Meta Analysis Of The Curative Effect Of Warm Acupuncture Moxibustion In The Treatment Of Post-herpetic Neuralgia(PHN)

BackgroundHerpes zoster(HZ)is a common skin disease caused mainly by reactivation of chickenpox-herpesvirus that lurks in nerve roots or ganglia.The most common and serious complication is Post-herpetic neuralgia(PHN),which has a high incidence,long duration,serious affect to the quality of life.Its treatment is very difficult.ObjectiveWe should take active and multi-tools collaborative therapy to achieve effective control of PHN-related pain,improve sleep,promote mental health and enhance the quality of life.Acupuncture is one of the therapies of Traditional Chinese Medicine that is used for treating pain with thousands years of history.Among the numerous methods of treatment,warm acupuncture moxibustion are well known for its clinical popularity,obvious effect,simplexity in handling,quick effect and other characteristics.More and more attentions are received clinically.Warm needling and moxibustion include fire needle,fire cupping,moxibustion;acupuncture and fire cupping refers to the fire needle and moxa.They are external treatment methods of Traditional Chinese Medicine.In recent years,a large number of clinical researches show that the warm needling moxibustion have good curative effect in the treatment of PHN.But there is lack of high quality clinical research or paper relating to the warm needling moxibustion treatment of PHN.So the research process of our systematic review analysed the efficacy of the above treatment of PHN retrospectively.We also assess the prospects of development of warm needling moxibustion in treating PHN.We aim at providing evidence-based basis for further clinical treatment.MethodWe conducted the search of Chinese medical journals,English medical journals published in the public and relevant literature before December 2017,with warm needling moxibustion as the main theme of treatment of postherpetic neuralgia.Warm needling moxibustion include fire needling,fire cupping,moxibustion;acupuncture and moxibustion therapy.Warm acupuncture moxibustion or warm acupuncture and moxibustion combining with other treatment methods,form,intensity and frequency are also included.ResultA total of 37 cases were included.The total number of cases was 2456.The JADAD score of 1-3 points was 10,accounting for 27%,and 27 of the 4-7 points of the JADAD score,accounting for 73%.The results of meta analysis showing treatment outcome advantage are as follow: 1)The evaluation of curative effect of the treatment for PHN: Warm needling and moxibustion(I2=0%,P=0.1,0R=4.28,95%CI[3.11,5.90],p<0.00001),pure needling((I2=0%,P=0.87),0R=7.18,95%CI[2.27,22.75],p< 0.00001),moxibustion plus other treatments(I2=0%,p=0.60),[OR=4.29,95%CI[2.24,8.23],P<0.0001),acupuncture with fire cupping + other treatments(P=0.93,I2=0%),[OR=4.06,95%CI[2.18,7.56],P<0.00001]);2)The evalution of treatment in reducing VAS score: Warm needling and moxibustion(I2=99%,P<0.0001,RR=1.77,95% CI [1.82,-1.77],p<0.00001),Acupuncture with fire cupping(I2=94%,P<0.00001),RR=-1.08,95%CI[-2.13,-0.02],P=0.04),fire needling + Acupuncture with fire cupping(I2=94%,P<0.00001),RR=-1.72,95%CI[-2.48,-0.96],P<0.0001),fire needling + moxibustion(I2=0%,P=0.81,0R=-1.87,95%CI[-2.36,-1.38],p<0.0001),moxibustion plus other treatment(I2=0%,P=0.60),0R=-2.17,95%CI [-2.36,-1.38],p<0.0001),acupuncture with fire cupping + other treatments(I2=99%,P<0.00001),RR=-3.89 95%CI [-6.52,-1.26],P=0.004);3)The evaluation of treatment in improving level of pain control: warm needling and moxibustio(I2=97%,RR=-1.88,95%CI [-3.64,-0.12],p=0.04),4)The evaluation of treatment in the pain relief onset time,fire needling + moxibustion / acupuncture + fire cupping(P=0.004,I2=74%,RR=-1.12,95%CI[-1.83,-0.41].The results of meta-analysis showing no obvious treatment outcome advantage: 1)The evaluation of curative effect in treating PHN: acupuncture and fire cupping(I2=0% P=0.47,0R=2.61,95%CI[0.72,9.43],p=0.14),fire needling + acupuncture with fire cupping(I2=0%,P=0.54,0R=1.93,95%CI[0.62,5.95],p=0.54),fire needling + moxibution(p=0.3,I2=8%,the OR=1.90,95%CI[0.61,5.95],P=0.30),2)The evaluation of treatment in reducing VAS score: pure fire needing(I2=94%,P<0.00001,RR=-1.34,95%CI [-2.78,-0.99],p=0.07),3)The evaluation of treatment in the pain relief onset time:Warm needling and moxibustion(I2=99%,RR=-1.71,95%CI[-4.27,-0.84],p=0.19),4)The evaluation of treatment in improving sleep quality: Warm needling and moxibustion(I2=96%,RR=0.22,95%CI[-1.13,1.55],p=0.76),5)The evaluation of treatment in recurrence rate: Warm needling and moxibustion((P=0.93,I2=0%,OR= 0.49,95%CI[-0.17],P=0.18)The results of meta-analysis showing the heterogeneity of the treatment group and the control group:Curative effect: Warm Needling Moxibustion Treatment(I2=97%,RR=-1.88,95%CI[-3.64,-0.12],p=0.04),pure needle treatment(I2=94%,P<0.00001,RR=-1.34,95%CI[-2.78,-0.99],p=0.07),acupuncture with fire cupping(I2=94%,P<0.00001,RR=-1.08).95%CI[-2.13,-0.02],P=0.04),Other aspects: the improvement of VAS score:acupuncture with fire cupping + other treatments(I2=99%,P<0.00001),RR=-3.89,95%CI [-6.52,-1.26],P=0.004).Improving the level of pain control: Warm Needling Moxibustion Treatment(I2=97%,RR=-1.88,95%CI [-3.64,-0.12],p=0.04);Warm Needling Moxibustion Treatment in the onset time of pain relief(I2=99%,RR=-1.71,95%CI[-4.27,-0.84],p=0.19);Sleep quality score: Warm Needling Moxibustion Treatment(I2=96%,RR=0.22,95%CI [-1.13,1.55]),Onset time of cuarative pain relief: fire needling + moxibustion / acupuncture with fire cupping(P=0.004,I2=74%,RR=-1.12,95%CI[-1.83,-0.41],p=0.004).Conclusion Evidences show that Warm Needling Moxibustion has curative effective in treating PHN,reducing the VAS score,improving the degree of pain,,immediate analgesic onset time.The results are statistically significant.