Data_Sheet_1_Acupuncture for neuropathic pain: A meta-analysis of randomized control trials.DOCX

BackgroundNeuropathic pain (NP) is expected to increase due to the high risk of global population aging. Acupuncture has a definite clinical effect on NP. Therefore, a systematic review and meta-analysis were conducted to evaluate the effect on pain intensity and safety of acupuncture in patients with NP.
MethodsAn encompassing search of specific authoritative databases in English, from their inception to 2022, was performed. The databases were as follows: Scopus, Ovid EMBASE, Ovid Cochrane Database of Systematic Reviews, Ovid Cochrane Central Register of Controlled Trials, Ovid MEDLINE(R) and Epub Ahead of Print, In-Process and Other Non-Indexed Citations, and Daily. All the randomized controlled trials regarding the acupuncture treatment of NP will be included. Methodological quality assessment of the included trials was assessed based on the risk of bias from the Cochrane handbook. A meta-analysis was performed for the main outcomes. In addition, sensitivity analysis, subgroup analysis, and funnel plot were also carried out.
ResultsA total of 16 studies with 1,021 patients with NP were evaluated in a systematic review. According to the results of the overall meta-analysis in eight RCTs with 338 participants, the acupuncture group was better than the control group in improving changes in pain intensity (SMD −0.59, 95% CI: −0.95 to −0.23, P = 0.001). In subgroup analysis, five trials indicated that acupuncture was more effective in improving changes in pain intensity than sham acupuncture (SMD −0.54, 95% CI: −0.95 to −0.13, P = 0.01), two trials evaluated the effect on changes in pain intensity in the comparison of acupuncture and conventional treatments, no significant difference existed (SMD −0.61, 95% CI: −1.83 to 0.61, P = 0.33), and one trial compared acupuncture with blank control evaluating the effect of changes in pain intensity with a significant difference. Eleven studies mentioned the safety conditions and acupuncture-induced AEs were mild and reversible. Both the sensitivity analysis and funnel plot analysis showed that the meta-analysis was stable and irreversible without publication bias. The GRADE was rated as “very low.”
ConclusionThe acupuncture group had higher effectiveness than sham intervention or blank control for changes in pain intensity, but there is no significant difference between acupuncture and conventional treatments in treating NP. The acupuncture-induced adverse events were mild and reversible. However, the interpretation of our results should be performed cautiously due to the low methodological quality of selected publications.
Systematic review registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306461.

背景：由于全球人口老龄化风险居高不下，神经性疼痛（Neuropathic Pain, NP）的患病率预计将持续攀升。针灸对神经性疼痛具有明确的临床疗效，因此本研究开展了一项系统评价与meta分析，以评估针灸对神经性疼痛患者疼痛强度的改善效果及其安全性。
方法：本研究系统检索了建库至2022年的英文权威专属数据库，具体包括：Scopus、Ovid EMBASE、Ovid Cochrane系统评价数据库（Ovid Cochrane Database of Systematic Reviews）、Ovid Cochrane对照试验中心注册库（Ovid Cochrane Central Register of Controlled Trials）、Ovid MEDLINE(R) 及提前在线出版文献（Epub Ahead of Print）、加工中文献（In-Process）与其他未标引引文数据库，以及每日更新的文献库。纳入所有关于针灸治疗神经性疼痛的随机对照试验（Randomized Controlled Trial, RCT）。采用Cochrane手册偏倚风险工具对纳入研究的方法学质量进行评价。针对主要结局指标开展meta分析，同时辅以敏感性分析、亚组分析及漏斗图分析。
结果：本项系统评价共纳入16项研究，涉及1021名神经性疼痛患者。针对其中8项包含338名受试者的随机对照试验开展的整体meta分析结果显示：针灸组在改善疼痛强度变化方面优于对照组（标准化均数差（Standardized Mean Difference, SMD）=-0.59，95%置信区间（Confidence Interval, CI）：-0.95~-0.23，P=0.001）。亚组分析结果表明：5项试验显示，与假针灸相比，针灸更能有效改善疼痛强度变化（SMD=-0.54，95%CI：-0.95~-0.13，P=0.01）；2项试验对比了针灸与常规治疗对疼痛强度变化的影响，结果未显示显著差异（SMD=-0.61，95%CI：-1.83~0.61，P=0.33）；另有1项试验对比了针灸与空白对照的效果，结果存在显著差异。11项研究报告了安全性结局，针灸相关不良事件（Adverse Event, AE）均为轻度且可逆。敏感性分析与漏斗图分析均显示，本meta分析结果稳定且不存在发表偏倚。采用GRADE分级系统将证据质量评为“极低”。
结论：本研究结果显示，相较于假干预或空白对照，针灸组在改善疼痛强度变化方面疗效更优；但针灸与常规治疗在治疗神经性疼痛方面未显示出显著差异。针灸相关不良事件均为轻度且可逆。然而，由于纳入文献的方法学质量偏低，对本研究结果的解读应持谨慎态度。
系统评价注册信息：https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022306461