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| Les deux révisions précédentes Révision précédente Prochaine révision | Révision précédente | ||
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acupuncture:evaluation:rhumatologie - orthopedie:16. sciatique [14 Nov 2024 10:13] Nguyen Johan [Tableau] |
acupuncture:evaluation:rhumatologie - orthopedie:16. sciatique [25 Oct 2025 11:26] (Version actuelle) Nguyen Johan [1.2.1.1. Ni 2025] |
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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.| | + | |
| - | | ☆ |Evidence for effectiveness of acupuncture mais limitées qualitativement et/ou quantitativement.| | + | |
| - | |Ø |No evidence or insufficient evidence.| | + | |
| ==== Generic Acupuncture ==== | ==== Generic Acupuncture ==== | ||
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| + | ==== Special Acupuncture Techniques ==== | ||
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| + | === Comparison of Acupuncture techniques === | ||
| + | == Ni 2025 == | ||
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| + | Ni D, Tong H, Wei S, Zheng Y, Wu W, Li M, Dong Y. Efficacy and Safety of Acupuncture and Acupuncture-Combined Therapies in the Treatment of Sciatica Caused by Lumbar Disc Herniation: A Network Meta-Analysis. J Pain Res. 2025 Sep 16;18:4809-4832. https://doi.org/10.2147/JPR.S542831 | ||
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| + | ^Background| Sciatica is a common complication of lumbar disc herniation (LDH). This network meta-analysis compared the efficacy of acupuncture monotherapies, acupuncture versus conventional rehabilitation, and acupuncture monotherapy versus combination therapies for LDH-related sciatica.| | ||
| + | ^Methods| We systematically searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CQVIP, and CBM. Bayesian network meta-analysis was performed using RStudio and GEMTC. STATA generated network and funnel plots. Treatment rankings were assessed using the Surface Under the Cumulative Ranking curve (SUCRA). Bias risk was evaluated with the Cochrane Risk of Bias tool 2.0.| | ||
| + | ^Results| According to SUCRA, in terms of total effective rate, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 92.93%); in terms of VAS, the better intervention was needle knife combined with rehabilitation therapy (NK+RT, 95.96%); in terms of ODI, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 98.03%); in terms of JOA, the best intervention was electrostimulation combined with rehabilitation therapy (ES+RT, 88.27%); in terms of IL-6 and TNF-α, the better intervention was electroacupuncture combined with electrostimulation (EA+ES, 99.99%).| | ||
| + | ^Conclusion| Acupuncture combined with other therapies demonstrates superior efficacy compared to rehabilitation treatment. Specifically, NK+RT is possibly a more effective intervention for pain relief; EA+Cupping shows a better benefit in improving disability and quality of life; ES+RT is likely a more effective strategy for promoting neurological recovery; and EA+ES is possibly better in reducing inflammatory responses.| | ||
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| + | === Acupotomy === | ||
| + | Lee 2025 | ||
| + | Lee S-H, Lee J-H, Choi H-K, Lee M-S, Choi S, Park S, Kim H-J, Kim YI, Kim YI, Lim YS, Park T-Y. Effectiveness of acupotomy combined with epidural steroid injection for lumbar radiculopathy: A systematic review and meta-analysis. Eur J Integr Med. 2025;77:102504. https://doi.org/10.1016/j.eujim.2025.102504 | ||
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| + | ^Background| Acupotomy—a combination of acupuncture and minimally invasive surgery—is a commonly used traditional East Asian medical intervention for treating patients with lumbar radiculopathy (LR). This study aimed to evaluate whether a combination of acupotomy and epidural steroid injections (ESIs) was more effective than ESIs alone or ESIs with interventions other than acupotomy for LR patients.| | ||
| + | ^Methods| Randomized controlled trials (RCTs) using acupotomy and ESIs in patients with LR were retrieved from thirteen databases on June 10, 2024 (PROSPERO CRD42023435441). Included studies assessed outcomes using the pain Visual Analogue Scale (VAS), total effective rate (TER), Oswestry Disability Index (ODI), and adverse events (AEs). Cochrane’s Risk of Bias Tool 2 (RoB2) was employed to assess the risk of bias, and the GRADE tool was used to assess evidence quality.| | ||
