A Clinical Study On The Efficacy Of Cervical Pain With Acupuncture Combined With Moxibustion

Objective1.Through the meta-analysis of the previously published study,this paper will explore the evidence of acupuncture and moxibustion in the treatment of cervical disease or neck pain.2.The clinical efficacy of acupuncture combined with fine moxibustion in the treatment of cervical spondylosis and cervical pain was evaluated by a clinical randomized controlled trial using NPQ soft tissue displacement MPQ sf-36 and other indicators,and the comparison between acupuncture combined with fine moxibustion and false acupuncture combined with false acupuncture and false acupuncture combined with false acupuncture and false acupuncture combined with false acupuncture and false moxibustion.Methods1.Systematic evaluationThe retrieval system included China Knowledge Network Database(CNKI),Wanfang,CBM,VIP Network database and PubMed database.Latest 5 years study-starting from January 1,2014 to January 1,2019 at home and abroad were searched.These studys are merged and screened with NoteExpress3.2 software,then the studys that conform to the standards are selected for the meta analysis.1)Retrieval method:The Chinese search formula is(cervical spondylosis or neck pain or bi)and(acupuncture or needle or needle)and(moxibustion or wheat moxibustion or AI stick incense moxibustion or warm acupuncture or mild moxibustion or moxibustion therapy or moxibustion or the moxibustion)English search formula for(cervical spondylosis or Neck pain or Cervical spondylopathy)and(acupuncture or acupuncture and moxibustion).2)Quality evaluation:Using the "Bias Risk Assessment" worksheet customized by the Cochrane Collaboration Network,which divided into 6 areas:?reports the method of random allocation,?whether callocation scheme is hidden;?whether blind to the subjects,the treatment plan and the implementers;?whether the results of the study use the blind method;?whether the result data is complete;?whether there are selective reporting results in.Each inclusion in the literature is judged at the "low","high","unclear".The evaluators are carried out independently by(JH Zhou,L Zhao),and the differences of opinion are settled by mutual consultation,and when the consultation is not unified,it is evaluated by the third evaluator(YT,Shan).3)Statistical analysisUsing RevMan5.3 software to do the analysis,using mean difference(MD)expression for variable data,the fixed effect model is chosen when there is no heterogeneity between the studies,and the stochastic effect model is chosen or its heterogeneity source is found when there is heterogeneity between the studies.In the result calculation,95 confidence interval representation is used.When the difference is statistically significant 0.05),in the heterogeneity test,the fixed effect model is adopted when I2<50%,if I2<50%the radom model is used instead.2.Clinical ResearchThis study is a randomized controlled trial,using SPSS20.0 software to make random numbers,according to 1:1:1:1 proportion the patients are divided into 4 groups:acupuncture group,acupuncture with shame moxibustion group,shame acupuncture with moxibustion group,shame acupuncture and shame moxibustion group.The number of effective cases in 4 groups was respectively 46 cases,46 cases,48 cases and 47 cases.1)Acupoint selectionAcupuncture Acupoint:Cervical positive reaction plane bilateral Jia JI(two pairs),bilateral Jian Yu,Da Zhui,Zhong Zhu.Moxibustion Acupoint(taking account the burning nature of moxibustion,there are two groups of acupoints alternating use)? Bai Lao,Jian Zhong Shu,Jian Jing,Xin Shu,Dan Shu,Shen Shu;? Xin Shen,Jian Wai Shu,Da Zhu,Tian Zong,Jue Yin Shu,San Jiao Shu;Acupoint standards is the 1990 "National standards of the People' s Republic of China·Meridian Site"2)Operation2.1)Acupuncture And Moxibustion GroupAcupuncture operation:using 0.30mm diameter disposable acupuncture needle,neck and back acupoints using a length of 40mm acupuncture needle,the middle of the acupoint using a length of 25mm acupuncture needle.Acupuncture operation straight into the acupoint,depth according to the Acupoint site,body fat and thin set to 10-20mm,each acupoint is the needle to the degree of gas,each time needle retention 20 minutes.Moxibustion operation:first coated the acupoint with oil,play a adhesion and anti-scalding effect,with homemade moxibustion device,70:1 proportion of gold Evelyn made into a unified standard bottom diameter of 2mmx3.0mm,when the evelyn is placed,use the thread incense evelyn,put the finger scratched around the acupoint,moxibustion to the evelyn remaining 1/4,take off the evelyn when the patients feel pain,each acupoint moxibustion 2 times,two sets of acupoints are alternating used.2.2)Acupuncture with sham moxibustion groupAcupuncture Acupoint and operation are the same as acupuncture group,the use of shame moxibustion method is different,its acupoint selection is the same as acupuncture group,the operation of the acupoint first coated with oil to let the evelyn stand on the points,with homemade moxibustion device,70:1 proportion