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Miyazaki T, Doi R, Matsumoto K. Post-thoracotomy pain syndrome in the era of minimally invasive thoracic surgery. J Thorac Dis 2024; 16:3422-3430. [PMID: 38883660 PMCID: PMC11170434 DOI: 10.21037/jtd-24-158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
Post-thoracotomy pain syndrome (PTPS) is defined as pain around the wound that persists for more than 2 months after surgery. Persistent pain not only increases the use of analgesics and their side effects but also causes many social problems, such as decreased activities of daily living, decreased quality of life, and increased medical costs. In particular, thoracic surgery is associated with a higher frequency and severity of chronic pain than is surgery for other diseases. The basic principles of postoperative pain treatment, not limited to thoracic surgery, are multimodal analgesic methods (using combinations of several drugs to minimize opioid use) and around-the-clock treatment (administering analgesics at a fixed time and in sufficient doses). Thoracic surgeons must always be aware of the following three points: acute severe postoperative pain is a major risk factor for chronic pain; neuropathic pain due to intercostal nerve injury is a major cause of postoperative pain after thoracic surgery, and its presence must not be overlooked from the acute stage; and analgesics must be administered in sufficient quantities according to dosage and volume. The frequency of PTPS has decreased compared with that in the standard thoracotomy era because of the development of analgesia and the widespread use of minimally invasive procedures such as thoracoscopic surgery and robot-assisted surgery. However, no consistently effective prevention or treatment strategies for PTPS have yet been established. In this review, we focus on PTPS in the era of minimally invasive surgery and discuss the role of thoracic surgeons in its management.
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Affiliation(s)
- Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
| | - Keitaro Matsumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Medicine, Nagasaki, Japan
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Zheng X, Lin J, Wang Z, Zeng Z, Chen H. Research of the analgesic effects and central nervous system impact of electroacupuncture therapy in rats with knee osteoarthritis. Heliyon 2024; 10:e21825. [PMID: 38226224 PMCID: PMC10788782 DOI: 10.1016/j.heliyon.2023.e21825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 01/17/2024] Open
Abstract
It aimed to observe the effects of TongDu TiaoShen (TDTS) electroacupuncture (EA) on the analgesia and central system of knee osteoarthritis (KOA) rats and explore its mechanism. SD rats were rolled into the blank group, model group (KOA), control group (duloxetine 500 mg/kg/d, Ctrl), conventional EA group, and TDTS-EA group. Radiometric pain measurements and the Lequesne MG scale were used to evaluate the behavioral performance of the rats. Dopamine (DA), norepinephrine (NE), 5-hydroxytryptamine (5-HT), β-endorphin (β-EP), and leucine-enkephalin (L-ENK) were detected in the midbrain and spinal cord of lumbar enlargement. Interleukin (IL)-1β protein expression was detected by Western blot. The incubation period of thermal pain and foot contraction was decreased in the KOA group versus blank group, the Lequesne MG score was increased, DA, NE, 5-HT, β-EP, and L-ENK in the midbrain and spinal cord were increased, and synovial tissue IL-1β protein expression was increased (P < 0.05). EA group and TDTS-EA group had an increased incubation period of thermal pain contraction, decreased Lequesne MG score, decreased DA, NE, etc. In the midbrain, increased 5-HT and NE in the spinal cord, and decreased IL-1β in the synovial tissue versus KOA group (P < 0.05). The Lequesne MG score and midbrain DA, NE, 5-HT, β-EP, and synovial tissue IL-1β expression were decreased in TDTS-EA group versus EA group (P < 0.05). EA can effectively improve the behavioral score of KOA and participate in central analgesia by regulating central DA, NE, 5-HT, β-EP, and L-ENK.
