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acupuncture:evaluation:rhumatologie - orthopedie:03. douleurs musculo-squelettiques [16 Aug 2024 18:39] Nguyen Johan [1.2.6.1. Choi 2022] |
acupuncture:evaluation:rhumatologie - orthopedie:03. douleurs musculo-squelettiques [24 Oct 2025 11:38] (Version actuelle) Nguyen Johan [1.2.1.1. Yu 2023] |
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| ===== Systematic Reviews and Meta-Analysis===== | ===== Systematic Reviews and Meta-Analysis===== | ||
| - | |☆☆☆ |Evidence for effectiveness and a specific effect of acupuncture. | | + | |
| - | |☆☆| Evidence for effectiveness of acupuncture.| | + | |
| - | | ☆ |Limited evidence for effectiveness of acupuncture. | | + | |
| - | |Ø |No evidence or insufficient evidence.| | + | |
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
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| ^Conclusions| Compared with SA, TA was effective in treating MPS. The effects produced by different SA procedures were different, and the order of effects from greatest to least was as follows: SANA, NPA, and NPANA.| | ^Conclusions| Compared with SA, TA was effective in treating MPS. The effects produced by different SA procedures were different, and the order of effects from greatest to least was as follows: SANA, NPA, and NPANA.| | ||
| + | === Comparison of Acupuncture techniques === | ||
| + | == Liu 2025 == | ||
| + | Liu Z, Cheng Z, Zhang K, Lin X, Fu Y, Wang L, Zhang Q, Zhang F, Wu X, Dong B. Comparison of the efficacy of acupoint stimulation therapy in the treatment of pain in musculoskeletal diseases: A network meta-analysis based on randomized controlled trials. J Back Musculoskelet Rehabil. 2025 Jul 15:10538127251358729. https://doi.org/10.1177/10538127251358729 | ||
| + | ^Background|Orthopedic patients often present with significant pain symptoms, which can impact both the physical and mental well-being of patients, emerging as a significant concern. Given its safety, effectiveness, and absence of side effects, acupoint therapy is being increasingly utilized in the pain management of orthopedic patients. This study conducted a network meta-analysis to compare analgesic efficacy, safety, and effectiveness of acupuncture (AP), electroacupuncture (EA), moxibustion, and acupressure, so as to provide a reference for the clinical application of acupoint therapies in managing orthopedic pain.| | ||
| + | ^Methods|Eight databases, including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, and VIP, were searched for clinical randomized controlled trials (RCTs) investigating the effects of AP, EA, moxibustion, and acupressure on orthopedic pain. The quality of the included documents was evaluated using the Cochrane Risk of Bias Tool, and graphs regarding the risk of bias and network meta-analysis were drawn by Revman 5.2, Stata 18.0 and R software (v4.3.2). Intervention ranking probabilities were quantified using SUCRA values derived from a Bayesian random-effects model.| | ||
| + | ^Results|1) For decreasing Visual Analogue Scale (VAS) scores in patients with orthopedic pain, moxibustion therapy was identified as the optimal intervention (SUCRA=94.84%); 2) For decreasing VAS scores in patients with orthopedic pain undergoing surgical intervention, AP therapy was identified as the optimal intervention (SUCRA=76.99%); 3) For decreasing VAS scores in patients with orthopedic pain not undergoing surgical intervention, moxibustion therapy was identified as the optimal intervention (SUCRA=90.26%); 4) AP therapy (SUCRA=83.73%) demonstrated the most favorable safety profile; 5) Acupressure therapy (SUCRA=77.93%) was identified as the most effective therapeutic method.| | ||
| + | ^Conclusion|It is recommended to select differentiated acupoint therapies tailored to the type of orthopedic pain. Specifically, post-operative patients with orthopedic pain should prioritize AP, while moxibustion is advised for non-surgical patients.| | ||
| === Acupotomy === | === Acupotomy === | ||
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| ^Discussion|While there was a moderate number of randomized controlled trials supporting the use of manual therapy, the evidence for dry needling ranged from very low to moderate compared to control groups, sham interventions, or other treatments and there was a paucity of data on dry cupping. Limitations included unclear methodologies, high risk for bias, inadequate blinding, no control group, and small sample sizes.| | ^Discussion|While there was a moderate number of randomized controlled trials supporting the use of manual therapy, the evidence for dry needling ranged from very low to moderate compared to control groups, sham interventions, or other treatments and there was a paucity of data on dry cupping. Limitations included unclear methodologies, high risk for bias, inadequate blinding, no control group, and small sample sizes.| | ||
