針灸用於緩解腫瘤浸潤引起疼痛之改善成效：隨機對照試驗之系統性文獻回顧與統合分析

研究目的：本研究旨在系統性摘錄探討針灸對癌症腫瘤浸潤侵犯引起疼痛之改善之文獻，並統合分析綜效。研究設計：隨機對照試驗之系統性文獻回顧與統合分析。研究方法：本研究以系統性文獻回顧方式，蒐集以針灸為介入措施，腫瘤浸潤疼痛分數下降或緩解之中、英文隨機對照試驗，並進行統合分析。分別使用EMBASE、PubMed、Medline、PsychINFO、CINAHL、Cochrane Library、華藝線上圖書館、萬方數據知識服務平台及中國知識資源總庫，共九個電子資料庫進行文獻檢索。所納入之文獻資料萃取及文獻品質由兩位研究者獨立閱讀，使用The Cochrane Collaboration’s Tool for Assessing Risk of Bias進行品質評讀。統計方法使用隨機式模型及Hedge’s g評定其效果量，使用Cochrane Q test及I2檢測異質性，使用Funnel plots及Fail-safe Number判定是否出現出版偏差，採Comprehensive Meta-Analysis 2.0統計軟體進行統合分析。研究結果：文獻搜尋後，共有565篇文獻，經刪去重複文獻、檢視文獻標題及摘要及檢視全文後，符合納入條件共14篇研究報告，5篇有1組以上的針灸介入，故最後納入19個試驗進行文獻回顧及統合分析。其效果量為-0.68(95%CI-0.89－-0.48, p<.001)，結果顯示針灸可顯著緩解腫瘤浸潤引起之疼痛，異質性檢定Q=24.75, I2=27.27%，文章之間有低度到中度的異質性，在統計上沒有顯著意義(p=.132)，出版偏差檢視漏斗圖所納入的研究呈對稱分布，Fail-safe N的結果則為需要277篇沒有顯著的原始研究才能推翻針灸能有效緩解腫瘤浸潤所引起疼痛的結論，故出版篇差可能性極低。結論：此研究結果顯示，針灸可以有效緩解癌症病人因腫瘤浸潤所引起之疼痛，除了使用藥物控制以外，可建議病人選擇針灸作為疼痛緩解的輔助及替代療法之一。

關鍵字

癌症疼痛；針灸；系統性文獻回顧

並列摘要

Objective: This study aims to assessed the effects of acupuncture on tumor compression pain. Design: Systematic review and meta-analysis of randomized controlled trials. Method: This study searched several databases, including EMBASE, PubMed, Medline, PsychINFO, CINAHL, Cochrane Library, Airiti Library, Wangfan Data, and CNKI, to systematically identify relevant studies. The inclusion criteria were studies that (1) used a randomized controlled design, (2) were published in English or Chinese, (3) investigated “acupuncture”, “electro acupuncture”, or “auricular acupuncture”, and (4) used relief of tumor compression pain as the main outcome. Two reviewers independently extracted data according to the predefined criteria and performed quality assessment based on the Cochrane Collaboration’s Tool for Assessing Risk of Bias. Random effects models and Hedge’s g were used to evaluate the effects of acupuncture on tumor compression pain. Cochrane Q test and I2 were used to determine the heterogeneity. Publication bias was assessed based on Funnel Plots and Fail-safe Number. All of the statistical analyses were performed using Comprehensive Meta-Analysis Software version 2.0 (Biostat, Englewood, NJ). Results: The initial search obtained 565 studies. After excluding duplicates and studies that did not meet the inclusion criteria, 14 studies were included in this study. Of these, five studies used two acupuncture groups. As a result, 19 trials were analyzed. The weighted effect size was -0.68 (95% confidence interval, -0.89 to -0.48, p<.001). I2 was 27.27% and Cochran Q was 24.75, indicating mild to moderate heterogeneity among the studies. The heterogeneity was not statistically significant (p=.132). The funnel plot showed symmetry, and the Fail-safe N was 277, indicating that publication bias was not a problem. Conclusion: Acupuncture yielded a medium effect size on tumor compression pain. The findings support that acupuncture can be a useful adjuvant therapy to medications for controlling tumor compression pain.