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Affiliation(s)
- Xiahai Zheng
- Department of Rehabilitation, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510375, Guangdong Province, China
| | - Jing Lin
- Department of Rehabilitation, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510375, Guangdong Province, China
| | - Zhenzhen Wang
- Department of Rehabilitation, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510375, Guangdong Province, China
| | - Zhenming Zeng
- Department of Rehabilitation, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510375, Guangdong Province, China
| | - Haoxiong Chen
- Department of Rehabilitation, The Third Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, 510375, Guangdong Province, China
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Feray S, Lemoine A, Aveline C, Quesnel C. Pain management after thoracic surgery or chest trauma. Minerva Anestesiol 2023; 89:1022-1033. [PMID: 37671536 DOI: 10.23736/s0375-9393.23.17291-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
Accidental or surgically induced thoracic trauma is responsible for significant pain that can impact patient outcomes. One of the main objectives of its pain management is to promote effective coughing and early mobilization to reduce atelectasis and ventilation disorders induced by pulmonary contusion. The incidence of chronic pain can affect more than 35% of patients after both thoracotomy and thoracoscopy as well as after chest trauma. As the severity of acute pain is associated with the incidence of chronic pain, early and effective pain management is very important. In this narrative review, we propose to detail systemic and regional analgesia techniques to minimize postoperative pain, while reducing transitional pain, surgical stress response and opioid side effects. We provide the reader with practical recommendations based on both literature and clinical practice experience in a referral level III thoracic trauma center.
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Affiliation(s)
- Sarah Feray
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France -
| | - Adrien Lemoine
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France
| | - Christophe Aveline
- Department of Anesthesia and Surgical Intensive Care, Sévigné Hospital, Cesson Sévigné, France
| | - Christophe Quesnel
- Department of Anesthesia and Surgical Intensive Care, Hôpital Tenon, APHP, Paris, France
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Liu L, Zhao G, Dou Y, Li L, Chen P, Li T, Gao M. Analgesic effects of perioperative acupuncture methods: A narrative review. Medicine (Baltimore) 2023; 102:e35759. [PMID: 37904453 PMCID: PMC10615492 DOI: 10.1097/md.0000000000035759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 10/03/2023] [Indexed: 11/01/2023] Open
Abstract
Postoperative pain occurs immediately after surgery. The most common perioperative analgesic methods are nerve block, patient-controlled intravenous analgesia, and patient-controlled epidural analgesia. However, overuse of opioid analgesics can cause many adverse reactions including excessive sedation, respiratory inhibition, postoperative nausea, and vomiting. In recent years, many clinical trials have shown that perioperative acupuncture has unique advantages in patients. Perioperative acupuncture can relieve intraoperative pain, improve postoperative pain management, reduce postoperative nausea and vomiting, and shorten the length of hospital stay. This study aimed to confirm the analgesic effect of perioperative acupuncture by reviewing studies on the different methods of perioperative acupuncture and their analgesic effects. The cited literature was searched in English and Chinese from PubMed, China National Knowledge Infrastructure, and Wanfang data, using the following keywords: "perioperative pain," "acupuncture," "electroacupuncture," and "perioperative analgesia." Studies published from 2005 to 2023 were included. All retrieved papers were read in detail. Perioperative acupuncture has benefits in reducing postoperative pain and opioid need. Although analgesic drugs are still the primary means of postoperative pain control, acupuncture provides a safe analgesic supplement or alternative. This review aimed to assist practitioners in choosing appropriate perioperative acupuncture methods by summarizing the recent literature on the role of different acupuncture approaches for perioperative pain management.
