| Objective:The objective of this review was to evaluate all the randomized controlled trials (RCTs) and Quasi-randomized controlled trials (Quasi-RCTs) of acupuncture and Moxibustion for treating sciatica due to lumbar intervertebral disc herniation (LIDH) by Cochrane systematic review methods.To assess the clinical effect of Acupuncture and Moxibustion in the treatment for sciatica induced by LIDH.Methods:According to the strict inclusion and exclusion criteria, developing the search strategies in accordance with the standards Cochrane Back Pain Group.Randomized controlled trials involving acupuncture for sciatica caused by LIDP were identified by computer searching from the Cochrane Central Register of Controlled Trials; OVID MEDLINE (1966to2011); PubMed (1966to2011); CBM(1979to2011); VIP (1979to2011); WANFANG Database (1998to2011(including dissertations and conference papers)); CNKI (1979to2011).We also hand searched relevant journals from library of Cheng Du University of Chinese Medicine. The two researchers independently assessed the methodological quality and extracted data of eligible RCTs and Quasi-RCTs in this systematic review, besides two researchers conducted cross-checking.If there is any difference solved by discussion or by the third party consultation. No improvement, VAS, JOA, ODI of acupuncture treated in sciatica due to LIDH were assessed in this review.Then. evaluated the quality according to Cochrane Handbook5.1. The Cochrane Collaboration’s RevMan5.0.25software was used for data analysis.’GRADE profiler’3.2software was making the evidence classification of this system review’s evaluation results.Results:A total of27trials involving2647patients were included.20trials are RCTs,7trials are Quasi-RCTs. About outcomes GRADE evidence classification is "low" or "very low". No included reports used ODI during the treatment as outcomes in the trials.Therefore clinical inefficiency,VAS,JOA scores were analyzed in the review. Meta-analysis or a descriptive analysis was adopted after exacting the data.①clinical inefficiency:Warming acupuncture was superior to western medicine (OR=0.20,95%CI(0.09-0.41);was superior to Chinese patent medicine (OR=0.07,95%CI(0.02-0.21).Electro-acupuncture(EA)was superior to western medicine(OR=0.34,95%CI(0.23-0.50).EA combined with cupping was superior to western medicine (OR=0.15,95%CI(0.04-0.81). Acupuncture was superior to Chinese patent medicine(OR=0.27,95%CI(0.08-0.87).Acupuncture was superior to traction(OR=0.12,95%CI (0.03-0.46).Acupuncture combined with Chinese herbs was superior to western medicine (OR=0.25,95%CI(0.09-0.67).No statistical difference was detected between warming acupuncture versus traction with OR=0.4195%CI (0.13-1.27). No statistical difference was detected between EA versus transecutanesous electrical stimulation with OR=0.19,95%CI(0.02-1.63).No statistical difference was detected between EA versus caudal injection with OR=0.48,95%C1(0.09-2.74). No statistical difference was detected between EA versus massage with OR=0.31,95%CI(0.06-1.59).No statistical difference was detected between EA combined with rehabilitation versus rehabilitation alone with OR=0.47,95%CI(0.14-1.61).No statistical difference was detected between EA combined with basic treatment versus basic treatment alone with OR=0.46,95%CI (0.08-2.59). No statistical difference was detected between acupuncture versus intermediate frequency therapy with OR=0.42,95%CI(0.11-1.60) No statistical difference was detected between acupuncture combined with massage versus Western medicine with OR=0.43,95%CI(0.1-1.83).②VASscore:Warming acupuncuture was superior to traction (WMD=1.15,95%CI(0.67-1.63).EA was superior to western medicine (Diclofenac sodium) for the improvement of different parts pain after treating1week buttock pain (WMD=6.81,95%CI(5.41-8.21); posterior side of thigh pain(WMD=3.33,95%CI (1.88-4.78);leg pain(WMD=3.91,95%(2.79-5.02). NO statistical difference was detected be-tween EA versus western medicine (Diclofenac sodium) with (WMD=0.15,95%CI(-0.9-0.6) after treating4weeks. EA was superior to western medicine on immediate ananlgesic effect, after treating1hour (WMD=2.80,95%CI(2.11-3.49);after treating48hours (WMD=2.70,95%CI(2.39-3.01).EA was superior to massage on immediate analgesic effect,after treating1hour (WMD=2.50,95%CI(1.91-3.09); after treating48hours (WMD=2.20,95%CI(2.19-2.81). No statistical difference was detected between EA versus massage with (WMD=-0.56,95%CI(-1.46-0.34).EA combined with rehabilitiaon was superior to pure rehabilitation therapy (WMD=1.01,95%CI(0.45-1.57).Acupuncture was superior to western medicine (WMD=2.10,95%CI=(0.34-3.86).(3)JOA score:Warming acupuncture was superior to traction (WMD=3.09,95%CI(2.16-4.02).EA was superior to western medicine (WMD=2.66,95%CI(1.27-4.0 5).EAwas superior to transcutaneous electrical stimulation (WMD=1.99,95%CI(0.94-3.04). Acupuncture was superior to intermediatie frequency therapy (WMD=10.89,95%CI(8.58-13.20), for improving low limbs pain and numbness is also superior to intermediaite frequency therapy (WMD=0.72,95%CI(0.54-0.90)Conclusion:All of the included trials in this systematic review were assessed to be of low methodological quality and the diagnostic standards, inclusion and exclusion criteria, and efficacy evaluation standards are not identical. The included individual study has small sample sizes, resulting in the total number of systematic review included patients is small. Because of the poor methodological quality of the included trials, there was not enough evidence to demonstrate the effectiveness of acupuncture in treating sciatica due to LIDH, so the conclusions were needed to be cautious to be applied in clinical works. In the future, acupuncture clinical trials should be strictly in accordance with the CONSORT statement and STRICTA standards.in order to have larger samples and high-quality randomized controlled trials, which confirms the exact effect of acupuncture treatment for sciatica caused by LIDH. |
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