[1]袁启令,刘亮,马江涛,等.针刺治疗慢性非特异性腰痛的临床研究[J].中医正骨,2016,28(06):12-17.
　YUAN Qiling,LIU Liang,MA Jiangtao,et al.A clinical study of acupuncture therapy for treatment of chronic nonspecific low back pain[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2016,28(06):12-17.
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针刺治疗慢性非特异性腰痛的临床研究()
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《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第28卷
期数:
2016年06期
页码:
12-17
栏目:
临床研究
出版日期:
2016-06-20

文章信息/Info

Title:
A clinical study of acupuncture therapy for treatment of chronic nonspecific low back pain
作者:
袁启令1; 刘亮1; 马江涛2; 武文韬1; 叶茂林2; 张银刚1
1.西安交通大学第一附属医院,陕西 西安 710061;
2.河南中医药大学,河南 郑州 450008
Author(s):
YUAN Qiling1; LIU Liang1; MA Jiangtao2; WU Wentao1; YE Maolin2; ZHANG Yingang1
1.The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,Shanxi,China
2.Henan University of Traditional Chinese Medicine,Zhengzhou 450008,Henan,China
关键词:
腰痛;  针刺疗法;  安慰针刺;  临床试验
Keywords:
low back pain;  acupuncture therapy;  sham acupuncture;  clinical trial
摘要:
目的:探讨针刺对于慢性非特异性腰痛的特异性治疗作用。方法:采用前瞻性、随机、单盲、安慰对照、平行、多中心研究。共纳入150例慢性非特异性腰痛患者,随机分配至针刺组、安慰针刺组和等待治疗组,每组50例。治疗时针刺组选择肾俞、大肠俞、委中、腰阳关、环跳5个穴位为固定针刺点,同时在腕骨、带脉、阳陵泉、足临泣、地仓、足三里、命门、悬枢、神庭、水沟10个穴位中灵活选取几个穴位进行针刺治疗,进针5～20 mm,得气后留针20 min。隔2 d治疗1次,共治疗6周。安慰针刺组选取与针刺组相同的5个固定穴位用安慰针灸针进行治疗,疗程与针刺组相同; 等待治疗组在本试验期间不接受治疗,待本试验结束后再接受针刺治疗。所有患者在必要的情况下,允许口服非甾体类抗炎药缓解腰痛。主要观察指标包括腰部疼痛视觉模拟评分量表(visual analogue scale,VAS)评分和Oswestry功能障碍指数(Oswestry disability index,ODI),观察时点设为针刺组和安慰针刺组治疗前和治疗结束后1、4、12周。同时观察并发症发生率,评价试验的盲法质量。结果:共有14例患者未完成试验观察,其中针刺组4例、安慰针刺组4例、等待治疗组6例。针刺组和安慰针刺组共有17例患者报告了24次小至中度的与治疗有关的不良反应,不良反应持续时间均不超过1周。2组不良反应发生率比较,差异无统计学意义(χ2=0.071,P=0.790)。治疗结束后,针刺组和安慰针刺组患者均接受了盲法评估。2组患者的评估结果比较,差异无统计学意义(χ2=0.230,P=0.891)。治疗前后不同时间腰痛VAS评分的差异有统计学意义,即存在时间效应(F=34.590,P=0.000); 除等待治疗组外(P=0.054),治疗结束后1周针刺组和安慰针刺组腰痛VAS评分均小于治疗前(P=0.000,P=0.000); 治疗结束后4、12周,针刺组、安慰针刺组和等待治疗组的腰痛VAS评分均小于治疗前(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.000)。3组腰痛VAS评分总体上比较,组间差异有统计学意义,即存在分组效应(F=22.340,P=0.000); 治疗前和治疗结束后12周3组腰痛VAS评分比较,组间差异均无统计学意义(F=1.073,P=0.345; F=1.666,P=0.192); 治疗结束后1周,针刺组腰痛VAS评分小于安慰针刺组和等待治疗组(P=0.004,P=0.000),安慰针刺组腰痛VAS评分小于等待治疗组(P=0.010); 治疗结束后4周,针刺组腰痛VAS评分小于安慰针刺组和等待治疗组(P=0.008,P=0.000),安慰针刺组腰痛VAS评分小于等待治疗组(P=0.030)。时间因素与分组因素存在交互效应(F=3.760,P=0.025)。治疗前后不同时间ODI评分的差异有统计学意义,即存在时间效应(F=68.020,P=0.000); 治疗结束后1、4、12周,针刺组、安慰针刺组和等待治疗组的ODI评分均小于治疗前(P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000)。3组ODI评分总体上比较,组间差异有统计学意义,即存在分组效应(F=14.390,P=0.000); 治疗前和治疗结束后12周3组评分比较,组间差异均无统计学意义(F=0.815,P=0.444; F=0.431,P=0.651); 治疗结束后1周,针刺组评分小于安慰针刺组和等待治疗组(P=0.001,P=0.000),安慰针刺组与等待治疗组比较,差异无统计学意义(P=0.124); 治疗结束后4周,针刺组评分与安慰针刺组比较,差异无统计学意义(P=0.127),针刺组和安慰针刺组评分均小于等待治疗组(P=0.000,P=0.001)。时间因素与分组因素不存在交互效应(F=1.800,P=0.169)。结论:针刺对于慢性非特异性腰痛存在特异性治疗作用,可在短期内(≤4周)缓解患者腰部疼痛症状、改善腰部功能,而且具有较高的安全性。
Abstract:
Objective:To explore the specific therapeutic effect of acupuncture therapy on chronic nonspecific low back pain.Methods:A prospective,randomized,single-blinded,placebo-controlled,parallel,multicenter trial was carried out.One hundred and fifty patients with chronic nonspecific low back pain were included and randomly divided into acupuncture group,placebo-acupuncture group and wait-to-treat group,50 cases in each group.The patients in acupuncture group were treated with acupuncture therapy and five acupoints including Shenshu(BL23),Dachangshu(BL25),Weizhong(BL40),Yaoyangguan(GV3)and Huantiao(GB30)were selected as fixed acupuncture points.Meanwhile,several points were selected for acupuncture treatment from 10 acupoints including Wangu(SI4),Daimai(GB26),Yanglingquan(GB34),Zulinqi(GB41),Dicang(ST4),Zusanli(ST36),Mingmen(GV4),Xuanshu(GV5),Shenting(GV24)and Shuigou(GV26)according to the specific conditions.The depth of needle insertion was 5-20 mm and the needles were retained for 20 mintues at a time after DEQI(GETTING QI).The acupuncture was performed every 3 days for consecutive 6 weeks.The patients in placebo-acupuncture group were treated with placebo-acupuncture therapy by selecting the same 5 acupoints as that of acupuncture group and the course of treatment was also same as that of acupuncture group.The patients in wait-to-treat group were not treated until the end of this trial.All of the patients were