非手术干预治疗慢性坐骨神经痛的有效性：网络荟萃分析的系统综述。

IF 4 2区医学 Q1 CLINICAL NEUROLOGY

Journal of Pain Pub Date : 2025-08-01 DOI:10.1016/j.jpain.2025.105431

Zhaochen Zhu , Tim Schouten , Rob Strijkers , Bart Koes , Heike Gerger , Alessandro Chiarotto

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引用次数: 0

摘要

该研究的目的是探讨非手术干预治疗成人慢性坐骨神经痛的比较效果。EMBASE、MEDLINE、Cochrane Library和CINAHL检索了截至2024年6月7日的关于慢性坐骨神经痛成人（18岁或以上）（3个月或更长）非手术干预的随机对照试验（rct）。在短期、中期和长期随访中，主要结局是腿部疼痛强度和身体功能。两名审稿人独立进行筛选过程、数据提取和偏倚风险评估（使用Cochrane风险偏倚2.0工具）。进行频率随机效应网络元分析，并采用CINEMA方法评估证据置信度。纳入50项随机对照试验（4,920名受试者）。在短期内，与安慰剂相比，脊柱推拿治疗（平均差[MD] -61.01, 95% CI -94.64至-27.39）、运动+神经动员（MD -60.01, -93.08至-26.95）和软组织麻醉注射（MD -60.01, -99.08至-20.95）显示腿部疼痛强度的最大降低（所有这些都基于非常低的置信度证据）。硬膜外镁注射可改善短期身体功能(MD -40.45, -54.00 ~ -26.89；非常低置信度)。硬膜外类固醇+氯胺酮注射（MD -15.51, -21.50至-9.52）和硬膜外注射+物理治疗(MD -12.01, -17.27至-6.75；非常低置信度)。总之，对于慢性坐骨神经痛患者非手术干预的有效性，证据是非常不确定的。未来的随机对照试验应尽量减少偏倚，并纳入更大的样本量，以提高慢性坐骨神经痛证据基础的可信度。视角：目前，没有高质量的证据证实任何非手术干预对慢性坐骨神经痛患者的优越疗效。虽然一些治疗方法可能会在短期内缓解腿部疼痛，但证据的可信度非常低，这表明需要进行严格的大规模试验，以更好地指导临床决策。

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Effectiveness of non-surgical interventions for patients with chronic sciatica: A systematic review with network meta-analysis

The objective of the study was to investigate the comparative effectiveness of non-surgical interventions for adults with chronic sciatica. EMBASE, MEDLINE, Cochrane Library, and CINAHL were searched until 7th June 2024 for randomized controlled trials (RCTs) of non-surgical interventions in adults (aged 18 or older) with chronic sciatica (3 months or longer). Primary outcomes were leg pain intensity and physical function at short-, medium-, and long-term follow-up. Two reviewers independently conducted the screening process, data extraction, and risk of bias assessment (with the Cochrane risk of bias 2.0 tool). Frequentist random effects network meta-analysis was conducted, and evidence confidence was evaluated with the CINEMA method. Fifty RCTs (4920 participants) were included. At short-term, spinal manipulative therapy (mean difference [MD] − 61.01, 95 % CI − 94.64 to − 27.39), exercise + neural mobilization (MD − 60.01, − 93.08 to − 26.95), and soft tissue anesthetic injections (MD − 60.01, − 99.08 to − 20.95) showed the largest reductions in leg pain intensity versus placebo (all based on very low confidence evidence). Epidural magnesium injections improved physical function at short-term (MD − 40.45, − 54.00 to − 26.89; very low confidence). Long-term reductions in physical function occurred with epidural steroid + ketamine injections (MD −15.51, − 21.50 to − 9.52) and epidural injections + physical therapy (MD − 12.01, − 17.27 to − 6.75; very low confidence). In summary, the evidence is very uncertain regarding the effectiveness of non-surgical interventions in patients with chronic sciatica. Future RCTs should minimize bias and include larger sample sizes to improve the confidence on the evidence base for chronic sciatica.

Protocol registration

PROSPERO (CRD42022361572).

Perspective

Currently, no high-quality evidence confirms the superior effectiveness of any non-surgical intervention for patients with chronic sciatica. While some treatments may provide short-term leg pain relief, the very low confidence of the evidence highlights the need for rigorous and large-scale trials to better guide clinical decision-making.

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来源期刊

Journal of Pain 医学-临床神经学

CiteScore

6.30

自引率

7.50%

发文量

441

审稿时长

42 days

期刊介绍： The Journal of Pain publishes original articles related to all aspects of pain, including clinical and basic research, patient care, education, and health policy. Articles selected for publication in the Journal are most commonly reports of original clinical research or reports of original basic research. In addition, invited critical reviews, including meta analyses of drugs for pain management, invited commentaries on reviews, and exceptional case studies are published in the Journal. The mission of the Journal is to improve the care of patients in pain by providing a forum for clinical researchers, basic scientists, clinicians, and other health professionals to publish original research.