| ObjectiveTo observe the short-and long-term clinical effectiveness of acupuncture combined with biofeedback therapy in the treatment of functional anorectal pain(FARP).Materials and MethodsClinical data of 278 patients who met the functional gastrointestinal disorders and functional anorectal pain based on criteria of RomeⅢundergoing acupuncture combined with biofeedback therapy from June 2010 to September 2016 in Pelvic floor disease center of The Third Afiliated Hospital of Nanjing University of Traditional Chinese Medicine were respectively analyzed.Telephone and outpatient clinic recheck were used as standard follow-up.The clinic effect of short-term and long-term data collected from the disease-based database was evaluated with visual analogue score(VAS)(0～10points),short form health survey questionnaire(SF-36)(0～148 points).The overall satisfaction and effectiveness(VAS was>30%)And the Glazer’s surface electromyography(sEMG)were evaluated at the end of treatment(short-term)and during follow-up(long-term)and analyze related influencing factors.Results1.The follow-up rate of patients with functional anorectal pain was 75.7%(128/169).The patients were followed up for 3-78 months(median follow-up time was 32 months).The VAS of 128 cases was 5.8±2.0,1.9±1.8,2.4±2.0 and 83.4±21.4 before treatment,at the end of treatment and during follow-up respectively.Though the VAS during follow-up was higher than that at the end of treatment,but still significantly lower than that before treatment,the difference was statistically significant(P<0.05)).The SF-36 score of 51 patients was 83.2±21.0,93.2±19.4 and 88.3±17.5 before treatment,at the end of treatment and during follow-up respectively.Though the SF-36 during follow-up was lower than that at the end of treatment,but still significantly higher than before treatment,the difference was statistically significant(P<0.05)).2.At the end of treatment 54(32.0%)cases were cured,18(10.7%)cases were good effective,75(44.4%)cases were general effective.The total effective rate was 87.6%(148/169).34.6%(59/169)of patients were greatly satisfied,26.6%(45/169)of patients were good satisfied,26.0%(44/169)of patients were generally satisfied,the patient’s overall satisfaction rate was 87.6%(148/169);In long term follow-up,27.3%(35/128)of patients were cured,3.9%(5/128)were good effective,47.7%(61/128)of patients were general effective,long-term efficacy of the total effective rate was 78.9%.31.2%(40/128)of patients were greatly satisfied,22.7%(29/128)of patients were good satisfied,21.9%(28/128)were generally satisfied.The total satisfaction rate of long-term efficacy was 75.8%(97/128).3.The differences of the surface electromyography(sEMG)between pre-treatment and on follow-up,In Pre-baseline process,the mean amplitude(AVG)on follow-up was lower than pre-treatment(P<0.01),and the median frequency(MF)was higher than pre-treatment(P<0.01);In Flick process,in Work and Endurance processes,the peak AVG on follow-up was higher than pre-treatment(P<0.01);In Work and Endurance processes,the Coefficient of Variance(CV)was lower than pre-treatment(P<0.01);In Post-baseline process,the AVG on follow-up was lower than pre-treatment(P<0.1),and the median frequency(MF)was higher than pre-treatment(P<0.01).Conlusion1.Acupuncture combined with biofeedback can significantly improve the pelvic floor muscle spasm,reduce the recurrence rate of pain,improve the quality of life of patients and maintain satisfactory long-term efficacy.2.Increase the patient’s family training compliance,encourage patient’s confidence to cure the disease and early intervention is the key to improve long-term efficacy in the treatment of acupuncture combined with biofeedback.3.Acupuncture combined with biofeedback treatment for FARP has the advantages of rapid onset time,stable and lasting curative effect and no adverse effect with clinical feasibility and superiority.4.sEMG assessment showed that:acupuncture combined with biofeedback therapy can coordinate the pelvic floor muscle coordination contradiction,reduce amplitude and frequency of abnormal muscle electrical activity,improve the coordination of the pelvic floor muscles and relaxation ability,reduces the sensitivity of pain of anorectal muscle,improve the stability of pelvic floor muscles.Maintain long-term efficacy.5.Acupuncture combined with biofeedback therapy FARP in the VAS score,SF-36 score,pelvic floor surface electromyography showed satisfactory clinical efficacy,long-term efficacy.It is worth further study and promotion for the treatment of complex pelvic disease. |
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