of gold Evelyn made into a unified standard bottom diameter of 2mmx3.0mm conical cone,put the evelyn cone on the point,with thread incense lightly placed around cone,do not ignite the evelyn cone,only to make the operation of ignition,and then take away thread incense,with the finger around its acupoints scratching,after 5-7 seconds,take away the evelyn cone,each point of the total false moxibustion 2 times.2.3)Sham acupuncture with moxibustion groupOnly do the treatment of shame moxibustion,at the same time with the treatment of placebo needles,its acupoint selection and operation are the same.At the same time,use 1 inch stacked blunt head needle straight into the fixed pad,to reach the skin surface,but do not pierce the skin,manipulation,needle retention time and needle retention in the process of operation with the acupuncture group,the whole process of needle tip in the fixed pad above,do not stab into the skin.2.4)Sham acupuncture with sham moxibustion groupUsing sham moxibustion plus placebo needle for treatment,its acupoint selection and treatment are the same as acupuncture group,operation first in the Acupoint coated with oil,play a adhesion effect,with homemade moxibustion device,70:1 proportion of gold Evelyn made into a unified standard bottom diameter of 2mmx3.0mm conical evelyn cone,with thread incense lightly placed around evelyn cone,do not ignite the evelyn cone,only to make the operation of ignition,and then take away thread incense,with the finger around its acupoints scratching for 5-7 seconds,take away the evelyn cone,each point of the total shame moxibustion 2 times.At the same time,use 1 inch stacked blunt head needle straight into the fixed pad,to reach the skin indicated,but do not pierce the skin,manipulation,needle retention time and needle retention in the process of operation with the treatment group,the whole process of needle tip in the fixed pad above,do not stab into the skin.3)CourseThe treatment last for 30 days,every 3 days give a treatment,2 treatments per week,moxibustion and shame moxibustion two groups of acupoints alternating use,10 treatments needs to be completed in total,after completing 8 treatments can be considered as an effective case.4)Tndicators of evaluation and timingThe evaluation was carried out before,at the end,1 months follow-up and 3 months follow-up.The evaluation indexes were Northwick Park neck pain Scale(NPQ),Simple McGill Pain Scale(MPQ),SF-36 quality of life scale,soft tissue displacement,and the difference of curative effect between group and group were evaluated in all groups.5)Statistics methodClinical trial data Properties(metering,classification data and grade information)select the appropriate statistical analysis method.The classification data with card square test or the precise probability method,the measurement data first carries on the normality test and the variance homogeneity test,satisfies the request person sample number comparison uses the T test,the own before and after comparison with the matching T test,the unsatisfied sample mean comparison uses the Wilcoxon rank and the test,before and after the comparison with the Wilcoxon.Grade data with sample comparison of Wilcoxon rank and test(correction)or multiple sets of comparison of the Kruskal-wallis test.The quantitative main outcome indexes of multiple observation points are analyzed by repeated measurement variance.Using bilateral test,baseline comparison Test level ?=0.10,the curative effect group comparison Test level take ?=0.05,groups compare take ?=0.0167.Results1.the results of meta-analysis:According to the experimental scheme and the Retrieval scheme,1931 literatures were retrieved in this literature study,which eventually included 18 literatures,including 17 Chinese studys and 1 English study,the results of the meta-analysis of relevant outcome indexes were as follows:1)Total Efficiency Analysis;Above the 18 included studys,the total efficiency evaluation is used in 15 articles.The 15 articles of the forest map are as follows,through the heterogeneity test to obtain the P=0.520.1,I2=0%,the test results are not heterogeneous,the selection of fixed model,by meta-analysis to obtain OR=3.24,95 CI(2.29,4.58).After examination shows P<0.05,there are statistical differences,the experimental group was superior to the control group,which showed that acupuncture combined with moxibustion therapy was superior to simple acupuncture therapy in the treatment of cervical spondylosis.2)Nerve root cervical spondylosis and cervical spondylosis(multiple types) sub-group efficiency analysis:During the 18 included studys,7 of the studys are cervical spondylosis of nerve root type,7 studys are cervical spondylosis of multiple types,two different subsetsare set up according to different research subjects for meta-analysis.Through meta-analysis heterogeneity test,it is concluded that P=0.550.1,I2=0%and is not heterogeneous,the fixed model is chosen,and the results of combined settlement statistics are OR=3.91,95CI(2.41,6.36)respectively,OR=2.34,95 CI(1.38,3.96),after examination shows P=0.05,the result