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Affiliation(s)
- Ling Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Guoqing Zhao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- Jilin University, Changchun, China
| | - Yuchang Dou
- Department of Traditional Chinese Medicine, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Longyun Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Peng Chen
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Tao Li
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Ming Gao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
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Jiang Y, Wu L, Wang Y, Tan J, Wang L, Cai J, Zhou Y, Sun G, Song Z, Gu L. Effects of Press Needling combined with general anesthesia on postoperative analgesia in thoracoscopic pulmonary resection for lung cancer: A randomized, single-blind, controlled trial. Complement Ther Med 2023; 77:102980. [PMID: 37640166 DOI: 10.1016/j.ctim.2023.102980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To investigate the effects of press needle therapy on postoperative analgesia and other relevant complications in patients undergoing thoracoscopic pulmonary resection. DESIGN randomized, single-blind, controlled trial SETTING: Teaching hospitals affiliated with universities. INTERVENTIONS Eighty-six patients were randomized into: the Acu group (press-needle group) and the control group MAIN OUTCOME MEASURES: Pain levels 24, 48, and three months after surgery were measured using the numeric rating scale (NRS). Perioperative hemodynamics, total and effective pressing numbers of patient-controlled intravenous analgesia (PCIA), and incidence of postoperative pulmonary complications were recorded. Peripheral blood samples were collected to measure the levels of inflammatory mediators RESULTS: Acu group had significantly lower NRS scores at 24 and 48 h after operation (NRS scores on movement at 24 h after surgery: Acu vs. Control, 3 (2,3) vs. 3 (3,5), Z = -3.393, P < 0.01 and NRS scores on movement at 48 h after surgery: 2 (1,3) vs. 3 (2,5), Z = -3.641, P < 0.01), lower number of PCIA attempts and effective rates (mean total pressing numbers: 4(2,8) vs. 6(3,19), Z = -1.994, P = 0.046 and mean effective pressing numbers: 3(2,8) vs. 6(3,16), Z = -2.116, P = 0.034). The Acu group had significantly reduced IL-1 (14.52 ± 3.84 vs. 16.36 ± 3.30, mean difference (MD): - 1.85, 95% confidence interval (CI): - 3.46, - 0.23, P = 0.026), HIF-1α (10.15 ± 1.71 vs. 10.96 ± 1.73, MD: -0.81, 95% CI: -1.59, -0.04, P = 0.040) and the incidence of pulmonary complications after surgery. CONCLUSION Press needles are a non-invasive and feasible adjunctive intervention for postoperative analgesic management in patients undergoing thoracoscopic pulmonary resection.
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Affiliation(s)
- Yueyi Jiang
- Nanjing Medical University, Nanjing, People's Republic of China
| | - Lei Wu
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Yue Wang
- Nanjing Medical University, Nanjing, People's Republic of China
| | - Jing Tan
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Li Wang
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China
| | - Jiaqin Cai
- Xuzhou Medical University, Xuzhou, People's Republic of China
| | - Yihu Zhou
- Nanjing Medical University, Nanjing, People's Republic of China
| | - Guowei Sun
- Dalian Medical University, Dalian, People's Republic of China
| | - Zhenghuan Song
- Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China.
| | - Lianbing Gu
- Nanjing Medical University, Nanjing, People's Republic of China; Department of Anesthesiology, Jiangsu Cancer Hospital, Nanjing, People's Republic of China.
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Sodders MD, Gause EL, Bayer S, Metcalf C, Lumiere K, Vavilala MS, Gordon DB. Electroacupuncture for Pain Outcomes in a Trauma Center's Acute Pain Service: A Retrospective Observational Study. Med Acupunct 2023; 35:135-143. [PMID: 37351442 PMCID: PMC10282799 DOI: 10.1089/acu.2022.0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background Evidence for acupuncture to treat pain is growing. Electrostimulation of acupuncture needles (electroacupuncture) is common for pain and is thought to augment the therapeutic effect. Objectives To examine the association of pain outcomes after a single acupuncture session with electrostimulation included (EA) compared with no electrostimulation included (NEA). Methods A retrospective observational study was conducted using electronic health records of acupuncture sessions for adults with acute pain under the care of an acute pain service. Paired t-test and linear regression were used to report pain intensity changes after a single acupuncture session and by including EA. Ordered logistic regression was used to report categorical pain relief. Logistic regression was used to explore the odds of adding EA and the patient's age, gender, and pretreatment pain. Results From July 24, 2017, through November 9, 2020, 465 acupuncture sessions recorded EA (n = 194), or NEA (n = 271). Acupuncture, independent of EA status, reduced pain intensity by a mean 2.5 points. EA was associated with a mean 0.38-point reduction in pain intensity more than NEA (confidence interval [95% CI]: -0.75 to -0.01). Among sessions reporting categorical pain relief (n = 415), higher relief was more likely with EA (odds ratio = 2.16, 95% CI: 1.52-3.08). There was no association between EA and the patient's age, gender, and pretreatment pain intensity. Conclusions After a single acupuncture session, both EA and NEA reduced pain intensity. Higher categorical pain relief was reported with EA, though the clinical meaning is uncertain. Future research should focus on well-defined populations for electroacupuncture and factors for including electrostimulation.
