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Ci-dessous, les différences entre deux révisions de la page.
| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:rhumatologie - orthopedie:12. nevralgie cervico-brachiale [11 Dec 2020 07:55] Nguyen Johan Replacement automatique de '===== Guidelines =====' par '===== Guidelines =====' |
acupuncture:evaluation:rhumatologie - orthopedie:12. nevralgie cervico-brachiale [28 Aug 2025 19:17] (Version actuelle) Nguyen Johan [1.2.3. Acupotomy] |
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| - | ====== Névralgie cervico-brachiale : évaluation de l'acupuncture ====== | + | /*English:Cervical Radiculopathy*/ |
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| + | ======= cervical radiculopathy ======= | ||
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| + | ====== Névralgie cervico-brachiale ====== | ||
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| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
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| + | === Zhao 2024 === | ||
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| + | Zhao H, Wang C, Wang X, Ju J, Yan C, Shi B. Efficacy and Safety of Acupuncture in the Treatment of Radicular Cervical Spondylosis: A Systematic Review and Meta-Analysis. Comb Chem High Throughput Screen. 2024;27(19):2951-2962. https://doi.org/10.2174 | ||
| + | ^Background| Cervical spondylotic radiculopathy is a serious and common degenerative disease of the cervical spine due to irritation and compression of the nerve roots of the cervical spine, resulting in a series of clinical symptoms based on sensory, motor and reflex disorders, such as numbness and pain in the neck, shoulders, upper limbs and fingers. Acupuncture is highly effective in treating CSR and has become a common treatment accepted by patients. This study aims to systematically review and analyze existing randomized controlled trials (RCTs) to evaluate the efficacy and safety of acupuncture in the treatment of CSR.| | ||
| + | ^Methods| We used the following eight databases for literature data search: PubMed, EMBASE, The Cochrane Library, Web of Science, China National Knowledge Infrastructure, China Biology Medicine Disc ( CBMdisc), Wanfang Database and China Science and Technology Journal Database (VIP). The search consisted of randomized controlled studies of acupuncture for CSR between 2000 and 2020 and the methodological quality of the included studies was assessed according to the Cochrane Collaboration's "Risk of Bias Assessment Tool."RevMan 5.4 software was used for statistical analysis only. Study screening, data extraction and statistics, and assessment of the risk of bias of the included studies were performed independently by two reviewers.| | ||
| + | ^Result| **27 studies with 3124 patients** were included. The results of the meta-analysis of the total efficiency index for acupuncture for CSR were [RR = 1.14,95% CI (1.09,1.19)]. The results of the meta-analysis of the PPI index were [MD = -0.35, 95% CI (-0.61,-0. 09)]. The results of META analysis of the total effective rate, VAS score, PRI(A) score, PRI(S) score and PRI(T) score showed heterogeneity in the studies included for each outcome index, and sources of heterogeneity were sought through subgroup analysis and sensitivity analysis to ensure more stable and reliable data results. The results of the combined meta-analysis showed that the treatment group was significantly more effective than the control group and more effective in lowering the nerves to reduce the pain index in patients with CSR, with a statistically significant difference (P<0.05). This indicates that acupuncture treatment is superior to traction for CSR.| | ||
| + | ^Conclusion| Acupuncture is significantly more effective than traction therapy in the treatment of cervical spondylosis and can reduce the pain index of patients with CSR.| | ||
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| + | === Plener 2023 === | ||
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| + | Plener J, Csiernik B, To D, da Silva-Oolup S, Hofkirchner C, Cox J, Cancelliere C, Chow N, Hogg-Johnson S, Ammendolia C. Conservative Management of Cervical Radiculopathy: A Systematic Review. Clin J Pain. 2023 Mar 1;39(3):138-146. https://doi.org/10.1097/AJP.0000000000001092 | ||
| + | ^Objective| The purpose of this systematic review was to assess the effectiveness and safety of conservative interventions compared with other interventions, placebo/sham interventions, or no intervention on disability, pain, function, quality of life, and psychological impact in adults with cervical radiculopathy (CR).| | ||
