Acupuncture and Moxibustion for Peripheral Neuropathic Pain: A Frequentist Network Meta-Analysis and Cost-Effectiveness Evaluation.

Weixuan Zhao,Wenjie Long,Guohua Lin,Kun Liu,Jingchun Zeng,Shiyu Lin,Haoming Huang,Shuxin Wang,Lixia Li,Jianliang Zhang

doi:10.1155/2022/6886465

Abstract

Purpose Acupuncture and moxibustion techniques have been increasingly used to treat peripheral neuropathic pain (PNP). However, there is a paucity of comparative information and cost-effectiveness assessment for techniques on PNP management. Patients and Methods. Randomized controlled trials studying the acupuncture or moxibustion treatments on PNP were identified from electronic databases. The quality of the included studies and the potential risk of bias was evaluated using the ROB 2.0 assessment tool. The primary outcome was at least 20% pain relief. The treatment effects were pooled through a frequentist-based network meta approach. Subsequently, the cost-effectiveness measured by incremental cost per additional responder (ICPR) was calculated. Results One three-arm trial and 15 two-arm trials comprising 1308 participants that satisfy the eligibility criteria were identified. Among the included studies, 12.5% were at low risk of bias, 68.75% had some concerns about the risk of bias, and 18.75% were at high risk of bias. The major sources of bias originated from the randomization processes of the studies. The patients were assigned to seven different acupuncture or moxibustion interventions and two pharmaceutical treatments. Except for acupoint injection, all the included acupuncture and moxibustion techniques showed superior improvements in PNP and were more cost-effective as compared to pharmaceutical treatments. Warm needling, fire needling, and moxibustion were the most effective treatments. Fire needling showed the lowest ICPR relative to the nonsteroidal anti-inflammatory drugs in the cost-effectiveness analysis of direct and indirect costs. Conclusion Acupuncture and moxibustion techniques are beneficial and cost-effective approaches for easing PNP and hence can be considered for PNP management.

Highlights

Neuropathic pain (NP) is a common condition caused by different sources of lesions or diseases underlying the damages to the somatosensory nervous system. e pain is subclassified as peripheral and central based on different pathological and anatomical origins [1]
As for peripheral neuropathic pain (PNP), the inflammatory processes triggered after peripheral nerve lesion together with the substantial release of immune modulators can contribute to peripheral sensitization and nociceptors excitation [2]
Search Strategies. e literature search was performed on the following electronic databases from inception to September 2020: Medline, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang database, WeiPu (VIP) database, and China Biology Medicine (CBM) database. e search terms included “acupuncture,” “electro-acupuncture,” “warming needling,” “fire needling,” “bloodletting,” “auriculo-acupuncture,” “moxibustion,” “cupping,” “collateral pricking,” “needle knife,” “neuropathic pain,” and “randomized controlled trial.”

Summary

Introduction

Neuropathic pain (NP) is a common condition caused by different sources of lesions or diseases underlying the damages to the somatosensory nervous system. e pain is subclassified as peripheral and central based on different pathological and anatomical origins [1]. Neuropathic pain (NP) is a common condition caused by different sources of lesions or diseases underlying the damages to the somatosensory nervous system. As for peripheral neuropathic pain (PNP), the inflammatory processes triggered after peripheral nerve lesion together with the substantial release of immune modulators can contribute to peripheral sensitization and nociceptors excitation [2]. According to the advanced classification defined by the International Association for the Study of Pain, chronic PNPs are as follows: trigeminal neuralgia, peripheral nerve injury, painful polyneuropathy, postherpetic neuralgia, and painful radiculopathy [3]. Peripheral and central NP together as the two fundamental conditions in pain is associated with serious social, psychological, and economic consequences. A cohort study implementing the US health insurance claims database indicated that patients with NP are associated with an approximately 3-fold increase in healthcare costs as compared to those without NP [11]. A cohort study implementing the US health insurance claims database indicated that patients with NP are associated with an approximately 3-fold increase in healthcare costs as compared to those without NP [11]. e total cost of NP per patient was around €9,305–14,446 in Europe [9]

Methods

Results

Discussion

Conclusion