針刺治療疼痛現(xiàn)狀及對策課件

針刺治療疼痛現(xiàn)狀及對策

疼痛是神經(jīng)系統(tǒng)被激發(fā)的一種感覺和情緒上的感受，是主觀性的。疼痛性質(zhì)：尖銳的或鈍性的，疼痛時間：發(fā)作的或持續(xù)的，疼痛部位：局部或全身的（流感）。有時疼痛的好處可提醒我們防止疾病的損害，慢性疼痛常是人體慢性疾病的損害。但持續(xù)周、月、年的疼痛會造成痛苦，長期疼痛?？墒共∪送床挥?。劇烈的疼痛可引發(fā)休克等一系列機(jī)體功能變化而成為

致病、致殘、致死的原因

。針灸中心1、應(yīng)用廣泛，方法眾多但缺少規(guī)范與指南。

2007年美國NIH調(diào)查有1.4%(310萬)近期接受過CAM，7/10與疼痛相關(guān)。美國的另一項全國性調(diào)查發(fā)現(xiàn)，超過三分之一的美國成年人中有四分之一最近經(jīng)歷了那種持續(xù)超過一天的疼痛痛苦。除了傳統(tǒng)的治療，如過度的非處方和處方藥，人們可能會嘗試針灸，以努力減輕疼痛。

中國沒有接受針刺治療人數(shù)的數(shù)據(jù)，但假針作為placebo在國內(nèi)的clinictrial中無法使用就是針刺具有深厚背景的證明。

全球的針刺治痛方法包括了針刺、灸法、電針、火針、皮膚針、放血、腹針、TENs、針刀等針具和各種各樣的刺法。但是，針刺方法一直缺少臨床的規(guī)范與指南，各種經(jīng)驗性治療層出不窮，雖有助于充滿活力，但卻會因大量的難于總結(jié)的重復(fù)性使用而不利于整體水平的提高。Acupuncturehasbeenstudiedforawiderangeofpainconditions,suchaspostoperativedentalpain（包括其他多種術(shù)后痛）,carpaltunnelsyndrome,fibromyalgia,headache,low-backpain,menstrualcramps,myofascialpain,osteoarthritis,andtenniselbow.這種研究的結(jié)論主要是從現(xiàn)代醫(yī)學(xué)臨床研究方法學(xué)角度得出的結(jié)論。已經(jīng)表達(dá)了多年，也有方法學(xué)研究的學(xué)者不斷在呼吁讓針灸臨床研究者提高研究質(zhì)量。但收效甚微。主要問題是我們很多人在具體的臨床研究中不善于總結(jié)文獻(xiàn)，對具體的項目設(shè)計存在問題。下面就舉具體的例子以說明一、肩周炎Acupunctureforshoulderpain(Review)