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Affiliation(s)
- Mark D. Sodders
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Emma L. Gause
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
| | - Sara Bayer
- Acupuncture and East Asian Medicine, Bastyr University, Seattle, WA, USA
| | - Carol Metcalf
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Kathleen Lumiere
- Acupuncture and East Asian Medicine, Bastyr University, Seattle, WA, USA
| | - Monica S. Vavilala
- Harborview Injury Prevention and Research Center (HIPRC), University of Washington, Seattle, WA, USA
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Debra B. Gordon
- Department of Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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Zhang J, Wu W, Ren Y, Yuan Y, Jia L. Electroacupuncture for the treatment of cancer pain: a systematic review and meta-analysis of randomized clinical trials. FRONTIERS IN PAIN RESEARCH 2023; 4:1186506. [PMID: 37255718 PMCID: PMC10225685 DOI: 10.3389/fpain.2023.1186506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 04/17/2023] [Indexed: 06/01/2023] Open
Abstract
Objective This paper aims to review the current evidence on electroacupuncture as an effective and safe therapy for cancer pain management. Methods Five databases were searched from their inception through November 11, 2022. Only the randomized controlled trials that meet the eligibility criteria were finally included in the study. Literature screening and data extraction were performed independently by two reviewers, and RevMan 5.3 used for meta-analysis. Results A total of 17 RCTs met our inclusion criteria. We used 8 indicators to estimate the meta-analysis results, most of which proved statistically significant, including VAS scores, NRS scores, and KPS scores. To be specific, VAS scores (MD = -1.41, 95% CI: -2.42 to -0.41, P = 0.006) and NRS scores (MD = -1.19, 95% CI: -1.72 to -0.66, P < 0.0001) were significantly lower in the treatment group compared to the control group. The treatment group's KPS scores (MD = 5.48, 95% CI: 3.27 to 7.69, P < 0.00001) were higher than those of the control group. Also, in the treatment group, the number of burst pain (MD = -2.66, 95% CI: -3.32 to -1.99, P < 0.00001) and side effect rates (RR = 0.51, 95% CI: 0.39 to 0.67, P < 0.00001) greatly reduced, while the response rate (RR = 1.17, 95% CI: 1.09 to 1.26, P < 0.0001) significantly increased compared to the control group. Conclusion This study demonstrates the advantages of electroacupuncture in the treatment of cancer pain. Meanwhile, rigorous RCTs should be designed and conducted in the future to further demonstrate the exact efficacy of electroacupuncture. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022376148.
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Affiliation(s)
- Junning Zhang
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Weizhen Wu
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yuehan Ren
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Yuan
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Liqun Jia
- Department of Oncology of Integrative Chinese and Western Medicine, China-Japan Friendship Hospital, Beijing, China
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Abstract
BACKGROUND To investigate the efficacy of electroacupuncture for postoperative pain in mixed hemorrhoids. METHODS Randomized controlled trials were searched in PubMed and Cochrane Library. The risk of bias assessment tool was used to assess methodological quality. Stata 14.0 software was used for meta-analysis. Weighted mean differences were calculated if all outcome variables were reported the same way, while standardized mean differences (SMD) were calculated if they were different. RESULTS From 27 identified studies, 5 Chinese studies (465 patients) were included in this meta-analysis. The electroacupuncture group had significantly lower postoperative pain scores compared with the control group at 6 hours postoperatively (SMD = -0.89, 95% CI: -1.091 to -0.692; P < .001), at 12 hours postoperatively (SMD = -1.089, 95% CI: -1.336 to -0.843; P < .001), at 24 hours postoperatively (SMD = -0.548, 95% CI: -0.721 to -0.374; P = .547), and 72 hours postoperatively (SMD = -1.089, 95% CI: -1.336 to -0.843; P < .001). CONCLUSION Electroacupuncture can improve pain after surgery for mixed hemorrhoids. It is an effective method to improve the pain after hemorrhoidectomy, which deserves further research and promotion.