| + | ^Methods| We searched MEDLINE, CENTRAL, CINAHL, Embase, and PsycINFO from inception to June 15, 2022 to identify studies that were randomized controlled trials, had at least one conservative treatment arm, and diagnosed participants with CR through confirmatory clinical examination and/or diagnostic tests. Studies were appraised using the Cochrane Risk of Bias 2 tool and the quality of the evidence was rated using the Grades of Recommendations, Assessment, Development, and Evaluation approach.| | ||
| + | ^Results|Of the 2561 records identified, 59 trials met our inclusion criteria (n = 4108 participants). Due to clinical and statistical heterogeneity, the findings were synthesized narratively. There is very-low certainty evidence supporting the use of **acupuncture**, prednisolone, cervical manipulation, and low-level laser therapy for pain and disability in the immediate to short-term, and thoracic manipulation and low-level laser therapy for improvements in cervical range of motion in the immediate term. There is low to very-low certainty evidence for multimodal interventions, providing inconclusive evidence for pain, disability, and range of motion. There is inconclusive evidence for pain reduction after conservative management compared with surgery, rated as very-low certainty.| | ||
| + | ^Discussion| There is a lack of high-quality evidence, limiting our ability to make any meaningful conclusions. As the number of people with CR is expected to increase, there is an urgent need for future research to help address these gaps.| | ||
| === Yin 2019 === | === Yin 2019 === | ||
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| - | ==== Techniques particulières ==== | + | ==== Special Acupuncture Techniques ==== |
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| + | === Comparison of Acupuncture techniques === | ||
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| + | == Zhao 2025 == | ||
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| + | Zhao S, Yang J. Network meta-analysis of tuina or acupuncture in combination with adjunctive therapy for cervical spondylotic radiculopathy. Front Neurol. 2025 Aug 8;16:1612024. https://doi.org/10.3389/fneur.2025.1612024 | ||
| + | ^Backgound| Tuina and acupuncture therapy have been widely applied in patients with cervical spondylotic radiculopathy (CSR). This network meta-analysis (NMA) was carried out to compare the effects of tuina or acupuncture in combination with adjunctive therapy on the physical signs, symptoms, and clinical outcomes of patients with CSR.| | ||
| + | ^Method| Relevant studies were searched in PubMed, Web of Science, Embase, Cochrane, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Data, and China Biology Medicine (CBM), up to June 15, 2023. Randomized controlled trials (RCTs) comparing tuina, acupuncture, or their combination with conventional Western medical adjunctive therapies were selected. Literature quality was assessed using the ROB2 tool, and statistical analyses were conducted using Stata SE15 and R 4.3.1.| | ||
| + | ^Results| **90 studies involving 8,612 participants** were included. Compared to acupuncture alone, acupuncture + warm needle acupuncture (RR: 17.97; 95% CrI [1.98, 563.78]), acupuncture + cupping (RR: 15.84; 95% CrI [1.48, 538.41]), tuina + auricular acupuncture and conventional therapy (RR: 12.83; 95%CrI [1.31, 170.78]), acupuncture + moxibustion (RR: 8.55; 95% CrI [2.17, 40.28]), and acupuncture + warm needle acupuncture (RR: 8.62; 95% CrI [1.78, 50.25]) significantly improved the clinical response rate, with acupuncture + warm needle acupuncture exhibiting the best effect (SUCRA: 85.9%). Tuina (SUCRA: 75%) ranked highest in improving the cervical function of patients. Electroacupuncture + moxibustion and conventional therapy (SUCRA: 97%) was most effective in relieving pain. None of these therapies effectively improved patient physical signs.| | ||
| + | ^Conclusion| Needling + warm needle acupuncture, warm needle acupuncture + auricular acupuncture, and warm needle acupuncture + conventional therapy may better alleviate symptoms in patients with CSR. However, more well-designed multicenter, large-sample RCTs are needed to further analyze the findings from this study.| | ||
| === Moxibustion === | === Moxibustion === | ||
