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acupuncture:evaluation:algologie-anesthesie par acupuncture:01. douleur [12 Oct 2019 15:26]
Nguyen Johan Links to acupuncture:evaluation:algologie-anesthesie par acupuncture:01. douleur aigue changed to acupuncture:evaluation:algologie-anesthesie par acupuncture:02. douleur aigue
acupuncture:evaluation:algologie-anesthesie par acupuncture:01. douleur [28 Jan 2020 07:25] (Version actuelle)
Nguyen Johan [8.1. Canadian Agency for Drugs and Technologies in Health 2019 ∼]
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 ^ Results ​    | Two studies provided information on 86 participants. One compared electroacupuncture with sham acupuncture for 20 minutes twice a week for six weeks; there was no difference between treatments. The other followed 11 weeks of cognitive behavioural therapy with either therapeutic interactive voice response through a computer for four months or usual treatment; the active group had a significant reduction in opioid use, while the usual care group had a significant increase. ​ | ^ Results ​    | Two studies provided information on 86 participants. One compared electroacupuncture with sham acupuncture for 20 minutes twice a week for six weeks; there was no difference between treatments. The other followed 11 weeks of cognitive behavioural therapy with either therapeutic interactive voice response through a computer for four months or usual treatment; the active group had a significant reduction in opioid use, while the usual care group had a significant increase. ​ |
 ^ Conclusions ​ | Both included studies were at significant risk of bias because of their small size, together with other important issues, including blinding. Because of this risk and the paucity of relevant studies, **no conclusions can be drawn regarding the effectiveness of interventions for opioid withdrawal in chronic non-cancer pain.** ​ | ^ Conclusions ​ | Both included studies were at significant risk of bias because of their small size, together with other important issues, including blinding. Because of this risk and the paucity of relevant studies, **no conclusions can be drawn regarding the effectiveness of interventions for opioid withdrawal in chronic non-cancer pain.** ​ |
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 ===== Revues de revues systématiques ===== ===== Revues de revues systématiques =====
  
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 +==== Nielsen 2019 ====
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 +Nielsen A , Wieland LS. Cochrane reviews on acupuncture therapy for pain: A snapshot of the current evidence. Explore (NY). 2019;​8307(19):​30454-9. ​  ​{{:​medias securises:​acupuncture:​evaluation:​algologie-anesthesie par acupuncture:​nielsen-202439.pdf|[202439]}}. <wrap lo>​Cochrane is an international non-profit organization established in 1993 to produce and disseminate high quality and unbiased systematic reviews of evidence on health care interventions. At the forefront of systematic review methodology,​ Cochrane is generally accepted to be among the most carefully prepared and rigorous sources of systematic review evidence. There are numerous Cochrane reviews on nonpharmacologic interventions for pain and multiple Cochrane reviews evaluating acupuncture therapy in pain conditions. But how complete and up to date are those reviews relative to other rigorous systematic reviews with meta-analyses of acupuncture therapy for pain published in the literature? In this '​snapshot'​ overview, we found 22 relevant Cochrane reviews, some concluding that acupuncture therapy is probably useful for treating specific pain conditions. However, many of the conditions for which acupuncture is most commonly used are either not represented in Cochrane reviews or the existing Cochrane reviews are seriously outdated and do not reflect current evidence. This creates confusion with the risks of adverse effects and addiction liability associated with pain medications,​ the prevalence of chronic pain, the ongoing opioid epidemic and the need for evidence-based options for pain as part of comprehensive pain care. Clinicians and patients want clarification on safe and effective options to treat pain. Issues involving reviewed trials'​ inadequate use of sham comparators,​ of acupuncture as a complex intervention with interactive components and a shift in research focus from efficacy trials to real-world pragmatic trials are discussed in relation to updating Cochrane reviews of acupuncture therapy for pain.</​wrap>​
 ==== Ernst 2011 ☆ ==== ==== Ernst 2011 ☆ ====
  
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 | ⊕ recommandation positive (quelque soit le niveau de preuve annoncé) \\ Ø recommandation négative (ou absence de preuve) | | ⊕ recommandation positive (quelque soit le niveau de preuve annoncé) \\ Ø recommandation négative (ou absence de preuve) |
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 +==== Canadian Agency for Drugs and Technologies in Health (CADTH, Canada) 2019 ∼====
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 +Sutton D, McCormack S. Acupuncture for Chronic Non-Cancer Pain: A Review of Clinical Effectiveness,​ Cost Effectiveness and Guidelines [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2019. 94P.   ​{{:​medias securises:​acupuncture:​evaluation:​algologie-anesthesie par acupuncture:​sutton-203760.pdf|[203760]}}. ​
 + ​[[https://​www.ncbi.nlm.nih.gov/​books/​NBK551954/​pdf/​Bookshelf_NBK551954.pdf|DOI]]
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 +|A total of 23 systematic reviews, one economic study, and nine evidence-based guidelines were identified regarding the clinical effectiveness,​ cost-effectiveness,​ and recommendations for the use of acupuncture (including electroacupuncture,​ dry needling, manual acupuncture,​ and warm needle acupuncture) in patients with a variety of chronic non-cancer pain conditions. The identified systematic reviews were largely considered to be high-quality,​ and most evaluated the clinical effectiveness of acupuncture in general compared with sham interventions or medications. When specified, the most common type of comparator medications was non-steroidal anti-inflammatory drugs (NSAIDs). Many systematic reviews suggested evidence of acupuncture effectiveness for decreased pain, with some additionally reporting no difference in adverse events between acupuncture and comparator groups, but the results were inconsistent overall and often varied depending on the patient population. Likewise, recommendations regarding acupuncture were conflicting depending on the guideline group. Six evidence-based guidelines provided recommendations of varying strengths for the use of acupuncture in several chronic pain conditions (including chronic low back pain, different types of arthritis, and other pain disorders), two guidelines did not provide recommendations for acupuncture in patients with chronic low back pain and spinal cord-related neuropathic injuries due to insufficient evidence, and one guideline recommended against acupuncture for neck pain and associated disorders due to evidence of no effectiveness. One economic evaluation conducted in Iran found that electropuncture had a lower average cost-effectiveness ratio than NSAIDs for patients with chronic low back pain. However, firm conclusions regarding the relative costs and benefits of electroacupuncture and NSAIDs cannot be drawn as the incremental cost-effectiveness ratio was not reported in this study. Despite the number of high-quality systematic reviews and evidence-based guidelines identified regarding acupuncture for chronic non-cancer pain and their support for acupuncture,​ evidence demonstrating clinical effectiveness of acupuncture is limited because of the low-quality primary studies contributing to the evidence base. The STRICTA (Standards for Reporting Interventions in Clinical Trials of Acupuncture) criteria can be used while planning primary studies to increase the quality of these primary studies and to develop robust evidence. Additional high-quality economic studies conducted in Canada are also required to determine the cost-effectiveness of acupuncture for the treatment of chronic non-cancer pain in a Canadian context. |
  
 ==== Agency for Healthcare Research and Quality (ARQ, USA) 2018 ⊕ ==== ==== Agency for Healthcare Research and Quality (ARQ, USA) 2018 ⊕ ====