Névralgie cervico-brachiale : évaluation de l'acupuncture

Articles connexes: - conduites thérapeutiques - pathologie - acupuncture expérimentale - qigong -

1. Revues systématiques et méta-analyses

1.1. Acupuncture générique

1.1.1. Hu 2012 ☆☆

[Acupuncture for cervical spondylotic radiculopathy: a systematic review]. Anhui Zhong Yi Xue Yuan Xue Bao. 2012;31(5):39–43. Hu J, Chu HR, Sun K, Xiao W, Song YC, Long XN. [Clinical effect of acupuncture in treatment of cervical spondylotic radiculopathy: a systematic review]. Journal of Anhui Traditional Chinese Medical College. 2012;5:39-43. [186982].

Objective	To assess and compare the clinical effects and safeties of acupuncture and traction therapy in the treatment of cervical spondylotic radiculopathy (CSR) by a systematic review.
Methods	A search was performed in various worldwide databases for a systematic review of randomised controlled trials of acupuncture and traction therapy for treating CSR. Methodological quality assessment was conducted according to Cochrane Handbook for Systematic Reviews of Interventions Version 5. 1. 0, and effect sizes were calculated. Meta-analysis or descriptive analysis was performed.
Results	Fourteen studies involving 1 542 cases were included. Acupuncture was safe in the treatment of CSR. Acupuncture showed better clinical effect than traction therapy in the treatment of CSR (RR: 1. 20;95% CI: 1. 13-1. 27 vs RR: 1. 14, 95% CI: 1. 09-1. 20). In addition, acupuncture had better analgetic effect and could reduce recurrence.
Conclusion	Acupuncture is probably superior to traction therapy in the treatment of CSR, but which is not definite due to relatively low level of evidence.

1.1.2. Sun 2009 ☆☆

Sun P, Du YH, Xiong J et al. [Acupuncture versus traction for cervical spondylotic radiculopathy: a systematic review]. Journal of Traditional Chinese Medicine. 2009. 24(10):1824–1830.[187023].

Objective	To assess the efficacy of acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy.
Methods	Randomized controlled trials (RCTs)involving acupuncture versus traction in the treatment of Cervical Spondylotic Radiculopathy were searched from PubMed (1950 to 2008)、Ovid (1950 to 2008)、EBSCO (1973 to 2008)、Cochrane Library (Issue 2, 2008)、CBM (1978 to 2006)、CNKI (1979 to 2008)、VIP (1989 to 2008) and WANFANG Database (1998 to 2008). We also hand searched relevant journals and conference proceedings. Data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan 4. 2. 8 software was used for data analyses.
Results	A total of 8 trials involving 1546 patients were included. Effective rate was used as the primary resultant index in all the eight syudies. Meta-analyses showed that effective rate between acupuncture group and traction group was significant difference [RR 1. 24, 95%CI (1. 16 to 1. 32)], significant difference was also noted when acupuncture plus traction group versus traction group [RR1. 10, 95%CI (1. 02 to 1. 18)]. MPQ score was used as the secondary resultant index in these three studies, there were significant differences between treatment group and control group as for VAS [WMD 1. 53, 95%CI (0. 85 to 2. 21)]and PPI [WMD 0. 61, 95%CI (0. 50 to 0. 71)].
Conclusion	Acupuncture treatment is effective for Cervical Spondylotic Radiculopathy and is superior to traction in the aspects of effective rate and pain alleviating. The curative effect of traction treatment could be improved when combining with acupuncture. However, the conclusion was uncertain because the quality of enrolled papers was partly low. Therefore, further high-quailty randomized controlled trials are required to prove the role of acupuncture in the treatment of Cervical Spondylotic Radiculopathy.

1.1.3. Lin 2009 ☆

Lin H-L, Song H-M, Zhong W-H, Chen S-Q, Wang S-Z. [Effects of different acupuncture and moxibustion treatments on cervical spondylotic radiculopathy: a systematic evaluation]. Journal of Clinical Rehabilitative Tissue Engineering Research. 2009;13(46):9017-21. [168343].