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| ^ Conclusions | It is indicated from the Meta analysis result that the clinical efficacy of **heat-sensitive moxibustion or acupuncture combined with heat-sensitive moxibustion in treatment of CSR is superior to that of simple acupuncture or traditional suspended moxibustion**, providing a new therapeutic method for treatment of CSR. However, the above mentioned conclusion still needs to be confirmed through randomized blind controlled trials with high quality and large sample size since the sample size of included studies was small, and the quality was low. | | ^ Conclusions | It is indicated from the Meta analysis result that the clinical efficacy of **heat-sensitive moxibustion or acupuncture combined with heat-sensitive moxibustion in treatment of CSR is superior to that of simple acupuncture or traditional suspended moxibustion**, providing a new therapeutic method for treatment of CSR. However, the above mentioned conclusion still needs to be confirmed through randomized blind controlled trials with high quality and large sample size since the sample size of included studies was small, and the quality was low. | | ||
| - | === Acupotomie === | + | === Acupotomy === |
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| + | == Choi 2025 == | ||
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| + | Choi HK, Lee SH, Lee JH, Choi S, Park S, Lim YS, Kim HJ, Kim YI, Park TY. Effectiveness of acupotomy combined with nerve block therapy for cervical radiculopathy: A systematic review and meta-analysis. Medicine (Baltimore). 2025 Jun 13;104(24):e42771. https://doi.org/10.1097/MD.0000000000042771 | ||
| + | ^Backgound| This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of combining acupotomy with nerve block therapy (NBT) for cervical radiculopathy (CR) compared to NBT alone.| | ||
| + | ^Methods| A comprehensive search was conducted across multiple databases to identify randomized controlled trials (RCTs) investigating the combined use of acupotomy and NBT for CR. Studies were assessed for risk of bias using the Cochrane Risk of Bias 2 tool. Data were synthesized through meta-analysis where applicable.| | ||
| + | ^Results|** Four RCTs with a total of 540 patients** were included. Meta-analysis showed that the combination of acupotomy and NBT significantly improved the total effective rate compared to NBT alone (risk ratio 1.16, 95% confidence interval 1.08-1.24, P < .0001). However, no significant pain reduction was observed based on the pain visual analog scale (SMD - 2.55, 95% confidence interval -5.32 to 0.22, P = .07), and there was substantial heterogeneity among the included studies (I² = 99%). The overall risk of bias was high, and safety data were limited, with only one study reporting adverse events.| | ||
| + | ^Conclusion| The findings suggest that acupotomy combined with NBT may enhance treatment effectiveness for CR, particularly in terms of overall therapeutic response. However, due to the high risk of bias, study heterogeneity, and insufficient safety reporting, further well-designed, large-scale RCTs with long-term follow-ups are needed to establish robust clinical evidence.| | ||
| == Zhao 2016 == | == Zhao 2016 == | ||
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| - | === Acupuncture des poignets et chevilles === | + | === Wrist-ankle Acupuncture === |
| == Fu 2018 ☆== | == Fu 2018 ☆== | ||
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| ^Conclusion| The wrist-ankle acupuncture and its combination therapy are more advantageous than the wrist-ankle acupuncture therapy in treating the disease and its clinical efficiency. However, limited by the quality and quantity of the included studies, the conclusions of this study may be biased, and more high-quality researches should be done to verify it. | | ^Conclusion| The wrist-ankle acupuncture and its combination therapy are more advantageous than the wrist-ankle acupuncture therapy in treating the disease and its clinical efficiency. However, limited by the quality and quantity of the included studies, the conclusions of this study may be biased, and more high-quality researches should be done to verify it. | | ||
| + | === Cervical Three-needle Acupuncture === | ||
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| + | == Yin 2020 == | ||
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| + | Yin Yueshan. [Meta-analysis of acupuncture with three cervical acupuncture for the treatment of cervical spondylotic radiculopathy]. The Journal of Cervicodynia and Lumbodynia. 2020. [212894]. | ||
| + | ^Objective|To systematically evaluate the effectiveness and safety of cervical three-needle acupuncture for the treatment of cervical spondylotic radiculopathy (CSR).| | ||