permitted to take nonsteroidal anti-inflammatory drugs(NSAID)for relieving low back pain if necessary.Low back pain visual analogue scale(VAS)scores and Oswestry disability index(ODI)were used as main indexes for measuring the treatment effectiveness before the treatment and at 1,4 and 12 weeks after the end of the treatment.Meanwhile,the complication rates were observed and the quality of blind method used in the trail was evaluated.Results:The experimental observation were unfinished in 14 patients,4 patients in acupuncture group,4 patients in placebo-acupuncture group and 6 patients in wait-to-treat group.A total of 17 patients in acupuncture group and placebo-acupuncture group reported mild-to-moderate adverse reactions related to treatment for 24 times,no more than 1 week at a time.There was no statistical difference in the incidence rate of adverse reactions between the 2 groups(χ2=0.071,P=0.790).The blind method was evaluated in the patients in acupuncture group and placebo-acupuncture group after the end of the treatment and there was no statistical difference in the evaluation results between the 2 groups(χ2=0.230,P=0.891).There was statistical difference in low back pain VAS scores between different time points,in other words,there was time effect(F=34.590,P=0.000).The low back pain VAS scores were lower at 1 week after the end of the treatment compared to pre-treatment in acupuncture group and placebo-acupuncture group(P=0.000,P=0.000),while there was no statistical difference between pre-treatment and post-treatment in wait-to-treat group(P=0.054).The low back pain VAS scores were lower at 4 and 12 weeks after the end of the treatment compared to pre-treatment in all of the 3 groups(P=0.000,P=0.000,P=0.002; P=0.000,P=0.000,P=0.0000).There was statistical difference in low back pain VAS scores between the 3 groups in general,in other words,there was group effect(F=22.340,P=0.000).There was no statistical difference in low back pain VAS scores between the 3 groups before treatment and at 12 weeks after the end of the treatment(F=1.073,P=0.345; F=1.666,P=0.192).The low back pain VAS scores were lower in acupuncture group compared to placebo-acupuncture group and wait-to-treat group and were lower in placebo-acupuncture group compared to wait-to-treat group at 1 week after the end of the treatment(P=0.004,P=0.000,P=0.010).The low back pain VAS scores were lower in acupuncture group compared to placebo-acupuncture group and wait-to-treat group and were lower in placebo-acupuncture group compared to wait-to-treat group at 4 weeks after the end of the treatment(P=0.008,P=0.000,P=0.030).There was interaction between time factor and group factor(F=3.760,P=0.025).There was statistical difference in ODI scores between different time points,in other words,there was time effect(F=68.020,P=0.000).The ODI scores were lower at 1,4 and 12 weeks after the end of the treatment compared to pre-treatment in all of the 3 groups(P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000; P=0.000,P=0.000,P=0.000).There was statistical difference in ODI scores between the 3 groups in general,in other words,there was group effect(F=14.390,P=0.000).There was no statistical difference in ODI scores between the 3 groups before treatment and at 12 weeks after the end of the treatment(F=0.815,P=0.444; F=0.431,P=0.651).The ODI scores were lower in acupuncture group compared to placebo-acupuncture group and wait-to-treat group at 1 week after the end of the treatment(P=0.001,P=0.000),and there was no statistical difference in ODI scores between placebo-acupuncture group and wait-to-treat group(P=0.124).There was no statistical difference in ODI scores between acupuncture group and placebo-acupuncture group at 4 weeks after the end of the treatment(P=0.127).The ODI scores were lower in acupuncture group and placebo-acupuncture group compared to wait-to-treat group(P=0.000,P=0.001).There was no interaction between time factor and group factor(F=1.800,P=0.169).Conclusion:Acupuncture therapy has specific therapeutic effect on chronic nonspecific low back pain,it can relieve low back pain and improve lumbar function in short term(≤4 weeks),meanwhile it has high safety.

