| ObjectiveSystematic review and Network Meta-analysis were used to evaluate the efficacy of different Chinese medicine interventions combined with Three-step analgesia in the treatment of cancer pain,providing evidence-based reference for clinical practice,and the medication rule of literature in the treatment of cancer pain was summarized.MethodsSearching databases as CNKI,Wanfang,CBM,VIP,PubMed,Embase,Web of Science(Search time from database building to October 2018),relevant randomized controlled trials(RCT)of the combination of Chinese medicine interventions and three step analgesic therapy in treating cancer pain were all enrolled.The retrieval strategies are "cancer pain",“traditional Chinese medicine","Chinese medicine","three-step analgesic therapy","random",etc.,which were searched by subject words or random words.The inclusion and exclusion criteria were established,and the RCT of different Chinese medicine interventions combined with three-step analgesic therapy for cancer pain were screened.The quality of the study was assessed by Jadad measuring scale.Meta-analysis was carried out by R software,and Network meta-analysis was fininshed by Addis 1.16.Also,the medication rules included in the literature were analyzed by Traditional Chinese Medicine Inheritance support system software.Results44 RCT studies(42 Chinese and 2 foreign literature)were included,including 7 Chinese Medicine interventions.There are twenty-one studies on external application of TCM,ten studies on Chinese medicine compound,seven studies on injection of Chinese medicine,three studies on acupuncture,one study about moxibustion,one study about Catgut implantation at Acupoint and one study on Chinese patent medicines.According to the Jadad Scale,4 articles were of high quality,others were of low quality.Twenty studies described specific random methods,only one study used blind method and four studies described case that dropped out.The meta-analysis showed that:the combination of three-step analgesic therapy and traditional Chinese medicine compound,external application,Chinese medicine injection or acupuncture could improve the effective rate of pain relief.Eexternal application and Chinese medicine injection could improve the improvement rate of KPS.Chinese medicine compound and external application combined with three-step analgesic therapy were better than three-step analgesic therapy in the incidence of constipation.Chinese medicine compound,Chinese medicine injection and external application combined with three-step analgesic therapy were better than three-step analgesic therapy in the incidence of nausea and vomiting.The results of network meta-analysis showed that:(1)compared with the three-step analgesic method,the five different Chinese Medicine interventions(Chinese Medicine compound,Chinese Medicine injection,external application,moxibustion,acupuncture)could improve effective rate of pain relief,and moxibustion might be the best one.(2)Chinese medicine injection,external application and Chinese medicine compound could improve the improvement rate of KPS,and external application was the most likely to be the best measure.(3)Chinese medicine compound,external application and acupuncture could reduce the incidence of constipation,and Chinese medicine injection had the greatest probability of becoming the best measure.(4)Chinese medicine compound and Chinese medicine injection could reduced the incidence of nausea and vomiting,and Chinese medicine injection was the most likely to be the best measure.(5)Chinese medicine compound was superior to traditional Chinese medicine external application(OR=0.28,95%CI:0.10,0.71)in reducing the incidence of nausea and vomiting,with significant differences.In reducing the incidence of constipation,traditional Chinese medicine compound was superior to Chinese patent medicine(OR=0.25,95%CI:0.08,0.79)and external application(OR=0.35,95%CI:0.14,0.83),and the difference was significant.There was no statistical difference between the other two groups.According to the analysis and statistics of the medication rule of Chinese medicine compound,the top six Chinese medicines were Astragalus membranaceus(Huangqi)","rhizoma corydalis(Yanhusuo)",“peach kernel(Taore)","safflower(Honghu)”,“Ligusticum wallichii(Chuanxiong)" and“Angelica(Danggui)”,and the most frequent pairs of medicines were "safflower(Honghua),peach kernels(Taoren)".The top four Chinese medicines for external application were“myrrh(Moyao)",“frankincense(Ruxiang)",“borneol(Bingpian)","asarum(Xixin)".The most frequent pairs of external application were frankincense(Ruxiang),myrrh(Moyao)".ConclusionThe results of Meta-analysis showed that Chinese Medicine interventions combined with three-step analgesic therapy could improve pain relief rate of cancer pain,improve quality of life,and reduce the incidence of nausea,vomiting and constipation.The results of network meta-analysis showed that Chinese Medicine compound was superior to external application in reducing the incidence of nausea and vomiting,and was superior to Chinese patent medicine and external application in reducing the incidence of constipation.However,due to the poor quality of the original literature,the interpretation of the results should be cautious.Through Traditional Chinese Medicine Inheritance support system,we had realized the analysis of Medication rule of the Chinese medicine compound and external application,which could be used as a reference for clinical and scientific research. |
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