| + | ^Methods| The computer searched Wanfang, HowNet, Weipu, Pubmed, Highwire, Springer, EBSCO and other databases, randomly collected the relevant randomized controlled research literature of cervical three-needle + other therapies, after evaluating the quality of the literature, Revman5. 3 was used for data analysis.| | ||
| + | ^Results| A total of **10 randomized controlled studies** were included. The clinical effective rate [OR=3. 79 (95%CI: 2. 49～5. 78), P<0. 001] of patients treated with cervical three-needle therapy was significantly higher than that of patients without cervical three-needle therapy. The VAS score (WMD =-1. 38, 95%CI is -1. 62～-1. 13, P<0. 001), NDI (WMD=-9. 23, 95%CI is -18. 20～-0. 25, P<0. 04) is significantly lower than that of non-neck three-needle patients . None of the literature reports the incidence of adverse reactions.| | ||
| + | ^Conclusion| Cervical three-needle acupuncture treatment of CSR can improve the clinical effectiveness, reduce the level of pain, and reduce the degree of cervical spine dysfunction. Its safety needs further research.| | ||
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| + | === Catgut Embedding === | ||
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| + | == Liang 2020 == | ||
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| + | Liang Long. [Systematic Review of Acupoint Embedding Treating for Cervical Radiculopathy ]. Guiding Journal of TCM and Pharmacy. 2020. [212900]. | ||
| + | ^Objective| To systematically evaluate the efficacy and safety of acupoint embedding in the treatment of cervical radiculopathy.| | ||
| + | ^Methods| All randomized controlled trials of acupoint embedding in the treatment of cervical spondylotic radiculopathy were retrieved by computer. The quality assessments were performed using the Cochrane risk of bias tool. Meta-analysis was carried out with RevMan 5. 3 and Stata 12. 0 software.| | ||
| + | ^Results| A total of nine articles were included and 1128 cases were studied. The results showed that acupoint embedding could improve clinical efficacy better than acupuncture and electro-acupuncture [OR =3. 85, 95% CI (2. 35, 6. 31), P <0. 000, 01]. In terms of improving VAS score, acupoint embedding is better than ordinary acupuncture[SMD=-1. 19, 95%CI (-1. 85, -0. 53), P=0. 000, 4]; in terms of improvement of NDI index, the acupoint embedding is superior to acupuncture [SMD=-0. 61, 95%CI (-1. 08, -0. 14), P=0. 01] in trems of improving Tianzhong Jingjiu scale, the acupoint embedding is superior to acupuncture and electro-acupuncture groups [SMD=1. 31, 95%CI (0. 89, 1. 73), P<0. 000, 01]; In terms of safety, the number of adverse reactions that occur after acupoint embedding was more than that of acupuncture.| | ||
| + | ^Conclusion| Acupoint embedding can effectively alleviate the pain of patients with cervical radiculopathy, improve the functional status of patients and improve clinical efficacy, but the safety is lower than that of acupuncture.| | ||
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| + | === Abdominal acupuncture === | ||
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| + | == Peng 2023 == | ||
| + | Peng Y, Wu J, Wu Y, Chen F. Abdominal acupuncture therapy for cervical spondylotic radiculopathy: A systematic review and metaanalysis. Asian J Surg. 2023 Dec;46(12):5776-5778. https://doi.org/10.1016/j.asjsur.2023.08.138 | ||
| - | ===== Overview of Systematic Reviews ===== | + | ===== Overviews of Systematic Reviews ===== |
| ==== Wei 2015 ==== | ==== Wei 2015 ==== | ||
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| ^ Results | We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent. | | ^ Results | We had included eight systematic reviews. The effectiveness and safety of acupotomy, acupuncture, Jingfukang granule, manual therapies, and cervical spine manipulation were investigated. Based on available evidence, the systematic reviews supported various forms of CAM for CR. Nevertheless, the methodological quality for most of systematic reviews was low or moderate. In addition, adverse reactions of primary studies were infrequent. | | ||
| ^ Conclusions | Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice. | | ^ Conclusions | Current systematic reviews showed potential advantages to CAM for CR. Due to the frequently poor methodological quality of primary studies, the conclusions should be treated with caution for clinical practice. | | ||
| - | ===== Guidelines ===== | + | ===== Clinical Practice Guidelines ===== |
| | ⊕ 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) | | ||