| ^Conclusion| While there is moderate evidence for manual therapy in myofascial pain treatment, the evidence for dry needling and cupping is not greater than placebo. Future studies should address the limitations of small sample sizes, unclear methodologies, poor blinding, and lack of control groups.| | ^Conclusion| While there is moderate evidence for manual therapy in myofascial pain treatment, the evidence for dry needling and cupping is not greater than placebo. Future studies should address the limitations of small sample sizes, unclear methodologies, poor blinding, and lack of control groups.| | ||
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| + | == Mohamed 2023 == | ||
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| + | Mohamed AA, Zhang X, Jan YK. Evidence-based and adverse-effects analyses of cupping therapy in musculoskeletal and sports rehabilitation: A systematic and evidence-based review. J Back Musculoskelet Rehabil. 2023;36(1):3-19. https://doi.org/10.3233/BMR-210242 | ||
| + | ^Backgound| Cupping therapy has been used to treat musculoskeletal impairments for about 4000 years. Recently, world athletes have provoked an interest in it, however, the evidence to support its use in managing musculoskeletal and sports conditions remains unknown.| | ||
| + | ^Objective| To evaluate the evidence level of the effect of cupping therapy in managing common musculoskeletal and sports conditions.| | ||
| + | ^Methods| 2214 studies were identified through a computerized search, of which **22 met the inclusion criteria**. The search involved randomized and case series studies published between 1990 and 2019. The search involved five databases (Scopus, MEDLINE (PubMed), Web of Science, Academic Search Complete PLUS (EBSCO), and CrossRef) and contained studies written in the English language. Three analyses were included: the quality assessment using the PEDro scale, physical characteristic analysis, and evidence-based analysis.| | ||
| + | ^Results| The results showed that most studies used dry cupping, except five which used wet cupping. Most studies compared cupping therapy to non-intervention, the remaining studies compared cupping to standard medical care, heat, routine physiotherapy, electrical stimulation, active range of motion and stretching, passive stretching, or acetaminophen. Treatment duration ranged from 1 day to 12 weeks. The evidence of cupping on increasing soft tissue flexibility is moderate, decreasing low back pain or cervical pain is low to moderate, and treating other musculoskeletal conditions is very low to low. The incidence of adverse events is very low.| | ||
| + | ^Conclusion| This study provides the first attempt to analyze the evidence level of cupping therapy in musculoskeletal and sports rehabilitation. However, cupping therapy has low to moderate evidence in musculoskeletal and sports rehabilitation and might be used as a useful intervention because it decreases the pain level and improves blood flow to the affected area with low adverse effects.| | ||
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| + | == Woods 2020 == | ||
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| + | Wood S, Fryer G, Tan LLF, Cleary C. Dry cupping for musculoskeletal pain and range of motion: A systematic review and meta-analysis. J Bodyw Mov Ther. 2020 Oct;24(4):503-518. https://doi.org/10.1016/j.jbmt.2020.06.024 | ||
| + | ^Objectives| This review evaluated the efficacy and safety of western dry cupping methods for the treatment of musculoskeletal pain and reduced range of motion.| | ||
| + | ^Methods| A systematic literature search was performed until April 2018 for randomised controlled trials (RCTs) pertaining to musculoskeletal pain or reduced range of motion, treated with dry cupping. Outcomes were pain, functional status, range of motion and adverse events. Risk of bias and quality of evidence was assessed using the modified Downs & Black (D&B) checklist and GRADE.| | ||
