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acupuncture:evaluation:algologie-anesthesie par acupuncture:02. douleur aigue [12 Oct 2019 15:26] (Version actuelle) Nguyen Johan Page name changed from acupuncture:evaluation:algologie-anesthesie par acupuncture:01. douleur aigue to acupuncture:evaluation:algologie-anesthesie par acupuncture:02. douleur aigue |
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| + | ====== Douleur aiguë : évaluation de l'acupuncture ====== | ||
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| + | ===== Revues systématiques et méta-analyses ===== | ||
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| + | ==== Acupuncture générique ==== | ||
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| + | === Chia 2018 === | ||
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| + | Chia KL, Lam RPK, Lam CK, Tsui SH. Acupuncture in the emergency department: a systematic review of randomised controlled trials. Acupuncture in Medicine. 2018;36(3):183-192. {{:medias securises:acupuncture:evaluation:algologie-anesthesie par acupuncture:chia-201340.pdf|[201340}}]. | ||
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| + | ^ Introduction|A comprehensive review of both English and Chinese language literature to inform acupuncture practice in emergency department (ED) settings is lacking. Accordingly, we aimed to conduct a systematic review of English and Chinese randomised controlled trials (RCTs) of acupuncture use in the ED. | | ||
| + | ^Methods|Four English databases (Embase, PubMed, AMED and CENTRAL) and two Chinese databases (CNKI and Wanfang) were systematically searched using the keywords 'acupuncture' and 'emergency department', followed by a bibliographic search of references. The data were extracted and assessed by two independent authors. RCTs were selected based on pre-defined criteria. Data were extracted and a risk of bias assessment was performed using the Cochrane risk of bias tool. The quality of evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. | | ||
| + | ^Results| In total, 1461 articles were screened and six RCTs involving 651 patients were included. For various acute pain conditions, acupuncture was superior to sham acupuncture, more effective than intravenous morphine, comparable to conventional ED treatment, and superior to standard ED care alone when used on an adjuvant basis; however, the overall level of evidence was low. Studies that applied acupuncture in hypertension and cardiac arrest were deemed to be at high risk of bias, and the level of evidence for these outcomes was very low. No major adverse events were reported in the included studies. | | ||
| + | ^Conclusion|There is a lack of high-quality evidence to support the use of acupuncture in the ED. Multicentre RCTs with rigorous designs are warranted. | | ||
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| + | ==== Techniques particulières ==== | ||
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| + | === Acupuncture auriculaire === | ||
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| + | == Jan 2017 (douleur aigue)☆ == | ||
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| + | Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC.. Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis. Med Acupunct. 2017;29(5):276-289. {{:medias securises:acupuncture:evaluation:algologie-anesthesie par acupuncture:jan-176734.pdf|[176734].}} | ||
| + | ^Objective|Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. | | ||
| + | ^Methods|Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. | | ||
| + | ^ Results| **Six randomized controlled trials and 2 observational studies, totaling 458 patients**, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. | | ||
| + | ^Conclusions|While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications. | | ||
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| + | == Murakami 2017 ★★== | ||
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| + | Murakami M, Fox L, Dijkers MP. Ear Acupuncture for Immediate Pain Relief-A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Pain Med. 2017;18(3):551-564. {{:medias securises:acupuncture:evaluation:algologie-anesthesie par acupuncture:murakami-99627.pdf|[99627].}} | ||
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| + | ^Objective| To systematically review the literature on the effectiveness of ear acupuncture (EA) for immediate pain relief|. | ||
| + | ^Methods| Data sources.: AMED, CINAHL, Cochrane Reviews, Embase, PsycINFO, PubMed, Scopus Web of Science, from inception through March 2015. Study selection.: English publications, randomized controlled trials on human subjects involving EA as a treatment for pain, with outcomes recorded within 48 hours. Data extraction and design.: Two authors independently assessed trial eligibility, quality, results, and side effects, and extracted data; a third author checked final data. Effect size (d), mean difference (MD), and 95% confidence interval (CI) were calculated. The Physiotherapy Evidence Database (PEDro) scoring system was used to assess study quality. Meta-analysis was performed for two primary outcomes measures-pain intensity score and analgesic requirements. | | ||
| + | ^Results|Ten studies met inclusion criteria. Quality per PEDro scores: four excellent, four good, two fair. Based on their primary outcome measures, six studies showed EA being superior to its comparator, three showed no difference to comparators (which in all cases were analgesics), and one study showed significant pain decrease at the first time point and no significant decrease at the second. Meta-analysis was completed for the three studies that evaluated pain intensity as a primary outcome measure, and EA was superior to comparator (MD = -0.96, 95% CI = -1.82- -0.11), but the MD was small. Meta-analysis was completed for the six studies that evaluated analgesic requirements, and EA was superior (MD = -1.08, 95% CI = -1.78- -0.38]), again with a small MD. Six studies reported side effects; all were minor and transient.| | ||
| + | ^Conclusions| Ear acupuncture may be a promising modality to be used for pain reduction within 48 hours, with a low side effect profile. Rigorous research is needed to establish definitive evidence of a clinically significant difference from controls or from other pain treatments.| | ||
