Acupuncture-moxibustion for chemotherapy-induced peripheral neuropathy: A systematic review and network meta-analysis
针灸干预化疗致周围神经病变：一项系统评价和网状meta分析

Yan LI (李岩)^a, Shuang LIU (刘双)^a, Hai-fa QIAO (乔海法)^a,b

^a College of Acupuncture and Tuina, Shaanxi University of Chinese Medicine, Xianyang 712046, China（陕西中医药大学针灸推拿学院，咸阳712046，中国）

^b The Key Laboratory of Acupuncture & Medicine of Shaanxi Province, Xianyang 712046, China（陕西省针药结合重点实验室，咸阳712046，中国）

Abstract

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a common neurotoxic reaction for patients undergoing anticancer regimens. More and more studies show that acupuncture-moxibustion plays a positive role in the management and prevention of CIPN.

Objective: To evaluate the clinical effect of acupuncture-moxibustion in patients with CIPN, with a focus on assessing its effectiveness on improving treatment response rates, alleviating pain, enhancing quality of life (QoL), and improving nerve conduction. Additionally, the study compares the differences in clinical effectiveness among various acupuncture therapies for CIPN management.

Methods: Six databases (PubMed, Embase, Cochrane Library, Web of Science, OVID, and CNKI) were searched from earliest available dates to December 1, 2024, and only randomized controlled trials (RCTs) containing relevant search terms were included. Network meta-analysis of the RCT data were conducted to assess the effective rate of the treatment as the primary outcome. Nerve conduction, pain scores, and QoL were assessed as secondary outcomes. The version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2) was used to examine methodological quality, and Stata 15.1 was used to take network meta-analysis.

Results: A total of 34 RCTs involving 2039 participants and 9 acupuncture-moxibustion therapies were included. The network meta-analysis evaluated the effect of different acupuncture therapies across four outcomes: effective rate, pain scores, QoL, and nerve conduction. For effective rate, electroacupuncture combined with moxibustion ranked first with a surface under the cumulative ranking curve (SUCRA) value of 62.9%, followed by acupoint application (56.9%) and moxibustion (52.3%). Electroacupuncture combined with moxibustion had the highest effective rate compared to standard of care treatments (odds ratio [OR] = 1.62, 95% confidence interval [CI] −5.18 to 8.43). For alleviating pain, auricular acupressure had the highest SUCRA value (85.9%), while electroacupuncture and electroacupuncture combined with three-edged needle ranked second (63.4%) and third (51.0%), respectively. Auricular acupressure significantly reduced pain (SMD= −1.73, 95%CI −3.54 to 0.08). For QoL, warming needle ranked first (SUCRA= 92.0%), followed by electroacupuncture (48.7%) and filiform needle (43.0%). Warming needle significantly improved QoL scores (SMD= −0.75, 95%CI −1.66 to 0.15). For nerve conduction, electroacupuncture combined with three-edged needle had the highest SUCRA value (100%), while moxibustion and filiform needle ranked second (65.3%) and third (39.2%), respectively. Electroacupuncture combined with three-edged had the best neuroprotective effect (SMD= 1.85, 95%CI 1.23 to 2.47).

Conclusion: Network meta-analysis based on the primary outcome (effective rate) suggests that electroacupuncture combined with moxibustion seems to be the optimal acupuncture therapy for chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes exhibited considerable heterogeneity: auricular acupressure demonstrated superior efficacy in pain relief, electroacupuncture combined with three-edged needle showed greater advantages in improving nerve conduction function, while warm needling was associated with more significant improvements in QoL. Given the variability in interventions across different outcome measures and the methodological limitations of included studies, the current evidence requires cautious interpretation.

Systematic review registration: Registration number in PROSPERO: CRD42024560017.

【摘要】

背景：化疗致周围神经病变是癌症治疗过程中常见的神经毒性反应。越来越多的研究显示针灸在CIPN管理和预防中有积极作用。

目的：评价针灸干预CIPN的临床疗效，重点评估其在提高治疗有效率、缓解疼痛、改善生活质量和神经传导方面的影响。同时比较不同针灸疗法在CIPN干预过程中临床疗效的差异。

方法：检索Pubmed，Embase，Cochrane Library，Web of Science，OVID和中国知网6个数据库从建库至2024年12月1日的相关文献，筛选包含相关检索词的随机对照研究，检索范围为全文检索。选取有效率作为主要结局指标，神经传导、疼痛评分和生活质量（QoL）作为次要结局指标。使用Cochrane偏倚风险工具（RoB 2）检查纳入研究的方法学质量，使用Stata 15.1进行网状meta分析。

结果：共纳入34项RCTs，涉及2039名参与者，9种针灸治疗方法。网状meta分析评估了不同针灸疗法在四个结局指标上的有效性：有效率、疼痛评分、生活质量和神经传导。在有效率方面，电针联合艾灸排名第一（SUCRA值为62.9%），其次是穴位贴敷（56.9%）和艾灸（52.3%）。与常规治疗相比，电针联合艾灸的有效率最高（odds ratio [OR]= 1.62，95% [CI] −5.18 to 8.43）。在缓解疼痛方面，耳穴压丸的SUCRA值最高（85.9%），电针排名第二（63.4%），电针联合三棱针排名第三（51.0%）。耳穴压丸显著缓解疼痛（standard mean difference [SMD]= −1.73，95%CI −3.54 to 0.08）。在生活质量方面，温针灸排名第一（SUCRA值为92.0%），其次是电针（48.7%）和毫针（43.0%）。温针灸显著改善生活质量评分（SMD= −0.75, 95%CI −1.66 to 0.15）。在神经传导方面，电针联合三棱针的SUCRA值最高（100%），艾灸和毫针分别排名第二（65.3%）和第三（39.2%）。电针联合三棱针具有最佳的神经保护作用（SMD= 1.85，95%CI 1.23 to 2.47）。

结论：基于主要结局指标（有效率）的分析结果显示，电针联合艾灸可能是治疗CIPN的最优干预措施。次要结局指标的结果存在异质性：耳穴压丸在疼痛缓解方面表现突出，电针联合三棱针在神经传导功能改善方面更具优势，而温针则在生活质量提升方面疗效显著。鉴于不同结局指标间干预措施的差异性以及纳入研究的方法学局限性，现有证据仍需谨慎解读。

研究注册：研究于PROSPERO注册，注册号为CRD42024560017。