| ObjectiveThis study aimed to assess the therapeutic effect of acupuncture combined with moxibustion on neck pain. On this basis, to obtain a clinical protocol which can improve both the short and the long term effects of acupuncture and moxibustion on neck pain.MethodsResearch time is between January2011and February2012. Most of the patients came from Outpatient Clinics of branch courts of Guangdong Hospital of TCM. Others were recruited from community.This study was a randomized controlled clinical trial.3groups were set, including acupuncture combined with moxibustion(AMG) treatment group, pure acupuncture treatment group(AG) and pure moxibustion treatment group(MG). PEMS3.1statistical software was used to estimate the sample size. Over operation,150cases of neck pain were determined and50cases in each group. Simple random method was used in this research. First, input the sample size into the PEMS3.1statistical package obtaining sequence random number. Then, make random cards and enclose the cards into envelopes. When trials, unfold the envelope in sequence, Follow the prompts to determine which group the subject was.AMG used acupuncture first, after needles, followed by moxibustion. AG used acupuncture treatment only. MG used moxibustion treatment only. All of the three groups used the same acupoints, Dazhui (GV14), bilateral Jingbailao (EX-HN15), bilateral Jianzhongshu(SI15), and bilateral Zhongzhu(TE3). When acupuncture operation, disinfected acupoints firstly, then punched the acupoints with0.30mm diameter disposable needle tube. The depth of the needle would be determined by the acupoints themselves and the sensation of De Qi. Place the needles in their place for20minutes. When moxibustion treatment, moxa cone should be prepared first (a conicalness like grain size that about5mm high and3mm long at the bottom). After ready, put the moxa cone onto the acupoints coated with WanHua oil and lighted. When unbearale causalgia was felt moved the moxa cone away. Repeat5times for each acupoint. Treating every other day, time interval between two treatments was48-72hours,2to3times a week, and10times is one treating cause. All of the treatments should be completed in4weeks, one cause later, observed the therapeutic effect.The main evaluation indicator is Northwick Park Neck Pain Questionnaire (NPQ), and McGill Pain Questionnaire (MPQ), Short Form36-items Health Survey (SF-36) and Pressing Pain Threshold in neck(PPT) are secondary evaluation indicators. PPT was measured by a pressing pain admeasure apparatus. When measured, searched tender points with your finger in neck muscles first, then marked the most tender one and put the pressure test probe on it. As the operator pressed the point with gradually increased strength, the display device showed the number of the pressure. When pressing pain was felt, the subject pressed down the button immediately and the PPT would be read.NPQ and MPQ was collected before treatment, after the fifth treatment, after the tenth treatment, after one month follow-up and after three months follow-up. SF-36was collected before treatment, after the tenth treatment, after one month follow-up and after three months follow-up. PPT was collected before and after treatment.The change of PPT in each treatment was used to assess the instant analgesic effect. Data of NPQ, MPQ and SF-36after the tenth treatment was used to assess the short term effect. Data of NPQ, MPQ and SF-36after three months follow-up was used to assess the long terrm effect.Established database by Epidata and analyze the data using SPSS18.0software. Analyzing methods include descriptive statistics, chi-square test, t test and rank sum test.Results1. Baseline DataThere is no difference in three groups before treatment, including Age, Gender Composition, Long-Term Head Drop or Not, Duration of Head Drop, Educational Level, Course of Disease, and Acupuncture Treatment Experience (P>0.05). The main symptoms are wind-cold-dampness symptom and qi stagnancy and blood stasis symptom. There is no difference in three groups in diagnosis of cervical vertebra disease classification (P>0.05).There is no difference in three groups in NPQ, MPQ, PPT and SF-36before treatment (P>0.05).2. Northwick Park Neck Pain Questionnaire(NPQ)The Scores of NPQ, after five times treating, are AMG24.9±8.0, AG27.3±7.7, MG28.6±7.0. There is statistically significant difference between AMG and MG(P<0.05). Score of NPQ of AMG is lower than that of MG. There are no statistically significant differences between AMG and AG(P>0.05) and between AG and MG(P>0.05).The Scores of NPQ, after ten times treating, are AMG15.9±4.7, AG18.2±5.0, MG20.2±4.5. There are statistically significant differences between the three groups (P<0.05). Score of NPQ of AMG is the lowest. Score of NPQ of AG is lower than that of MG.The Scores of NPQ, after one month follow-up, are AMG17.4±+4.3, AG21.6±3.8, MG22.0±3.8. There are statistically significant differences between AMG and AG (P<0.05) and between AMG and MG (P<0.05). Score of NPQ of AMG is the lowest. There is no statistically significant difference between AG and MG (P>0.05).The Scores of NPQ, after three months follow-up, are AMG21.9±4.1,AG26.5±3.2, MG25.8±3.2. There are statistically significant differences between AMG and AG (P<0.05) and between AMG and MG (P<0.05). Score of NPQ of AMG is the lowest. There is no statistically significant difference between AG and MG (P>0.05).3. Pressing Pain Threshold (PPT)There are differences between the three groups in the D-values of PPT (D-PPT) before and after every time treating.The D-PPT of three groups in the first time are AMG0.39+0.13, AG0.28±0.07, MG0.17±0.03. There are statistically significant differences between the three groups (P<0.01).The D-PPT of three groups in the second time are AMG0.36±0.10, AG0.35±0.08, MG0.30±0.05. There are statistically significant differences between AMG and MG (P<0.01) and MG and AG (P<0.01). There is no statistically significant differences between AMG and AG (P>0.05). The D-PPT of three groups in the third time are AMG0.51±0.14, AG0.48±0.12, MG0.38±0.07. There are statistically significant differences between AMG and MG (P<0.01) and MG and AG (P<0.01). There is no statistically significant differences between AMG and AG (P>0.05).The D-PPT in fourth time are AMG0.62±0.19, AG0.52±0.12, MG0.39±0.07. There are statistically significant differences between the three groups (P<0.01).The D-PPT of three groups in the fifth time are AMG0.50±0.20, AG0.53±0.14, MG0.43±0.08. There are statistically significant differences between AMG and MG (P<0.01) and MG and AG (P<0.05). There is no statistically significant differences between AMG and AG (P>0.05).The D-PPT of three groups in the sixth time are AMG0.45±0.18, AG0.41±0.11, MG0.47±0.09. There are statistically significant differences between MG and AG (P<0.05). There are no statistically significant differences between AMG and AG (P>0.05) and AMG and MG (P>0.05).The D-PPT of three groups in the seventh time are AMG0.31±0.15, AG0.34±0.09, MG0.39±0.09. There are statistically significant differences between MG and AG (P<0.05) and MG and AMG. There is no statistically significant differences between AMG and AG (P>0.05).The D-PPT of three groups in the eighth time are AMG0.20±0.15, AG0.27±0.08, MG0.28±0.07. There are statistically significant differences between AMG and AG (P<0.01) and AMG and MG (P<0.01). There is no statistically significant differences between MG and AG (P>0.05).The D-PPT of three groups in the ninth time are AMG0.14±0.12, AG0.25±0.07, MG0.22±0.06. There are statistically significant differences between AMG and AG (P<0.01) and AMG and MG (P<0.01). There is no statistically significant differences between MG and AG (P>0.05).The D-PPT in the tenth time are AMG0.10±0.05, AG0.14±0.04, MG0.17±0.03. There are statistically significant differences between three groups (P<0.01).4. McGill Pain Questionnaire (MPQ)The Scores of MPQ, after five times treating, is AMG9.0±2.4, AG9.4±2.3, MG10.1±2.3). There is statistically significant difference between AMG and MG (P<0.01). Score of MPQ of AMG is lower than that of MG. There are no statistically significant differences between AMG and AG (P>0.05) and between AG and MG (P>0.05).The Scores of MPQ, after ten times treating, is AMG3.3±2.4, AG4.7±2.5, MG5.3±2.5), There are statistically significant differences between AMG and AG (P<0.05) and AMG and MG (P<0.05). Score