| + | ^Results| **Five studies involving 577 patients** were included. Compared with ESIs alone, the combination of acupotomy and ESIs led to improvement in pain VAS scores (three RCTs, standard mean difference [SMD] −0.73 [−1.01 to −0.45], very low certainty of evidence [CoE]) and TER (four RCTs, risk ratio 1.31 [1.02 to 1.69], very low CoE), although most studies were at high risk of bias in the RoB2 evaluation. However, the combination showed no improvement in ODI (two RCTs, SMD 0.46 [−1.58 to 2.50], very low CoE). No major AEs were reported.| | ||
| + | ^Conclusion| Although the quality of evidence was very low, combined acupotomy and ESIs proved more effective than ESIs alone for LR patients. Further rigorously designed studies are warranted to confirm the effects of this combination therapy.| | ||
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| + | ===== Overviews of systematic reviews ===== | ||
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| + | ==== Zhang 2025 ==== | ||
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| + | Zhang J, Guo Z, Wang L, Lin R, Xiao B, Liu W, Xu N, Cui S. Acupuncture Therapy for Sciatica: An Overview of Systematic Reviews and Meta-Analysis. J Pain Res. 2025 Sep 7;18:4651-4671. https://doi.org/10.2147/JPR.S549214 | ||
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| + | ^Background| Acupuncture shows potential as a treatment for sciatica, but the credibility and consistency of supporting evidence remain unclear, warranting critical and comprehensive evaluation. This overview aims to assess the reliability, adequacy, and limitations of current evidence on acupuncture for sciatica using a multidimensional approach and further examine its efficacy through a secondary meta-analysis.| | ||
| + | ^Methods| Systematic reviews and meta-analyses (SRs/MAs) meeting PICOS criteria were identified from eight databases by two independent reviewers. Evidence reliability was assessed using AMSTAR-2, ROBIS, PRISMA-A, and the GROOVE tool across four domains: methodological quality, bias risk, reporting accuracy, and study overlap. Duplicate randomized controlled trials (RCTs) were excluded based on the Corrected Covered Area (CCA) analysis, and a secondary meta-analysis was conducted. Sensitivity analyses and funnel plots assessed robustness and publication bias.| | ||
| + | ^Results| Seven SRs/MAs were included. AMSTAR-2 revealed significant methodological flaws, particularly due to a lack of protocol pre-registration. ROBIS assessments showed a high risk of bias, with most studies relying on single-database searches and lacking comprehensive strategies. PRISMA-A indicated generally low reporting quality, especially regarding descriptions of acupuncture sensation. The GROOVE tool yielded a CCA of 7.23%, reflecting moderate study overlap. The secondary meta-analysis showed that acupuncture significantly improved treatment effectiveness (RR = 1.23; 95% CI: 1.20-1.26; P = 0.008), reduced pain intensity, and increased pain threshold. Sensitivity analyses confirmed the robustness of results, while funnel plots suggested some publication bias. Acupuncture was generally considered safe across studies.| | ||
| + | ^Conclusion| Although current evidence is limited by methodological flaws, publication bias, and poor reporting quality, acupuncture shows promising clinical potential for sciatica. High-quality, rigorously designed studies are needed to confirm its efficacy.| | ||
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| ===== Clinical Practice Guidelines ===== | ===== Clinical Practice Guidelines ===== | ||
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| + | ==== American College of Occupational and Environmental Medicine (ACOEM, USA) 2020 Ø ==== | ||
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| + | Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Donelson R, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Non-Invasive and Minimally Invasive Management of Low Back Disorders. J Occup Environ Med. 2020 Mar;62(3):e111-e138. https://doi.org/10.1097/JOM.0000000000001812 | ||
| + | |For treatment of acute, subacute, radicular, or postoperative LBP, there are no quality studies, there are other effective treatments for those patients, and thus, acupuncture is Not Recommended (I), Moderate Confidence.| | ||