SallyGreen1,RachelleBuchbinder2,SarahEHetrick3Australia

Authors’conclusionsDuetoasmallnumberofclinicalandmethodologicallydiversetrials,littlecanbeconcludedfromthisreview.Thereislittleevidencetosupportorrefutetheuseofacupunctureforshoulderpainalthoughtheremaybeshort-termbenefitwithrespecttopainandfunction.Thereisaneedforfurtherwelldesignedclinicaltrials.Doesacupunctureworkfortreatingshoulderpain?評價Toanswerthisquestion,scientistsfoundandanalyzed9researchstudies.Thestudiestestedover500peoplewhohadshoulderpain.Peoplehadeitheracupuncture,aplacebo(faketherapy),ultrasound,gentlemovementorexercisesusuallyfor20-30minutes,twotothreetimesaweekfor3to6weeks.(治療時間)Eventhoughthestudiesweresmallandnotofthehighestquality,thisCochranereviewprovidesthebestevidencewehavetoday.Howwelldoesacupuncturework?Theimprovementswithacupunctureforpainandfunctionwereaboutthesameastheeffectsofreceivingafake（安慰法）therapyfor2to4weeks.Onestudyshowedthatacupunctureimprovedshoulderfunctionmorethanfaketherapyafter4weeks.Butafter4months,improvementswereaboutthesamewithonlyanimprovementof4morepointsonascaleof0to100withacupuncture.Onesmallstudyshowedthatacupunctureplusexercisewasbetterthanjustexerciseforimprovingpain,rangeofmotionandfunctionforupto5months.中國的研究1中國針灸，2008目的:科學(xué)評價使用一次性×針的有效性及安全性。方法:將60例肩周炎患者隨機(jī)分為×針組和常規(guī)針組,×針組采用特制的×針針具治療,常規(guī)針組采用直徑0.38mm、長40mm的一次性針灸針治療,對比治療前后患者最受限方位的關(guān)節(jié)活動度、肩關(guān)節(jié)活動中軟組織疼痛自評分及肩部壓痛自評分,以及2組患者分別在治療進(jìn)針、掃散、留針過程中發(fā)生刺痛的次數(shù)、出針時出血情況等不適情況。結(jié)果:活動相關(guān)性疼痛、壓痛、最受限方位的關(guān)節(jié)活動程度的改善均為×針組優(yōu)于常規(guī)針組,提示×針組的即刻療效明顯優(yōu)于常規(guī)針組;進(jìn)針過程中的刺痛次數(shù)×針組少于常規(guī)針組,留針時的刺痛次數(shù)以及出針時出血次數(shù),2組差別無統(tǒng)計學(xué)意義。結(jié)論:從本試驗看,在×針療法中使用一次性×針比常規(guī)針灸針更為有效、更為安全。分析：診斷、治療時間、評價方法、對照組設(shè)計均存在問題二、下腰痛Acupunctureanddry-needlingforlowbackpain(Review)AndreaDFurlan1,MauritsWvanTulder2,DanCherkin3,HiroshiTsukayama4,LixingLao5,BartWKoes6,BrianMBerman5SelectioncriteriaRandomizedtrialsofacupuncture(thatinvolvesneedling)foradultswithnon-specific(sub)acuteorchroniclow-backpain,ordryneedlingformyofascialpainsyndromeinthelow-backregion.（診斷）Authors’conclusionsThedatadonotallowfirmconclusionsabouttheeffectivenessofacupunctureforacutelow-backpain.Forchroniclow-backpain,acupunctureismoreeffectiveforpainreliefandfunctionalimprovementthannotreatmentorshamtreatmentimmediatelyaftertreatmentandintheshort-termonly.Acupunctureisnotmoreeffectivethanotherconventionaland“alternative”treatments.Thedatasuggestthatacupunctureanddry-needlingmaybeusefuladjunctstoothertherapiesforchroniclow-backpain.Becausemostofthestudieswereoflowermethodologicalquality,therecertainlyisafurtherneedforhigherqualitytrialsinthisarea.TypesofoutcomemeasuresRCTswereincludedthatusedatleastoneofthefouroutcomemeasuresconsideredtobeimportantinthefieldoflow-backpain:painintensity(e.g.,visualanalogscale(VAS)),aglobalmeasure(e.g.,overallimprovement,proportionofpatientsrecovered,subjectiveimprovementofsymptoms),backspecificfunctionalstatus(e.g.,RolandDisabilityScale,OswestryScale)andreturntowork(e.g.,returntoworkstatus,numberofdaysoffwork).Theprimaryoutcomesforthisreviewwerepainandfunctionalstatus.Physiologicaloutcomesofphysicalexamination(e.g.,rangeofmotion,spinalflexibility,degreesofstraightlegraisingormusclestrength),generichealthstatus(e.g.,SF-36,NottinghamHealthProfile,SicknessImpactProfile)andothersymptoms,suchasmedicationuseandsideeffectswereconsideredsecondaryoutcomes.國內(nèi)綜述：下腰痛的中西醫(yī)結(jié)合治療-中國臨床康復(fù)2006

下腰痛已是現(xiàn)代社會最常見的、花費最多的肌肉骨骼疼痛綜合征。因其病因復(fù)雜,治療方法雖多,但并無特效方法,且有治療顯效慢、易復(fù)發(fā)的特點,嚴(yán)重影響了患者的生活和工作。目前有關(guān)本病的機(jī)制、診斷標(biāo)準(zhǔn)、治療方法仍不完善,尚需進(jìn)一步研究,本文應(yīng)用計算機(jī)檢索萬方數(shù)據(jù)庫2001-06/2006-07及Ovid2001-06/2006-07有關(guān)下腰痛臨床治療方面的文獻(xiàn),主要對其臨床治療方法的研究進(jìn)展進(jìn)行回顧。原發(fā)性痛經(jīng)Acupunctureforprimarydysmenorrhoea(Review)CarolineASmith1,XiaoshuZhu2,LinHe3,JingSong4InclusioncriteriaWomenneededtomeetthefollowingcriteriatobeincludedinthereview:?primarydysmenorrhoea,i.e.noidentifiablepelvicpathologyasindicatedbypelvicexamination,ultrasoundscans,orlaparoscopy;?primarydysmenorrhoea(self-reportedpain)duringthemajorityofthemenstrualcyclesorforthreeconsecutivemenstrualcycles;?moderatetosevereprimarydysmenorrhoea(painthatdoesnotrespondwelltoanalgesics,affectsdailyactivities,orhasahighbaselinescoreonavalidatedpainscale).Authors’conclusionsAcupuncturemayreduceperiodpain,howeverthereisaneedforfurtherwell-designedrandomisedcontrolledtrialsPrimaryoutcomes1.Painreliefmeasuredbyavisualanaloguescale(VAS)orothervalidatedscales,ormeasuredasdichotomousoutcomes(i.e.painrelief:yesorno).Secondaryoutcomes1.Overallimprovementingenericmenstrual-relatedsymptoms(e.g.nausea,tiredness)measuredbychangesinoveralldysmenorrhoeicsymptom