of MPQ of AMG is the lowest. There is no statistically significant difference between AG and MG (P>0.05).The Scores of MPQ, after one month follow-up, is AMG4.8±2.3, AG6.8±2.0, MG7.0±1.9). There are statistically significant differences between AMG and AG (P<0.01) and between AMG and MG (P<0.01). Score of MPQ of AMG is the lowest. There is no statistically significant difference between AG and MG (P>0.05).The Scores of MPQ, after three months follow-up, are AMG7.5±2.2, AG10.2±1.8, MG9.8±1.5). There are statistically significant differences between AMG and AG (P<0.05) and between AMG and MG (P<0.05). Score of MPQ of AMG is the lowest. There is no statistically significant difference between AG and MG (P>0.05).5. Short Form36-items Health Survey (SF-36)There are statistically significant differences in four dimensions in SF-36in three groups (P<0.05) after ten times treating. The four dimensions are Physical Functioning (AMG87.2±7.7, AG83.8±6.3, MG82.1±4.3), Role-Physical (AMG94.1±15.8, AG87.7±17.1, MG84.0±16.8), Bodily Pain (AMG77.1±9.4, AG74.2±9.9, MG69.6±7.0) and Vitality (AMG55.6±7.1, AG52.1±7.5, MG53.5±7.2). There is statistically significant difference between AMG and MG (P<0.05) in there dimensions. There is statistically significant difference between AMG and AG (P<0.05) in Physical Functioning and Vitality. There is statistically significant difference between AG and MG (P<0.05) in Bodily Pain. There are no statistically significant differences in General Health, Social Functioning, Role-Emotional and Mental Health in three groups (P>0.05).There are statistically significant differences in five dimensions in SF-36in three groups (P<0.05) after one month follow-up. The five dimensions are Physical Functioning (AMG83.5±7.1, AG80.1±5.1, MG79.5±4.4), Bodily Pain (AMG69.7±6.8, AG67.9±5.9, MG66.0±6.1), Vitality (AMG53.8±6.7, AG49.4±6.3, MG49.6±7.8), Role-Emotional (AMG75.8±20.5, AG68.0±13.8, MG62.4±20.4) and Mental Health (AMG49.7±8.9, AG46.1±7.4, MG45.3±7.4). There is statistically significant difference between AMG and MG (P<0.05) in five dimensions. There is no statistically significant differences in five dimensions between AG and MG (P>0.05). There is statistically significant difference between AMG and AG in Physical Functioning, Vitality, Role-Emotional and Mental Health (P<0.05). There are no statistically significant differences in Role-Physical, General Health, Social Functioning in three groups (P>0.05).There are statistically significant differences in six dimensions in SF-36in three groups (P<0.05) after three month follow-up. The four dimensions are Physical Functioning (AMG80.7±5.3, AG77.3±4.4, MG77.7±4.0), Role-Physical (AMG59.0±13.2, AG48.9±7.2, MG54.2±13.1), Bodily Pain (AMG66.2±7.7, AG61.7±7.6, MG61.1±7.4) and Role-Emotional (AMG60.9±18.8, AG50.3±21.8, MG56.0±20.9). There is statistically significant difference between AMG and MG (P<0.05) in Physical Functioning, Role-Physical and Bodily Pain. There is statistically significant difference between AMG and AG in Physical Functioning, Role-Physical, Bodily Pain and Role-Emotional (P<0.05). There is statistically significant difference between AG and MG in Physical Functioning (P<0.05). There are no statistically significant differences in General Health and Social Functioning in three groups (P>0.05).6. Effective RateA change in the Northwick Park score of5points was considered a clinically relevant change. After treatment, the clinical effective rates of three groups are91.8%,89.4%,85.4%, the chi-square test show no significant difference between any two groups (P>0.05). There months after the treatment, the clinical effective rates of three groups are89.8%,79.2%,81.3%, the chi-square test show no significant difference between any two groups (P>0.05). All there groups are effective.Conelusiona. Acupuncture combined with moxibustion has better therapeutic effect in instant analgesia, short term and long term than acupuncture or moxibustion in treating neck pain due to cervical spondylosis.b. Acupuncture combined with moxibustion can both relieve pain and improve life quality of the patients of neck pain due to cervical spondylosis. |
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