has statistical differences,the experimental group is better than the control group,indicating that acupuncture combined with moxibustion is superior to simple acupuncture therapy in the treatment of cervical spondylosis of all types.3)Analysis of the efficiency of warm acupuncture and wheat moxibustion subgroup:In the research method intervention,the included 18 study,according to the experimental group intervention method can be divided into warm acupuncture therapy,acupuncture combined with wheat moxibustion therapy two ways.The effective rate analysis of the above two types of preset subsets is carried out respectively.In the aspect of warm acupuncture,a total of 8 literatures were included,and P=0.690.1,I2=0%was obtained by meta-analysis heterogeneity test,which was not heterogeneous,and the fixed effect model was selected,and the results of the combined settlement statistics were OR=4.51,95CI(2.82,7.19),after examination shows P<0.05,the result has statistical differences,the experimental group is better than the control group,indicating that warm acupuncture therapy in the treatment of cervical spondylosis is superior to simple acupuncture therapy.In the aspect of acupuncture combined with wheat moxibustion therapy,a total of 4 studys are included,P=0.200.1,I2=0%by meta-analysis heterogeneity test,there is no heterogeneity,select the fixed model,combined settlement statistics results of OR=0.03,95CI(-0.04,0.10),after testing P=0.35,there is no statistical difference,the results show that the experimental group and the control group have the same curative effect,indicating that acupuncture combined with wheat moxibustion therapy in the treatment of cervical spondylosis and simple acupuncture therapy is the same effect.4)Symptoms Volume score,PRI score,McGill,VAS,NPQ,after meta-analysis of the results are indicated that the scale score experimental group is better than the control group,it is proved that acupuncture combined with moxibustion therapy in the scale reduction is better than simple acupuncture therapy.2.Clinical trial Results(1)BaselineIn terms of emographic data,the study shows acupuncture Group,acupuncture with shame moxibustion group,shame acupuncyure with moxibustion group,shame acupuncyure with shame moxibustion Group,respectively in gender(P=0.213),age segment(P=0.458),Education(P=0.095),Course of disease(P=0.703),TCM diagnostic type(P=0.132,P=0.052)There were no significant differences.In terms of outcome indicators,there were no significant differences in the NPQ scale(P=0.978),MPQ scale(P=0.863),SF-36 scale(P=0.974)and soft tissue Displacement(P=0.188)among the first 4 groups of the study are comparable.(2)NPQ scale scoreThe comparison of NPQ scores before and after treatment in the four groups was statistically significant(P<0.01),which showed that four kinds of treatment methods could be effective for cervical pain.The variance analysis of the NPQ scores of the four groups of subjects showed that there were statistical differences(P<0.01)between the observation point and the group on the NPQ results,and the interaction between the two(P<0.01)showed that there were statistical differences between the four therapies.Through the method of LSD test,four groups of NPQ scores were compared between the pair mixed groups,acupuncture and moxibustion group and acupuncture with sham moxibustion group,sham acupuncture with moxibustion group,sham acupuncture with moxibustion group were statistically different(P<0.01),acupuncture with sham moxibustion group,sham acupuncture with sham moxibustion group group there was no statistical difference(P=0.555),There were statistical differences between the two and the sham acupuncture with moxibustion group(P<0.01).By analyzing the NPQ score line chart and the mean value before and after treatment,the NPQ scores of the four subjects were decreased after treatment,among which the acupuncture with moxibustion group decreased most obviously,the sham acupuncture with moxibustion group and the acupuncture with moxibustion group were the second,and the sham acupuncture with shem moxibustion group was the worst.Four groups obtained the difference operation,the acupuncture group,acupuncture with moxibustion group,sham acupuncture with moxibustion group in three evaluation point of the NPQ reduction rate and the sham acupuncture with sham moxibustion group there are statistical differences(P0.01),in 1 months of follow-up,acupuncture Group and Acupuncture moxibustion Group between the statistical difference(P=0.025),There was no statistical difference(P=0.132)between acupuncture with moxibustion group and sham acupuncture with moxibustion group(P=0541),and there were statistical differences between acupuncture with moxibustion group and acupuncture with sham moxibustion group and sham acupuncture with moxibustion group(P=0.001,P=0.044)at 3 months of follow-up.There was no statistical difference between acupuncture with sham moxibustion group and sham acupuncture with sham moxibustion group(P=0.235).