| Objectives Myofascial pain syndrome(MPS)is one of the common clinical pain disorders.Acupuncture therapy is usually considered to be a popular and effective form of initial treatment and rehabilitation for MPS.Based on a literature review and evidence analysis,this study is expected to introduce the network meta-analysis method in the evaluation of acupuncture analgesia and to conduct a quantitative comparison of the efficacy and safety between the different acupuncture techniques and to identify which is the best technique for MPS.An Observational Comparative Effectiveness Research(CER)of different therapeutic parameters of superiority acupuncture,meanwhile,will be carried out to explore the external validity and the best therapeutic parameter,and to provide evidence for the clinical decision-making and research of acupuncture for myofascial pain syndrome in the future.Methods 1.Literature review and evidence analysis: A PubMed search of randomized controlled trials(RCTs)and systematic reviews(SRs)/Meta-analysis(MA)of acupuncture analgesia was conducted and all related literatures were included.The bibliometric analysis was used for analyzing the publication characters,and the evidence quality assessment tools were used to rate the quality of the inclusions.Subgroup analysis was conducted using RevMan 5.1.The results were presented by forest plots.The statistical level of significance was set at P ? 0.05.2.Network meta-analysis: assessing and comparing the efficacy and safety of different techniques of acupuncture for MPS,a systematic search of databases and supplementary search were performed,and only full texts of RCTs comparing acupuncture therapies with any other therapies or placebo-sham acupuncture were included.The Cochrane Collaboration Risk of Bias Tool(CCRBT)was used to assess the potential risk of bias of all selected trials.Network meta-analysis on pain intensity,pressure pain threshold(PPT),range of motion(ROM)and adverse events were performed using Stata 13.0 software.Standardized mean difference(SMD)was calculated for continuous outcomes,odds ratio(OR)were considered for dichotomous outcomes.Results were reported with 95% confidence intervals(CIs),and a P value ?0.05 was considered statistically significant.The ranking probabilities of interventions,meanwhile,were displayed by the surface under the cumulative ranking curve(SUCRA).3.Observational CER: A prospective cohort study was designed to compare the efficacy of the different electroacupuncture waveforms for MPS.One hundred and twenty patients who met the diagnostic criterias,inclusion criterias,and volunteered to participate in the study were observed.Considering visual analog scale(VAS)of pain and ROM of neck as outcomes,the data were collected from 5 time points and were analyzed by repeated measure Generalized Estimating Equation(GEE).The statistical level of significance was set at P ? 0.05.Results 1.Evidence analysis: A total of 206 RCTs on acupuncture analgesia were identified across 59 journals,of which 56.3% of articles were Science Citation Index(SCI)-indexed(impact factor 0.4–20).Nearly half of the articles were published in China.The next most represented countries of origin were the UK(21.8%)and USA(21.4%).Of the included trials,postoperative pain was the most prevalent phenotype(8.7%),and manual acupuncture was the most frequently applied type of stimulation(46.1%).The most frequently used acupuncture points were Hegu(34.5%),Zusanli(24.8%),Neiguan(19.4%),Sanyinjiao(18.9%)and Shenmen(11.7%).The overwhelming majority of trials were considered to be at high risk of bias(81.1%),as the sample size was not up to standard.In addition,one hundred and nine SRs were included in our analysis,the yearly number of publications ranging from 1 in 1997 to 15 in 2015.Only 16.5% of these publications were Cochrane Systematic Reviews,and 93.6% were published in Science Citation Index journals.The United Kingdom(45.0%)and United States(38.5%)were the countries with the higher number of publications.Low back pain(10.1%),neck and shoulder pain(9.2%),and headache(8.3%)were the most reported diseases or phenotypes.Nearly 72.5% of these SRs conducted a meta-analysis,53.2% used RevMan software to analyze data,and 44.0% used the Cochrane Risk of Bias Tool for quality assessment.Only a few SRs assessed the likelihood of publication bias(12.8%)and reported details about the protocol and the registration information(22.9%).2.Network meta-analysis: Thirty-three trials with 1692 patients were included.Patients were allocated to 22 kinds of interventions,of which Dry Needling and Manual Acupuncture was the most frequently investigated intervention.Compared with placebo acupuncture,11 interventions showed statistically significant difference in pain intensity,of which,Scraping combined with Warming Acupuncture and Moxibustion was more likely to be the best(SUCRA=96.5%);6 interventions showed statistically significant difference in pressure pain threshold,of which,Miniscalpel-needle was more likely to be the best(SUCRA=97.8%);only Electro-acupuncture showed a significant difference in the cervical range of motion(SMD=-4.4,95%CI:-7.46,-1.34),and the SUCRA=1.2%;4 interventions showed statistically significant difference in the odds ratio of adverse effects,of which,Trigger Points Injection with Bupivacaine was less likely to be the best(SUCRA=10.6%).3.The baselines of the 3 groups were balance.The continuous wave,discontinuous wave and disperse-dense wave could reduce the patient VAS score and improve the cervical ROM respectively(P ? 0.05),and the observation results were of significant difference in the courses of treatment(P ? 0.05).After the second course,the effects of disperse-dense wave were better than that of continuous wave and discontinuous wave,which were of statistically significant.Conclusions 1.The number of evidence on acupuncture analgesia has been increasing yearly and considered contents extensively.However,the number of comparisons between different acupuncture techniques is still small,and the report quality and method quality are worrying.In the future,more attention should be paid attention to the comparisons between acupuncture techniques and to improve the quality of research from design to reporting.2.For the treatment of myofascial pain syndromes,of the included interventions,the efficacy of acupuncture combined with other physical therapies is generally superior to simple physical therapies;the efficacy of acupuncture alone is generally superior to other simple physical therapies;treatments have different advantages and disadvantages in different aspects,such as the Electroacupuncture which is of better effect in pain intensity and is poor in the cervical range of motion improvement;the current results are also limited to the difference between treatment parameters.3.Taking the Trigger points as acupoints,with comparable conditions,continuous wave,discontinuous wave and disperse-dense wave of Electroacupuncture are all effective for cervical MPS,of which,the disperse-dense wave is of higher treatment effect which is more prominent after the second treatment generally.When Electroacupuncture is used,considering disperse-dense wave might improve the clinical efficacy. |
PDF Full Text Request