| + | ^Results| A total of **21 RCTs with 1049 participants** were included. Overall, the quality of evidence was fair, with a mean D&B score of 18/28. Low-quality evidence revealed dry cupping had a significant effect on pain reduction for chronic neck pain (MD, -21.67; 95% CI, -36.55, to -6.80) and low back pain (MD, -19.38; 95%CI, -28.09, to -10.66). Moderate-quality evidence suggested that dry cupping improved functional status for chronic neck pain (MD, -4.65; 95%CI, -6.44, to -2.85). For range of motion, low quality evidence revealed a significant difference when compared to no treatment (SMD, -0.75; 95%CI, -0.75, to -0.32).| | ||
| + | ^Conclusion| Dry cupping was found to be effective for reducing pain in patients with chronic neck pain and non-specific low back pain. However, definitive conclusions regarding the effectiveness and safety of dry cupping for musculoskeletal pain and range of motion were unable to be made due to the low-moderate quality of evidence. Further high-quality trials with larger sample sizes, long-term follow up, and reporting of adverse events are warranted.| | ||
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| | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | | ⊕ positive recommendation (regardless of the level of evidence reported) \\ Ø negative recommendation (or lack of evidence) | | ||
| + | ==== American Psychological Association (APA, USA) 2024 ⊕ ==== | ||
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| + | American Psychological Association (2024). Guideline for Psychological and Other Nonpharmacological Treatment of Chronic Musculoskeletal Pain in Adults. Retrieved from https://www.apa.org/practice/guidelines/nonpharmacological-treatment-chronic-musculoskeletal-pain.pdf | ||
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| + | | For patients with //chronic LBP//, the panel suggests offering patients the following interventions over usual care, attention control, or another intervention (Strength/Direction: Conditional For) : Acupuncture for short-term pain management. \\ For patients //with chronic neck pain//, the panel suggests offering patients acupuncture over sham, placebo, or usual care for shortand intermediate-term pain relief (Strength/Direction: Conditional For).| | ||
| ==== Institute for Clinical Systems Improvement. (ICSI, USA) 2017 ⊕ ==== | ==== Institute for Clinical Systems Improvement. (ICSI, USA) 2017 ⊕ ==== | ||
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| | The evidence for the effectiveness of acupuncture is most convincing for the treatment of chronic neck and shoulder pain. In terms of other injuries, the evidence is either inconclusive or insufficient. The state of the evidence on the effectiveness of acupuncture is not dissimilar to other physical therapies such as physiotherapy, chiropractic and osteopathy. \\ // General // \\ - There is insufficient evidence to make a recommendation for the use of acupuncture in the management of acute neck, back or shoulder pain \\ - There is emerging evidence that acupuncture may enhance/facilitate other conventional therapies (including physiotherapy & exercise-based therapies) \\ - There is a paucity of research for the optimal dosage of acupuncture treatment for treating shoulder, knee, neck and lower back pain \\ - Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic non-specific low back pain (LBP) have been largely inconclusive. \\ //Lower back// \\ - The evidence for the use of acupuncture in (sub)acute LBP is inconclusive \\ - There is limited evidence to support the use of acupuncture for pain relief in chronic LBP in the short term (up to 3 months) \\ - The evidence is inconclusive for the use of acupuncture for long term (beyond 3 months) pain relief in chronic LBP \\ - There is no evidence to recommend the use of acupuncture for lumbar disc herniation related radiculopathy (LDHR) \\ //Neck// \\ - There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain \\ - There is moderate evidence that real acupuncture is more effective than sham acupuncture for the treatment of chronic neck pain \\ - There is limited evidence that acupuncture has a long term effect on chronic neck pain \\ Shoulder \\ - There is good evidence from one pragmatic trial that acupuncture improves pain and mobility in chronic shoulder pain \\ - There is limited evidence for the efficacy of acupuncture for frozen shoulder \\ - There is contradictory evidence for the efficacy of acupuncture for subacromial impingement syndrome \\ //Knee// \\ - There is no evidence to recommend the use of acupuncture for injury-related knee pain. \\ //Ankle:// \\ - There is no evidence to recommend the use of acupuncture for ankle pain | | | The evidence for the effectiveness of acupuncture is most convincing for the treatment of chronic neck and shoulder pain. In terms of other injuries, the evidence is either inconclusive or insufficient. The state of