Acupuncture for postherpetic neuralgia: Systematic review and meta-analysis

Yang Wang, Wang Li, Weina Peng, Jing Zhou, Zhishun Liu, Yang Wang, Wang Li, Weina Peng, Jing Zhou, Zhishun Liu

Abstract

Background: Acupuncture is widely used for postherpetic neuralgia (PHN) in China but its effect is unclear. We aim to evaluate the effect and safety of acupuncture for PHN.

Methods: The Cochrane Skin Group Trials Register, The Cochrane Central Register of Controlled Trials, MEDLINE, Embase, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, and the gray literature were searched. Randomized controlled trials (RCTs) comparing acupuncture alone versus no treatment/another active therapy/sham acupuncture, or comparing acupuncture with another active therapy versus the same active therapy were included.

Results: Seven RCTs comparing acupuncture versus pharmacologic therapy were included. Meta-analysis was conducted for acupuncture's effect on PHN evaluating by pain intensity. Results from 2 RCTs showed that compared with pharmacologic therapy, acupuncture was better in decreasing the pain intensity measured by visual analog scale score (mean difference: 1.80, 95% confidence interval 1.72-1.87; P < .001). The limitations of the study are as follows: only trials comparing acupuncture versus pharmacologic therapy were included and all of the included trials were performed in China.

Conclusion: There was not enough evidence to suggest that acupuncture was superior to pharmacologic therapy in improving global impression or life quality. No adverse effects about acupuncture were reported. In all, acupuncture is safe and might be effective in pain relieving for patients with PHN. Given the low quality of included studies, the results are not conclusive and more large-scale RCTs with high quality are needed.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Risk of bias summary.
Figure 2
Figure 2
Forest plot of 3 randomized controlled trials comparing acupuncture versus pharmacologic therapy on the visual analog scale score using a random model.
Figure 3
Figure 3
Forest plot of 2 randomized controlled trials comparing acupuncture versus pharmacologic therapy on the visual analog scale score using a fixed model.