(3)Soft tissue Tension Displacement(D0.2kg)Compared with the D0.2kg displacement value group before and after treatment,the comparison between the four groups was statistically significant(P<0.01,P<0.01,P<0.01,P=0.012),which showed that four kinds of treatment methods could relieve the neck stiffness of patients with cervical pain.The variance analysis of repeated measurements shows that there are statistical differences between time factors and grouping statistics(P<0.01),and the interaction between grouping and time(P=0.01)indicates that there are statistical differences between the four therapies.Using LSD to detect pairs comparison can be concluded,acupuncture group and acupuncture with sham moxibustion group,sham accupunture with moxibustion group,sham accupunture with sham moxibustion group have statistical differences(P=0.023,P=0.01,P<0.01),acupuncture with sham moxibustion group and sham accupunture with sham moxibustion group there is no statistical difference(P=0.320),There were statistical differences(P<0.01)between them and the sham acupuncture group.Analysis of D0.2kg displacement is worth the line chart and displacement mean,four groups of displacement value to the end of the treatment showed an upward trend,and in the follow-up two period,the four groups showed a downward trend,indicating that four therapies in the short term can improve the elasticity of the neck soft tissue,but in the long-term effect is not obvious.Through the comparison of the difference before and after treatment,it was concluded that there were statistical differences between acupuncture with moxibustion group and sham accupunture with moxibustion group during the end of treatment and follow-up,but there was no significant difference with acupuncture with sham moxibustion group and sham accupunture with sham moxibustion group(P>0.05).Through the comparison of the difference before and after treatment,it was concluded that there were statistical differences between acupuncture group and sham acupuncture with moxibustion group during the end of treatment and follow-up,but there was no significant difference with acupuncture with sham moxibustion group and sham acupuncture with sham moxibustion group(P>0.05).(4)McGill Pain Evaluation Scale(MPQ)Compared with the d0.2kg displacement value group before and after treatment,the comparison between the four groups was statistically significant(P<0.01,P<0.01,P<0.01,P=0.012),which showed that four kinds of treatment methods could relieve the neck stiffness of patients with cervical pain.The variance analysis of repeated measurements shows that the time factor and grouping have statistically different(P<0.01)MPQ results,and the two have interaction(P<0.01).It shows that there are statistical differences between the four therapies.There was no statistical difference between acupuncture group and Acupuncture moxibustion group(P=0.238),and there was no statistical difference between acupuncture group and sham accupunture with sham moxibustion group 390)by using LSD test to compare the group 22.There was a statistical difference between acupuncture group and false Needle moxibustion Group(P<0.01),there was no statistical difference between acupuncture with sham moxibustion group and sham accupunture with moxibustion group(P=0.738),there was statistical difference between acupuncture with moxibustion group and sham accupunture with sham moxibustion group(P<0.01),and there was statistical difference between sham acupuncture group and sham accupunture with sham moxibustion group(P<0.01).Through the analysis of MPQ score line chart and mean value before and after treatment,four groups of MPQ scores showed a decreasing trend after treatment,among which acupuncture group,acupuncture with sham moxibustion group,sham accupunture with moxibustion group score decline degree is quite and better than the sham accupunture with sham moxibustion group.Through the comparison of the difference before and after treatment,it is concluded that there are statistical differences between acupuncture group and sham accupunture with moxibustion group and sham accupunture with sham moxibustion group at the end of treatment(P=0.022,P<0.01),there were statistical differences(P<0.01)between acupuncture with sham moxibustion group and sham accupunture with sham moxibustion group,and there was a statistical difference between the sham accupunture with moxibustion group and the sham accupunture with sham moxibustion group(P=0.012).At 1 or 3 months of follow-up,there was no statistical difference(P>0.05)between acupuncture group,acupuncture and moxibustion Group and three group of fake needle moxibustion group,and there were statistical differences(P<0.01)with sham accupunture with moxibustion groupThe results showed that acupuncture group,acupuncture with sham moxibustion group and sham acupuncture with moxibustion group were effective in relieving the degree of cervical pain,and the curative effect was better than that of sham acupuncture with sham moxibustion group.