the evidence on the effectiveness of acupuncture is not dissimilar to other physical therapies such as physiotherapy, chiropractic and osteopathy. \\ // General // \\ - There is insufficient evidence to make a recommendation for the use of acupuncture in the management of acute neck, back or shoulder pain \\ - There is emerging evidence that acupuncture may enhance/facilitate other conventional therapies (including physiotherapy & exercise-based therapies) \\ - There is a paucity of research for the optimal dosage of acupuncture treatment for treating shoulder, knee, neck and lower back pain \\ - Studies comparing effective conservative treatments (including simple analgesics, physical therapy, exercise, heat & cold therapy) for (sub) acute and chronic non-specific low back pain (LBP) have been largely inconclusive. \\ //Lower back// \\ - The evidence for the use of acupuncture in (sub)acute LBP is inconclusive \\ - There is limited evidence to support the use of acupuncture for pain relief in chronic LBP in the short term (up to 3 months) \\ - The evidence is inconclusive for the use of acupuncture for long term (beyond 3 months) pain relief in chronic LBP \\ - There is no evidence to recommend the use of acupuncture for lumbar disc herniation related radiculopathy (LDHR) \\ //Neck// \\ - There is good evidence that acupuncture is effective for short term pain relief in the treatment of chronic neck pain \\ - There is moderate evidence that real acupuncture is more effective than sham acupuncture for the treatment of chronic neck pain \\ - There is limited evidence that acupuncture has a long term effect on chronic neck pain \\ Shoulder \\ - There is good evidence from one pragmatic trial that acupuncture improves pain and mobility in chronic shoulder pain \\ - There is limited evidence for the efficacy of acupuncture for frozen shoulder \\ - There is contradictory evidence for the efficacy of acupuncture for subacromial impingement syndrome \\ //Knee// \\ - There is no evidence to recommend the use of acupuncture for injury-related knee pain. \\ //Ankle:// \\ - There is no evidence to recommend the use of acupuncture for ankle pain | | ||
| + | ===== Overviews of Clinical Practice Guidelines ===== | ||
| + | ==== Ho 2025 ==== | ||
| + | |||
| + | Ho L, Lai CNT, Chen H, Law SW, Yu ECL, Lam FPY, Cheung YC, Wu IX, Wong SYS, Sit RWS. Systematic review of clinical practice guidelines on acupuncture for chronic musculoskeletal pain. BMC Complement Med Ther. 2025 Sep 1;25(1):322. https://doi.org/10.1186/s12906-025-05070-y | ||
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| + | ^Background|Acupuncture is increasingly utilised in primary care to manage chronic musculoskeletal pain, supported by a growing body of evidence. This rising adoption has driven demand for clinical practice guidelines (CPGs). We summarised the characteristics of recent acupuncture CPGs for osteoarthritis, low back pain, neck pain, and shoulder pain, and critically appraised their methodological quality.| | ||
| + | ^Methods|We searched nine databases to identify acupuncture CPGs published from January 2014 to November 2024. Eligible CPGs were required to be developed by guideline committees and to include evidence-informed recommendations linked to clearly defined levels of evidence. Two independent reviewers extracted CPG characteristics and assessed methodological quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument.| | ||
| + | ^Results|Of the 1,999 records screened, **17 CPGs were included, encompassing 35 recommendations**. Shoulder pain was the most addressed condition (n = 14), followed by low back pain (n = 11), osteoarthritis (n = 8), and neck pain (n = 2). Various types of acupuncture were considered, with manual acupuncture featuring in most (n = 26) recommendations. Overall, 60% of the recommendations supported the use of acupuncture, comprising 5.7% strong recommendations and 54.3% weak or conditional recommendations. In contrast, 22.9% of recommendations offered no explicit guidance, while 17.1% advised against its use. Methodological assessment classified 10 CPGs as high quality, while seven were of moderate quality.| | ||
| + | ^Conclusion|Contradictions exist among the included CPGs regarding whether acupuncture should be recommended for routine practice, potentially reflecting differences in clinical and cultural contexts. Local CPGs should be developed using rigorous methodology, ensuring the involvement of local stakeholders. An AGREE II extension should be developed for the methodological quality assessment of acupuncture CPGs.| | ||