Objective	To evaluate the effect and safety of conservative treatment for treating cervical spondylotic radiculopathy by Cochrane evaluation systems.
Data Source	CBM (from January 1978 to October 2008), CNKI (from January 1978 to October 2008) and VIP (from January 1989 to October 2008) databases were retrieved by computer and partial documents were searched by hands.
Data Selection	Randomized controlled trial was adopted in course of acupuncture and moxibustion treatment for cervical spondylotic radiculopathy and its quality was assessed. Data source was randomized and semi-randomized controlled. Some evaluations such as random method-selection bias, allocation concealment-selection bias, blind method-performance bias and measurement bias, exclusion, lose to follow-up, withdraw-attrition bias were chosen.
Main Outcome Measures	Circled digit one Abdominal acupuncture needles were superior to the conventional method's efficiency. Circled digit two Electro-acupuncture plus cupping with barbed floc were superior to the conventional method's efficiency. Circled digit threeAbdominal acupuncture were superior to traction's efficiency. Circled digit fourCervical traction, electro-acupuncture combined with point injection and massage were superior to traction's efficiency. Circled digit fiveTraction, electro-acupuncture, massage, TDP-guided were superior to traction, physiotherapy, TDP combined with exercise therapy's efficiency. Circled digit sixVinegar iontophoresis and electro-acupuncture were superior to simple electro-acupuncture's efficiency. Circled digit sevenLong's approach acupuncture was superior to simple acupuncture's efficiency. Circled digit eight Adverse reaction.
Results	A total of 1,416 subjects were selected from 7 randomized controlled trials. All the studies have selection bias, measurement bias, loss of the high probability of bias, the quality and grade of “C” grade. And only one study proved that the efficiency of the experimental group was better than that of the control group. Study 1 showed that there was insufficient evidence suggested that acupuncture treatment of abdominal cervical spondylotic radiculopathy was efficient than conventional acupuncture. Study 2 showed that there was insufficient evidence suggested that electro-acupuncture plus cupping therapy with barbed floc was efficient than conventional acupuncture to cure cervical spondylotic radiculopathy. Study 3 showed that there was insufficient evidence suggested that acupuncture treatment of abdominal cervical spondylotic radiculopathy was efficient than traction. Study 4 showed that the cervical traction, electro-acupuncture combined with acupoint-injection treatment of cervical spondylotic radiculopathy was efficient than traction combined massage therapy. Study 5 showed that there was insufficient evidence suggested that traction, electro-acupuncture, massage, TDP-guided therapy was efficient than traction, physical therapy, TDP combined with exercise therapy. Study 6 showed that there was insufficient evidence suggested that electro-acupuncture combined with vinegar iontophoresis treatment of cervical spondylotic radiculopathy was better than the simple electro-acupuncture therapy. Study 7 showed that there was insufficient evidence suggested that the acupuncture therapy using Long's approach was better than simple acupuncture. No adverse reactions appeared to terminate the test in 7 studies.
Conclusion	The above seven studies mainly present with low quality, absence of a unified curative method, small samples, difference of follow-up time, Judgment standard and measurement standard. So more samples, multicenter and more regular randomized controlled trial should be performed.

1.2. Techniques particulières

1.2.1. Zhang 2016 (moxibustion) ☆

Zhang Yang , Zhou Mei-qi ,Tang Wei , Song Xiao-ge. System evaluation and Meta analysis on clinical efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radicuiopathy World Journal of Acupuncture of Moxibustion. 2016;26(4):41. [178238].

Objectives	To systematically evaluate the efficacy of heat-sensitive moxibustion in treatment of cervical spondylotic radiculopathy (CSR).
Methods	Chinese National Knowledge Infrastructure (CNKI), China Biology Medical (CBM) database, Chinese Science and Technology Periodical Database (VIP), WanFang Data, Pubmed and Cochrane Library were retrieved to search the randomized controlled trials (RCT) on heat-sensitive moxibustion in treatment of CSR, and Meta analysis was conducted by applying RevMan 5.3 software.
Results	Eventually, 10 papers were included in this study, including 1008 subjects. Meta analysis result showed: the total effective rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.13, 95%C1(1.06, 1.21), Z=3.54, P=0.000 4]; the cure rate of treatment group was higher than that of control group, and the difference was statistically significant [RR=1.80, 95%C1(1.52, 2.13), Z=6.82, P<0.000 01]; the improvement of short-form McGill pain questionnaire (SF-MPQ) of treatment group was superior to that of control group, and the difference was statistically significant [MD=-4.44, 95%Cl(-6.38, -2.50), Z=4.49, P<0.000 01]; visual analogue scale (VAS) of treatment group was lower than that of control group, and the difference was statistically significant [MD=-0.36, 95%Cl(-0.50, —0.23), Z=5.42, P<0.00001]; and the improvement of interleukin-6 (IL-6) of treatment group was superior to that of control group, and the difference was statistically significant [MD=-7.32, 95%Cl(-11.49, —3.14), Z=3.44, P=0.000 6].
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.