(4)SF-36 Quality of life scaleThrough the comparison of four groups before and after treatment,it was concluded that there was no statistically significant(P=0.182)in the SF-36 score group before and after the treatment of acupuncture with moxibustion group,sham acupuncture and moxibustion group and sham acupuncture with sham moxibustion group(P<0.01,P<0.01,P=0.01),which explained acupuncture therapy,acupuncture with moxibustion therapy,sham acupuncture with moxibustion therapy can improve the quality of life of patients with cervical spondylosis,while the fake needle moxibustion group has no obvious effect on improving the quality of life.Through repeated measurement variance analysis,it is concluded that the time factor and grouping have an effect on the SF-36 score(P<0.01),and there is interaction between the two(P<0.01),the curative effect between the four groups is different,through the LSD test method pairs comparison,the acupuncture group and acupuncture with sham moxibustion group,There were no statistical differences in the moxibustion group(P=0.404 and P=0.256),and there were statistical differences with the sham acupuncture Group(P<0.01),and there was no statistical difference between acupuncture with moxibustion group and sham acupuncture with moxibustion group(P=0.769),and both were statistically significant with the sham acupuncture group(P<0.01).By analyzing the line chart and mean value of SF-36 before and after treatment,the scores of acupuncture group,acupuncture with moxibustion group and sham acupuncture with moxibustion group were all rising,and the upward trend was about the same,the sham acupuncture with moxibustion showed a mild upward trend 1 months before follow-up,and fell to the baseline level 3 months after follow-up.Compared with the difference before and after treatment,it was concluded that there was no statistical difference between the four groups(P=0.109)at the end of treatment.During the follow-up of 1 or 3 months,there were statistical differences between the groups(P=0.033,P<0.001),pair comparison concluded that the sham acupuncture with moxibustion group,acupuncture with moxibustion group,f sham acupuncture with sham moxibustion were statistically significant(P<0.05),and there was no statistical significance between the remaining groups.In the 9 dimensions of the SF-36 scale,there were differences between energy(VT),somatic pain(BP),and physiological functions(RP).In terms of energy(VT),at the end of treatment,there were statistical differences between the four groups(P=0.022),at the end of treatment,there were statistical differences between acupuncture group and false Needle moxibustion Group(P=0.012),during follow-up,acupuncture group,acupuncture moxibustion group,there were statistical differences(P<0.05)between the sham acupuncture with moxibustion group and the sham acupuncture with sham moxibustion group.In the aspect of somatic pain(BP),at the end of treatment,there were statistical differences between acupuncture group and false needle moxibustion group and fake needle moxibustion group(P=0.024,P<0.01),during the follow-up period,there were statistical differences between acupuncture group,acupuncture with sham moxibustion group and sham acupuncture with moxibustion group(P<0.01).In the physiological function(RP),at the end of treatment,acupuncture Group,acupuncture false moxibustion group,and false needle moxibustion group were statistically different from the sham acupuncture with moxibustion group(P=0.005,P=0,033,P=0.015),1 months follow-up,acupuncture group and f sham acupuncture with sham moxibustion group there were statistical differences(P=0.043),At 3 months of follow-up,there was no statistical difference between the four groups(P=0.647).The above results suggest that all four groups have the effect of improving the quality of life,acupuncture group in improving energy,physiological functions to better than other groups,somatic pain and acupuncture with sham moxibustion group and sham acupuncture with moxibustion group has the same curative effect.(5)Efficiency aspectsIn terms of efficiency,the total effective rates of the four groups were 91.3,89.1,87.5 and 55.3,respectively.There were statistical differences between the groups(P<0.01),compared with the acupuncture group,acupuncture with sham moxibustion group and and sham acupuncture with moxibustion group were statistically different(P<0.05).Conclusion1.Meta-analysis showed that acupuncture combined with moxibustion in the treatment of cervical spondylosis was superior to acupuncture alone in TCM symptom volume score,PRI score,McGill,VAS and NPQ.2.After treatment,the four treatments were effective in cervical spondylosis and cervical pain.The NPQ scoring efficiency was 91.3%,89.1%,87.5%and 55.3%.3.Acupuncture combined with moxibustion has more advantages in improving the pain degree and quality of life of cervical spondylosis,and the improvement effect of local soft tissue is comparable to that of acupuncture alone.Acupuncture combined with moxibustion has obvious advantages in the follow-up period.4.In terms of physical pain,energy and physiological functions,acupuncture combined with moxibustion has the same efficacy as simple acupuncture and fine moxibustion.