参考文献/References:

[1] Lewith GT.How effective is acupuncture in the management of pain?[J].J R Coll Gen Pract,1984,34(262):275-278.
[2] 陈罗西,刘波.桡骨茎突狭窄性腱鞘炎的针灸治疗进展[J].中医正骨,2014,26(6):46-47.
[3] 李艺彬,吴昭克,朱勇.针灸治疗膝骨性关节炎临床研究现状[J].中医正骨,2013,25(2):74-75.
[4] 史莹莺.针刺治疗急性踝关节扭伤[J].中医正骨,2013,25(4):12-14.
[5] 王金法,鲍航行,蔡运火,等.全膝置换围手术期耳针镇痛的临床应用[J].中医正骨,2012,24(5):3-6.
[6] 江涛,江林,史俊德,等.动气针法在踝关节骨折术后中后期康复中的应用[J].中医正骨,2015,27(11):20-24.
[7] Lewith GT,Machin D.On the evaluation of the clinical effects of acupuncture[J].Pain,1983,16(2):111-127.
[8] Xu M,Yan S,Yin X,et al.Acupuncture for chronic low back pain in long-term follow-up:a meta-analysis of 13 randomized controlled trials[J].Am J Chin Med,2013,41(1):1-19.
[9] Lam M,Galvin R,Curry P.Effectiveness of acupuncture for nonspecific chronic low back pain:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2013,38(24):2124-2138.
[10] Dorsi M,Belzberg A.Low back pain[M]//Jeffery.Non-specific low back pain.New York:McGraw Hill,2005:141-146.
[11] Lee JH,Park HJ,Lee H,et al.Acupuncture for chronic low back pain:protocol for a multicenter,randomized,sham-controlled trial[J].BMC Musculoskelet Disord,2010,11:118.
[12] Streitberger K,Kleinhenz J.Introducing a placebo needle into acupuncture research[J].Lancet,1998,352(9125):364-365.
[13] Harris RE,Zubieta JK,Scott DJ,et al.Traditional Chinese acupuncture and placebo(sham)acupuncture are differentiated by their effects on mu-opioid receptors(MORs)[J].Neuroimage,2009,47(3):1077-1085.
[14] Le Bars D,Villanueva L,Bouhassira D,et al.Diffuse noxious inhibitory controls(DNIC)in animals and in man[J].Patol Fiziol Eksp Ter,1992,(4):55-65.
[15] Macpherson H,Nahin R,Paterson C,et al.Developments in acupuncture research:big-picture perspectives from the leading edge[J].J Altern Complement Med,2008,14(7):883-887.

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备注/Memo

备注/Memo:
基金项目:国家自然科学基金项目1371987,81171761); 陕西省科技计划项目(2013K12-14-04)
通讯作者:张银刚 E-mail:zyingang@mail.xjtu.edu.cn
更新日期/Last Update: 2016-06-30