1.2.2. Liu 2007 ( acupotomie)

Liu XQ, Deng JF, Lin DK. [The evaluation of clinical articles about cervical spondylotic radiculopathy treated with acupotomy]. Chinese Journal of Traditional Medical Traumatology & Orthopedics 2007.15(4):34–37. [168341].

Objective	To evaluate the quality of clinical study and efficacy of the treatment for cervical spondylotic radiculopathy(CSR)by acupotomy.
Methods	Dialog Online Retrieval system was used, extracting targeted articles were selected about the treatment in CSR by acupotomy assessed. Grades of recommendation and level of evidence to evaluate and compare the methodological quality in these articles, and the efficacy in the treatment for CSR by acupotomy.
Results	Seventy-six articles were evaluated 12 randomized controlled trials, 8 non- randomized controlled trials and 56 clinical retrospective studies. The grades of evidence recommendation and the frequency: B level 12, C level 8, D level 56.The level of evidence and the frequency: 2a level 2, 2b level 4, 4 level 8, 5 level 56.The methodological quality and the frequency of 20 clinical controlled trials: diagnostic criteria, 13A, 7B.The inclusive criteria, 5A, 15C; exclusive criteria, 7A, 13C; randomized method, 7A, 5B, 8C; base line, 9A, 11C; follow-up, 1A, 19C;therapeutical effect, 6A, 13B; statistical algorithm, 9A, 11B; the sample evaluation, the randomized assignment protocol hiding, blind trial and lost to follow are 20C. The total effective rate was 80%～100%; Three results of the Meta-analysis about these clinical controlled trial: there is a great difference between the treatment of acupuncture and acupotomy; the group of acupotomy is better than that of acupuncture; there`s no damage on the nerve or on the circulation system, or fainting during the treatment,etc.
Conclusions	There is no enough high grades of evidence recommendation. the level of evidence is rather low; there`s some defects in clinical study on the treatment for CSR by acupotomy; treatment for CSR by acupotomy is safe and efficient treatment for CSR, but the bad quality of articles and the deficiency of methodological decline the efficacy and the reliability.

2. Revues de revues systématiques

2.1. Wei 2015

Wei X, Wang S, Li J, Gao J, Yu J, Feng M et al. Complementary and alternative medicine for the management of cervical radiculopathy: an overview of systematic reviews. Evid Based Complement Alternat Med 2015. [183367].

Background	Complementary and alternative medicine (CAM) is widely applied in the clinical practice of neck pain owing to cervical radiculopathy (CR). While many systematic reviews exist in CAM to improve CR, research is distributed across population, intervention, comparison, and setting.
Objective	This overview aims to summarize the characteristics and evaluate critically the evidence from systematic reviews.
Methods	A comprehensive literature search was performed in the six databases without language restrictions on February 24, 2015. We had identified relevant systematic reviews that examined the subjects with neck pain due to cervical radiculopathy undergoing CAM. Two authors independently appraised the methodological quality using the revised assessment of multiple systematic reviews instrument.
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.

3. Recommandation de bonne pratique

3.1. American College of Occupational and Environmental Medicine (ACOEM, USA 2011)

American College of Occupational and Environmental Medicine (ACOEM). Cervical and thoracic spine disorders. Elk Grove Village (IL): American College of Occupational and Environmental Medicine (ACOEM). 2011; 332P. [166312].

Radicular Pain Syndromes. Not recommended: Routine use of acupuncture for acute radicular pain (I)

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