Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis

Wenya Pei, Jingchun Zeng, Liming Lu, Guohua Lin, Jingwen Ruan, Wenya Pei, Jingchun Zeng, Liming Lu, Guohua Lin, Jingwen Ruan

Abstract

Background: Postherpetic neuralgia (PHN) refers to pain which remains after the healing of rashes from herpes zoster. Previous literatures have shown that acupuncture has potential benefits for PHN, but evidence remains lacking. Thus, we have performed a systematic review and meta-analysis to identify the effectiveness of acupuncture in the treatment of PHN.

Methods: Six databases were searched for randomized controlled trials (RCTs) to assess the effects of acupuncture on PHN. After selecting the studies, extracting the data, and assessing study quality, meta-analysis was performed on several of the studies with RevMan 5.3. The GRADE (Grading of Recommendations Assessment Development and Evaluation) system was used to assess the overall quality of the evidence.

Results: Acupuncture helps relieve pain intensity (standardized mean difference [SMD]: -1.78, 95% confidence interval [CI]: -2.36 to -1.21). For other intervention types, electroacupuncture (SMD: -1.28, 95% CI: -2.51 to -0.05), fire needle (SMD: -2.23, 95% CI: -2.62 to -1.84), bloodletting and cupping (SMD: -2.46, 95% CI: -2.95 to -1.97) have better effects on pain intensity relief. To date, no study has reported on the onset of pain relief time. The Hamilton Anxiety Scale score (SMD: -18.94, 95% CI: -37.37 to -0.52) was lower for the acupuncture group than for the control group. It was also found that acupuncture can improve quality of life (QOL) (SMD: 3.78, 95% CI: 2.50 to 5.06). The quality of evidence for acupuncture for PHN pain intensity was moderate according to the GRADE system.

Conclusion: Acupuncture may reduce pain intensity, relieve anxiety and improve quality of life in patients with PHN. Further randomized trials with larger sample sizes and of higher methodological quality are needed to confirm these results.

Keywords: acupuncture; postherpetic neuralgia; systematic review.

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flow diagram of study selection and identification.
Figure 2
Figure 2
Risk of bias graph for included studies.
Figure 3
Figure 3
Forest plot of acupuncture for PHN. Outcome:pain intensity-VAS. (A) Subgroup: Based on different types of acupuncture therapy; (B) Subgroup: Based on different sample sizes. Abbreviations: EA, electroacupuncture; PHN, postherpetic neuralgia; VAS, visual analogue scale.
Figure 4
Figure 4
Forest plot of acupuncture for PHN. Outcome: pain intensity-VAS. Subgroup: Based on different sample sizes. Abbreviations: EA, electroacupuncture; PHN, postherpetic neuralgia.
Figure 5
Figure 5
Funnel plot of publication bias of acupuncture for PHN. Outcome: pain intensity. Subgroup: different methods. Abbreviation: PHN, postherpetic neuralgia.

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