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Affiliation(s)
- Binglin Du
- Department of Anorectal, South District of Guang, Anmen Hospital, Academy of Chinese Medical Sciences, Beijing, PR China
| | - Zhongmiao Xu
- Department of Pharmacy, Fangzhuang Community Health Service Center, Beijing, PR China
| | - Xin Zhong
- Department of Mastopathy, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, PR China
- * Correspondence: Xin Zhong, Department of Mastopathy, Dongfang Hospital of Beijing University of Chinese Medicine, 100078 Beijing, PR China (e-mail: )
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Clark A, Lucke-Wold BP. Acupuncture and Spinal Stenosis: Considerations for Treatment. FUTURE INTEGRATIVE MEDICINE 2022; 1:23-31. [PMID: 36705625 PMCID: PMC9875941 DOI: 10.14218/fim.2022.00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Acupuncture has been a staple of Eastern medicine for thousands of years. Recent evidence has shown that benefits for spinal stenosis are strong. In this comprehensive review, we overview the history and available literature. We discuss how the techniques have evolved and the clinical utility. The process and progression of spinal stenosis is addressed. We discuss mechanism of action for acupuncture as well as relevant treatment implications. This is important in alleviating pain and providing strong quality of life. We highlight both the findings in the pre-operative, peri-operative, and post-operative periods. Finally, the pre-clinical data provides compelling evidence in terms of novel pathways being targeted. This resource will serve as a user-friendly guide for the clinician and scientist regarding this important topic. It will be the catalyst of ongoing investigation from both the clinical and pre-clinical side.
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Affiliation(s)
- Alec Clark
- University of Central Florida, School of Medicine, Orlando, United States
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Efficacy and Safety of Electroacupuncture for Pain Control in Herpes Zoster: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4478444. [PMID: 35832527 PMCID: PMC9273388 DOI: 10.1155/2022/4478444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/02/2022] [Accepted: 06/13/2022] [Indexed: 11/17/2022]
Abstract
Introduction Herpes zoster is caused by the reactivation of the latent varicella-zoster virus, which leads to acute pain that may disturb routine activities and affect patients' quality of life. Electroacupuncture (EA) has been commonly used for treating herpetic pain in clinical treatment. However, no relevant studies have been performed to evaluate the efficacy and safety of EA for acute control in herpetic neuralgia patients. The purpose of the current study was to conduct a systematic review and meta-analysis to address the deficiencies of the current research. Methods Three English (PubMed, Cochrane Library, and Web of Science) and four Chinese (China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature database (CBM), Wan-fang database, and the Chinese Scientific Journals Full-text Database (VIP)) were comprehensively searched from inception to 31 December 2021. Two independent reviewers evaluated the retrieved data based on the eligibility criteria in advance. In addition, the Cochrane Risk of Bias Tool was used to assess the methodological quality of the included studies. Outcome indexes in this study included the visual analog scale, the time to cessation of pustules, the time to scabs, the time to rash healing, adverse reactions, and the incidence of postherpetic neuralgia. Sensitivity and subgroup analyses were also performed to evaluate the intervention effect specifically. In addition, publication bias was analyzed. Results Six randomized controlled trials (167 participants in the experimental groups and 174 participants in the control groups) were identified as reporting the application of EA for acute herpes zoster pain and were included in this study. The results from our meta-analysis revealed that EA was superior to control treatment according to visual analog scale, the time of rash healing, and the incidence of postherpetic neuralgia. However, in terms of the time to cessation of pustules, scabs, and adverse reactions, the results showed that EA compared with the control group showed no significant difference. In addition, subgroup analyses indicated that 2/100 Hz-EA has more significant effects on herpetic pain. Sensitivity analyses revealed that the results of EA for acute pain control and the rash healing time in herpetic neuralgia patients were stable. However, a publication bias was observed. Conclusion Our meta-analysis results showed that EA could offer certain advantages in treating acute pain in herpetic neuralgia patients. However, small sample sizes, heterogeneity in study design, and variable methodological quality weaken these inferences. In addition, weak evidence was found for the safety of EA.
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