針剌治療下背疼痛療效與影響因子探討之病歷回溯性研究

Effects Of Acupuncture Treatment On Low Back Pain : A Retrospective Study

葛晏如(Yan-Ru Ko) ； 楊雲明(Yun-Ming Yang)

《中醫藥雜誌》 29卷2期 (2018/12) Pp. 101-112

https://doi.org/10.3966/241139642018122902007

摘要

下背疼痛是現代社會中所常見的病。既有的文獻顯示，針灸治療下背痛在短期時間之內可有效緩解症狀，且鮮少有副作用。然而，過往的研究皆是以疼痛指數等主觀因子做為判斷嚴重程度的依據，鮮少採用放射線影像等客觀因子；並且，也少有研究探討，有接受過手術治療的患者，其術後疼痛是否會影響針刺治療下背痛的療效。此篇論文為回溯性研究，自病歷系統擷取下背痛病人就診資料，探討針灸對於下背疼痛，對於不同年齡、性別、針灸配穴、脊椎影像學上有無病變與接受手術治療與否等因子，是否會有不同治療之效果。此研究的收案人數為53人，由結果可知，針刺治療下背痛，整體的疼痛指數（Visual Analogue Scale，VAS）於治療前與後是有顯著改善的（VAS差異2.8，P值＜0.0001）。以各因子做分組比較治療前後的VAS差異值，結果顯示：性別分組（女2.61±1.22 vs 男3.15±1.31，P = 0.13）、年齡世代分組（變異數分析 P=0.0798）、針刺配穴分組（僅局部2.95±0.94 vs 局部及遠端2.73±1.44, P=0.54）並無統計上的差異；而有無脊椎病變（無病變 3.56±0.86 vs 有病變2.43±1.29, P=0.0016）及是否接受過手術治療分組（無2.96±1.13 vs 有1.86±1.77, P=0.0317） 有統計上的差異。在經過迴歸矯正後，結果顯示，初始疼痛較輕微者（P＜0.0015）、未接受過手術治療者（p=0.0072）、脊椎影像學上無病變者（p=0.0003）以及男性（p=0.0139），對於針刺治療的反應效果更好。綜合以上結果，針對下背痛的病人，針刺治療早期介入能否使病人有效緩解疼痛，進而降低手術機率，這點是未來可再進一步探討的部分。

關鍵字

針灸 ； 下背痛 ； 術後疼痛 ； 手術 ； 放射線影像

並列摘要

Low back pain is a common symptom among individuals in industrialized countries. Recent literature has shown that acupuncture treatment of low back pain can effectively relieve symptoms during short term follow-up, with few side effects. However, past studies have used subjective factors rather than objective factors, such as radiography, for assessing the severity of the condition. In addition, few studies have discussed if prior lumbar surgery can influence the results of acupuncture treatment of low back pain. We retrospectively collected the data of patients with low back pain from the medical records system of Keelung Chang Gung Memorial Hospital. We hypothesized that objective factors, such as age, gender, acupoints used, vertebral radiography findings, and prior lumbar surgery have an effect on the results of acupuncture treatment of low back pain. The study included 53 patients. Our results showed that after acupuncture treatment, the visual analogue scale (VAS) pain scores of all patients were significantly improved (p ＜0.0001). Comparing the VAS difference in the mean VAS score before and after acupuncture treatment in each group, there were no statistically significant differences based on sex, age , or acupoints used. However, there were statistically significant differences in the radiographic diagnosis group and the prior lumbar surgery group. After regression analysis, patients with a low pre-treatment VAS score (p＜0.0015), no prior lumbar surgery (p=0.0072), no anomalous findings on spine radiography (p=0.0003), and male gender (p=0.0139), had a better response to acupuncture treatment. In conclusion, for patients with low back pain, further investigation into whether early intervention with acupuncture treatment may be beneficial before lumbar surgery is warranted.

並列關鍵字

acupuncture ； low back pain ； postoperative pain ； surgery ； radiography

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