研究，涉及3142名CIBP患者。meta分析结果显示，与单独口服三步镇痛阶梯治疗相比，EA-TCM联合三步镇痛阶梯治疗在疼痛缓解率上有显著改善[风险比(RR) = 1.32, 95%可信区间（CI）： 1.24 ~ 1.41, P <；0.000 01]，镇痛时间[mean difference (MD) = 1.33, 95% CI: 0.97 ~ 1.69, P <；[0.000 01]，生活质量(MD = 5.66, 95% CI: 4.88 ~ 6.44, P <；0.000 01)。此外，联合治疗显著降低疼痛强度(MD = - 1.00, 95% CI: - 1.19至- 0.80,P <；0.000 01)，突破疼痛频率(MD = - 0.43, 95% CI: - 0.51 ~ - 0.36, P <；0.000 01)，不良反应(RR = 0.60, 95% CI: 0.53 ~ 0.68, P <；0.000 01)。根据GRADE评估，证据水平从低到中等不等。结论ea - tcm联合三步镇痛阶梯疗法可有效缓解CIBP患者疼痛症状，提高患者生活质量。此外，EA-TCM可以有效降低三步镇痛相关不良反应的发生率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

查看原文本刊更多论文

External application of traditional Chinese medicine in combination with three-step analgesic ladder therapy for cancer-induced bone pain: a systematic review and meta-analysis

Objective

To systematically evaluate the overall efficacy of external application of traditional Chinese medicine (EA-TCM) in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain (CIBP).

Methods

We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems. It included four Chinese databases [Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure (CNKI), Wanfang Database, and China Science and Technology Journal Database (VIP) ], six English databases (Scopus, Embase, Web of Science, PubMed, Cochrane Library, and OpenGrey), and two registration systems (Chinese Clinical Trial Registry and ClinicalTrials.gov). The timeframe for the literature search extended from the inception of each database to December 31, 2023. Meta-analysis was performed using RevMan (v5.4.1), and the outcome indicators (pain relief rate, analgesic duration, quality of life, pain intensity, breakthrough pain frequency, and adverse reactions) were graded using GRADE profiler (v3.6).

Results

According to the established inclusion and exclusion criteria, a total of 43 studies was deemed eligible, involving 3 142 participants with CIBP. The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone, the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate [risk ratio (RR) = 1.32, 95% confidence interval (CI): 1.24 to 1.41, P < 0.000 01], analgesic duration [mean difference (MD) = 1.33, 95% CI: 0.97 to 1.69, P < 0.000 01], and quality of life (MD = 5.66, 95% CI: 4.88 to 6.44, P < 0.000 01). Furthermore, the combined therapy significantly reduced pain intensity (MD = – 1.00, 95% CI: – 1.19 to – 0.80, P < 0.000 01), breakthrough pain frequency (MD = – 0.43, 95% CI: – 0.51 to – 0.36, P < 0.000 01), and adverse reactions (RR = 0.60, 95% CI: 0.53 to 0.68, P < 0.000 01) in CIBP patients. Based on the GRADE assessment, the level of evidence varied from low to moderate.

Conclusion

EA-TCM combined with the three-step analgesic ladder therapy can effectively alleviate pain symptoms in patients with CIBP and improve their quality of life. Additionally, the EA-TCM can effectively reduce the incidence of adverse reactions associated with three-step analgesic therapy.

求助全文

通过发布文献求助，成功后即可免费获取论文全文。去求助

来源期刊