References

    1. Wang J, Zhu Y. Different doses of gabapentin formulations for postherpetic neuralgia: a systematical review and meta-analysis of randomized controlled trials. J Dermatol Treat 2017;28:65–77.
    1. Argoff CE. Review of current guidelines on the care of postherpetic neuralgia. Postgrad Med 2011;123:134–42.
    1. Liu ZS, Peng WN, Liu BY, et al. Clinical practice guideline of acupuncture for herpes zoster. Chin J Integr Med 2013;19:58–67.
    1. Forbes HJ, Thomas SL, Smeeth L, et al. A systematic review and meta-analysis of risk factors for postherpetic neuralgia. Pain 2016;151:30–54.
    1. FDA. FDA Approves New Drug Treatment for Long-Term Pain Relief After Shingles Attacks. Silver Spring, MD: U S Food and Drug Administration (FDA); 2009.
    1. Yawn BP, Saddier P, Wollan PC, et al. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007;82:1341–9.
    1. NICE. NICE clinical guideline. Neuropathic pain: the pharmacological management of neuropathic pain in adults in non-specialist settings. National Institute for Health and Clinical Excellence. Available at: . Accessed June 5, 2010.
    1. Hanania MM, Brietstein D. Postherpetic neuralgia: a review. Cancer Invest 1997;15:165–7.
    1. Baron R, Wasner G. Prevention and treatment of postherpetic neuralgia. Lancet 2006;367:186–8.
    1. Friesen KJ, Falk J, Alessi-Severini S, et al. Price of pain: population-based cohort burden of disease analysis of medication cost of herpes zoster and postherpetic neuralgia. J Pain Res 2016;9:543–50.
    1. Christo PJ, Hobelmann G, Maine DN. Post-herpetic neuralgia in older adults. Drugs Aging 2007;24:1–9.
    1. Rowbotham M, Harden N, Stacey B, et al. Gabapentin for the treatment of postherpetic neuralgia: a randomized controlled trial. JAMA 1998;280:1837–42.
    1. Rice AS, Maton S. Postherpetic Neuralgia Study Group. Gabapentin in postherpetic neuralgia: a randomised, double blind, placebo controlled study. Pain 2001;94:215–24.
    1. Goßrau G. Postherpetic neuralgia. Schmerz 2014;28:93–102.
    1. Van SR, Sadosky A, Lucero M, et al. A cross-sectional survey of health state impairment and treatment patterns in patients with postherpetic neuralgia. Age Ageing 2006;35:132–7.
    1. Qin L, Fu Y. Literature review on acupuncture for PHN [in Chinese]. Henan Tradit Chin Med 2012;32:250–2.
    1. Ou D, Zhou C. System evaluation of RCT systematic about the treatment of postherpetic neuralgia by using fire needle. Clin J Tradit Chin Med 2015;27:115–9.
    1. Li Z. Observation of the fire needle and point injection for PHN. Guide J Tradit Chin Med Pharmacol 2013;19:63–4.
    1. Liu P. The effect of fire needle and gastrodin for PHN. J Guiyang Coll Tradit Chin Med 2008;18:2–3.
    1. Nie B, Ma X. Evaluation of the half needling with fire needle for herpes zoster. J Jiangxi Univ TCM 2006;18:38–9.
    1. Ma X, Li J, Jiang Y. The fire needle and cupping and body acupuncture for PHN. JETCM 2011;19:1864–5.
    1. Zhu Y, Zhu L, Li Y, et al. Jiaji points combined with surrounding needling for the treatment of postherpetic neuralgia: a meta-analysis. J Clin Rehab Tiss Eng Res 2011;15:2064–8.
    1. Li W, Peng W, Zhou J, et al. Acupuncture for postherpetic neuralgia: a systematic review protocol. BMJ Open 2014;4:e005725.
    1. Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011. Available at: . [accessed on 11.25.2016].
    1. Chen J, Zhang Z, Tong J. Clinical observation of effect of fire needle in treating neuralgia due to herpes zoster. Mod Hosp 2007;7:78–9.
    1. Chen Y. Observation on acupuncture for 40 cases of PHN. Chin J Prim Med Pharm 2011;18:79–80.
    1. Chen Y. The clinical observation on fire needle combine cobamamide in treating post-herpetic neuralgia. Chin Manipul Rehabilit Med 2013;4:66–7.
    1. Dai J, Zhang L, Su X, et al. Observation of acupuncture and cupping on PHN. J Chengdu Coll 2012;7:75–6.
    1. Jiang X, Jin Z. Observation of herb on PHN strengthening by scalp acupuncture. Hubei J Tradit Chin Med 2013;35:58–9.
    1. Tong B. The fire acupuncture on 30 cases of PHN. Capital Med 2014;16:68.
    1. Wang H, Xie Z, Feng J. Gabapentin and acupuncture for PHN. Chin J Gonvalescent Med 2014;23:130–1.
    1. Zhao R. The bloodletting therapy for 30 cases of PHN. Shanexi J Tradit Chin Med 2011;32:595–7.
    1. Wu A. Observation of acupuncture and herb for PHN. China Naturopathy 2017;25:57–8.
    1. Zhang Y, Peng Y, He N. Observation of fire needle and bloodletting for PHN. J Sichuan Tradit Chin Med 2014;33:165–7.
    1. Zuo X, Wang Z, Cui W, et al. Clinical effect of skin needle stabbing combined with blood - letting puncture and cupping for the treatment of neuralgia caused by herpes zoster. J Clin Acupunct Moxibust 2015;31:20–2.
    1. Fan L. Pyonex and point injection for PHN. Contemp Med 2016;22:156–7.
    1. Liu G, Liu C. Treatment of 68 cases of shingles by puncturing collateral plus cupping. J Acupunct Tuina Sci 2003;1:11.
    1. Ding X. Observation about the clinical effect of electro-acupuncture combined with moxibustion on the 56 patients with post herpetic neuralga (PHN) of herpes zoster. J China Tradit Chin Med Info 2011;2:40–1.
    1. Huang X, Yang B. Effect of acupuncture for 23 cases of PHN. J Clin Acupunct Moxibust 2010;26:22–3.
    1. Li W, Cai G, Wang Y. Clinical observation of 30 cases of PHN with electroacupuncture and bloodletting. Mod Diagn Treat 2014;25:1506–7.
    1. Wang X, Zhang F, Xu A. Observation of elongated needle and bloodletting for PHN. J Pract Tradit Chin Med 2015;31:943–4.
    1. Wang M, Cai S. Clinical observation of acupuncture combined with plum blossom tapping and cupping treatment to shingles neuralgia. J Shanxi Univ Chin Med 2017;40:58–66.
    1. Fang X, Han L, Wu H. Effect of electroacupuncture on PHN. Military Surg 2013;56:1427–8.
    1. Zhu M, Kuang L, Yang H, et al. Observation on 126 cases of PHN with acupuncture. J TCM Univ Hunan 2006;26:52–3.
    1. State Administration of Traditional Chinese Medicine of the People's Republic of China. The TCM Standards of Diagnosis and Syndrome. 1994;Nanjing: Nanjing University Press, 144.
    1. Ministry of Science and Technology of the People's Republic of China. The Disease Diagnosis and Improvement Standard. 1998;Beijing: People's Military Medical Press, 281.
    1. The PHN Consensus Group. The China consensus on diagnosis and treatment for postherpetic neuralgia. Chin J Pain Med 2016;22: 161–167.
    1. Ursini T, Tontodonati M, Manzoli L, et al. Acupuncture for the treatment of severe acute pain in herpes zoster: results of a nested, open-label, randomized trial in the VZV pain study. BMC Complement Altern Med 2011;11:46.

Source: PubMed

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