针刺能否对三叉神经痛产生持久镇痛？一项更新的系统综述与Meta分析
Does Acupuncture Produce Durable Analgesia in Trigeminal Neuralgia? An Updated Systematic Review and Meta-Analysis.
摘要(中文译文)
三叉神经痛（TN）是一种复发缓解性疾病，主要在基层医疗中管理，卡马西平仍是唯一推荐的一线治疗。既往荟萃分析报道针刺可减轻治疗结束时疼痛，但未按偏倚风险分层、未审核疼痛结局报告质量，也未检验镇痛效应是否在治疗期后持续。本更新的系统评价针对这些空白进行了探讨。检索7个数据库自建库至2026年2月的随机对照试验，比较针刺与非针刺对照在成人TN中的疗效（PROSPERO：CRD420251271469）。采用随机效应模型及Hartung-Knapp-Sidik-Jonkman校正分析治疗结束时VAS、随访VAS、发作频率、复发率和不良事件。采用Cochrane RoB 2评估偏倚风险。对所有疼痛结局的回溯期设定进行审核。共纳入23项试验（1774例受试者），均来自中国，其中仅1项为假针刺对照。不足15%的VAS结局明确了回溯期。治疗结束时疼痛强度支持针刺（MD = -1.49；95% CI -1.81至-1.16；I = 93.1%），但预测区间跨越零，且显著性仅限于高偏倚风险研究（k = 16；< 0.001）。在三个月随访时，合并估计值幅度相当（k = 3；MD = -1.50；I = 47.0%），但对剔除单项研究不稳健。两项报告复发率的研究均支持针刺。针刺不良事件少于卡马西平（RR = 0.31；I = 0%）。治疗结束时的估计值受偏倚风险依赖性和普遍的回溯期缺失影响。随访数据显示镇痛持续性呈方向一致但统计学上脆弱的信号。需要开展以假针刺为对照、采用前瞻性疼痛日记并将随访作为共同主要终点的试验。
Abstract
Trigeminal neuralgia (TN) is a relapsing-remitting condition predominantly managed in primary care, where carbamazepine remains the sole recommended first-line therapy. Prior meta-analyses report end-of-treatment pain reductions with acupuncture but have not stratified results by risk of bias, audited pain outcome reporting quality, or examined whether analgesic effects persist beyond the treatment period. This updated systematic review addressed these gaps. Seven databases were searched from inception to February 2026 for randomized controlled trials comparing acupuncture against non-acupuncture controls in adults with TN (PROSPERO: CRD420251271469). End-of-treatment VAS, follow-up VAS, attack frequency, recurrence rate, and adverse events were analyzed using random-effects models with Hartung-Knapp-Sidik-Jonkman adjustment. Risk of bias was assessed with Cochrane RoB 2. Recall period specification was audited for all pain outcomes. Twenty-three trials (1774 participants) were included, all from China, with one sham-controlled comparator. Fewer than 15% of VAS outcomes specified a recall period. End-of-treatment pain intensity favored acupuncture (MD = -1.49; 95% CI -1.81 to -1.16; I = 93.1%), but the prediction interval crossed zero and significance was confined to high-risk studies (k = 16; < 0.001). At three-month follow-up, the pooled estimate was comparable in magnitude (k = 3; MD = -1.50; I = 47.0%) but was not robust to single-study removal. Recurrence rate favored acupuncture in both reporting studies. Acupuncture was associated with fewer adverse events than carbamazepine (RR = 0.31; I = 0%). End-of-treatment estimates are compromised by risk-of-bias dependence and pervasive recall period omission. Follow-up data showed a directionally consistent but statistically fragile signal of analgesic persistence. Sham-controlled trials with prospective pain diaries and follow-up as a co-primary endpoint are needed.
如何引用
AMA
Wei Wang, Weiming Wang, He Chen, Xinyu Shen, Jiarong Fan, Shuai Gao, et al. Does Acupuncture Produce Durable Analgesia in Trigeminal Neuralgia? An Updated Systematic Review and Meta-Analysis.. Healthcare (Basel, Switzerland). 2026; doi:10.3390/healthcare14131926.
APA
Wei Wang, Weiming Wang, He Chen, Xinyu Shen, Jiarong Fan, Shuai Gao, et al (2026). Does Acupuncture Produce Durable Analgesia in Trigeminal Neuralgia? An Updated Systematic Review and Meta-Analysis.. Healthcare (Basel, Switzerland). https://doi.org/10.3390/healthcare14131926
GB/T 7714
Wei Wang, Weiming Wang, He Chen, Xinyu Shen, Jiarong Fan, Shuai Gao, et al. Does Acupuncture Produce Durable Analgesia in Trigeminal Neuralgia? An Updated Systematic Review and Meta-Analysis.[J]. Healthcare (Basel, Switzerland), 2026 doi:10.3390/healthcare14131926.
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