Acupotomy therapy for joint pain relief of lumbar disc herniation-systematic review and meta-analysis

Abstract

Purpose: Lumbar disc herniation (LDH) is a major public health problem and a serious affect on work and life. Few effective medical treatments for the disease currently exist. Acupotomy therapy as an acceptful minimally-invasive surgical treatment has been used for LDH pain. It combines tradition Chinese medicine and micro-surgery that separates neurolemma and muscle of patients' back, resulting in pain relief. A comprehensive literature review is a key link to understand its benefits and for guiding treatment for LDH pain relief. We conducted a systematic review and meta-analysis to evaluate the efficacy of acupotomy for pain associated with LDH. Methods: We performed a search on Cochrane Library, PubMed, EMBASE, 3 universal Chinese databases (CNKI, Wan Fang and VIP), and reference lists of published articles through Oct 2017. We include randomized controlled trials using acupotomy therapy for LDH patients who met the LDH of State Administration of Traditional Chinese Medicine (TCM diasease diagnosis and efficacy standards). The effect of acupotomy on pain relief was measured with Visual Analogue Scale (VAS) and Japanese Orthopaedic Association (JOA). Study quality was evaluated with Jadad criteria assessing randomization, single blinding, and dropout rates for each study. The differences between treatment groups were reported as mean change (P-value). Results: After screening 513 abstracts, 9 studies met eligibility criteria and were conducted between 2008 and 2017. A total of 1,118 LDH patients (39% female, mean age = 48years, mean symptom duration = 48 months) were included. Table 1 summarizes the trials evaluating the effect of acupotomy therapy on pain relief of LDH. The typical treatment was once a week, for 1–4 weeks. Nine studies used all acupuncture .The overall quality of trials was modest (mean Jadad score = 2.5). All studies reported an effect of acupotomy on pain relief compared to controls. Figure 1 shows a meta-analysis comparing effects of acupotomy therapy with controls on pain relief. A meta-analysis comparing acupotomy with other controls is not reported due to variation in outcomes assessed. Adverse events were not reported. Conclusions: Acupotomy treatment may improve pain which is connected with LDH. Further rigorously designed and well-controlled RCTs with long-term follow-up are warranted.Table 1Nine RCTs of acupotomy therapy on Lumbar disc herniationAuthor YearNa(Age)bAcupotomy therapyControlsDuration - (weeks)Pain Mean Differencec (P-value)-1Peng 2014200 (ND)Release soft tissue adhesion (once/5day;3times)Acupuncture therapy (30 min,1time/1day, 7days)2VASd score: ↓0.76 (P < 0.01) JOA score: ↑4.24 (P < 0.01)Meng 2012120(48y)Release soft tissueadhesion (once/wk;4times)Acupuncture therapy (30 min,3times/1wk,4wks)4JOAe score: ↑0.6 (P < 0.01)Liu 2015196 (46y)Release soft tissue adhesion (once/3days;5times)Acupuncture therapy (30 min, 1time/1day,15days)2VAS score: ↓1.2 (P < 0.01)Zhang 201390 (42y)Release soft tissue adhesion (once/3-5days;2wks)Acupuncture therapy (30 min,1time/1day,2wks)2VAS score: ↓0.76 (P < 0.05)Shi 2008120 (48y)Release soft tissue adhesion (once/5-7days;6times)Acupuncture therapy (30 min, 1times/1day, 4wks)4VAS score: ↓1.33 (P < 0.01)Wu 2012100 (57y)Release soft tissue adhesion (once/wk,3times)Acupuncture therapy (30 min, 1times/1day, 3wks)3VAS score: ↓1.82 (P < 0.05)Li 2017130 (ND)Release soft tissue adhesion (once/wk;4times)Acupuncture therapy (30 min, 1times/1day, 4wks)4JOA score: ↑2.02 (P < 0.01)Hao 201580 (ND)Release tissue under points of pain (once/wk,4times)Acupuncture therapy (30 min, 1times/1wk, 4wks)4VAS score: ↓1.72 (P < 0.05)Wang 201382 (53y)Release soft tissue adhesion (once/3days;5times)Acupuncture therapy (30 min, 1times/1day, 15days)2JOA score: ↑9.72 (P < 0.01)a N= number of patients included;b Mean age reported in years; cMean difference was calculated between group comparisons; dVAS; Visual Analogue Scale (range 0-10, lower score = better outcome);e JOA: Japanese Orthopedic Association (higher score = better outcome). Open table in a new tab a N= number of patients included;b Mean age reported in years; cMean difference was calculated between group comparisons; dVAS; Visual Analogue Scale (range 0-10, lower score = better outcome);e JOA: Japanese Orthopedic Association (higher score = better outcome).