JAMA:针灸治疗膝关节疼痛的争鸣,是否确有疗效?

2015-02-14 MedSci MedSci原创

《美国医学会杂志》10日发表来自5个国家8名学者的5封“致编辑的信”,就该刊发表的一篇关于针灸治疗关节疼痛随机临床试验报告提出不同意见,同时原始论文发表认为针灸无效的作者Hinman RS等也给予了回复。多家美国主流媒体和网站发表了相关消息和评论。(相关资料:JAMA: 针灸对于膝关节疼痛无改善作用 )5封信来自美国、中国、新西兰、瑞士和德国,从不同角度对针灸治疗膝关节疼痛无效的结论提出

《美国医学会杂志》10日发表来自5个国家8名学者的5封“致编辑的信”,就该刊发表的一篇关于针灸治疗关节疼痛随机临床试验报告提出不同意见,同时原始论文发表认为针灸无效的作者Hinman RS等也给予了回复。多家美国主流媒体和网站发表了相关消息和评论。(相关资料:JAMA: 针灸对于膝关节疼痛无改善作用 

5封信来自美国、中国、新西兰、瑞士和德国,从不同角度对针灸治疗膝关节疼痛无效的结论提出疑问。认为论文在试验设计、针灸方法和计量、患者观察和评估、数据比较和结论、以及学术诚信等存在诸多方面的问题。杂志同时刊登了澳大利亚作者拉纳·欣曼等人的回复,对信中提出的大部分问题做了正面回答。

《美国医学会杂志》2014年10月发表题为“针灸治疗慢性膝关节疼痛:随机临床试验”的文章,介绍了澳大利亚博士拉纳·欣曼领导的一个14人工作小组进行的一次与针灸有关的实验,其结论是:“对于50岁以上患有中度或重度膝关节慢性疼痛的患者,同假治疗相比,激光针灸或针刺针灸治疗对改善疼痛或功能没有益处。我们的研究发现不支持对这些病人使用针灸治疗。”

欣曼在接受路透社等媒体采访时强调,这一研究证明针灸治疗膝关节疼痛无效,建议膝关节疼痛患者选择膝关节托架、身体锻炼等物理治疗。

美国许多中医针灸师对这一研究结果表示质疑。他们认为,这项研究与针灸医生的临床经验、患者的亲身体验,以及近几十年来大量基础实验和临床试验研究结论不一致。

2014年11月在美国休斯敦召开的世界针灸联合会大会专门设立研讨会,探讨这一问题。与会的近百名学者对这项研究的方法等方面提出质疑,希望医学研究和相关管理机构不要过于草率得出结论。

在美国新泽西行医的博士李永明是5封信的作者之一。他对新华社记者说,在世界一流临床医学杂志上对针灸进行如此大范围的讨论非常罕见。编辑选发的几封信都很有代表性,指出了此项临床研究的许多不足,以及得出的结论过于草率。

针灸在美国常被用于西医的辅助性治疗,包括各种急性和慢性疼痛病症、抑郁症、不孕症、过敏症、戒毒、减肥、癌症辅助治疗等相关症状。

MedSci认为,这属于良性争议,虽然一个RCT研究认为针灸对膝关节疼痛疗效不明显,但是RCT也不一定是完美的,需要更多的,更严谨的临床试验进行证实。通过不断、科学地争论,进而通过更严谨的临床研究设计,有助于揭示针灸疗效之谜。

相关评论:

Hinman RS, Pirotta M, Bennell KL.Treating chronic knee pain with acupuncture--reply. JAMA. 2015 Feb 10;313(6):628-9

Li YM.Treating chronic knee pain with acupuncture. JAMA. 2015 Feb 10;313(6):628

Lao L, Yeung WF.Treating chronic knee pain with acupuncture. JAMA. 2015 Feb 10;313(6):627-8

Fleckenstein J, Banzer W.Treating chronic knee pain with acupuncture. JAMA. 2015 Feb 10;313(6):627.

He H.Treating chronic knee pain with acupuncture. JAMA. 2015 Feb 10;313(6):626.

Baxter GD, Tumilty S.Treating chronic knee pain with acupuncture. JAMA. 2015 Feb 10;313(6):626-7. 

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    2016-08-04 清流

    中医的治疗方法不能用我们平时所用的实验方法,单纯的表面控制变量就行的,人的体质也要考虑

    0

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  4. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-04-13 吴颖

    有争论才有进步。

    0

  6. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-04-12 x35042875

    患OS这个疾病的高风险人群提供干预措施以避免不良预后和机械治疗措施

    0

  7. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-04-08 吴颖

    必须要有

    0

  8. 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05 01:14:00 CST 2015, time=2015-05-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1928892, encodeId=4dc41928892b4, content=<a href='/topic/show?id=3c6e8586939' target=_blank style='color:#2F92EE;'>#膝关节疼痛#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85869, encryptionId=3c6e8586939, topicName=膝关节疼痛)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1ce4238, createdName=dangious, createdTime=Fri Jan 01 18:14:00 CST 2016, time=2016-01-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2055500, encodeId=d8c92055500a7, content=<a href='/topic/show?id=3b2096294d7' target=_blank style='color:#2F92EE;'>#针灸治疗#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=96294, encryptionId=3b2096294d7, topicName=针灸治疗)], 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authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20150920/IMG55FDE671A89482379.jpg, createdBy=cef3108336, createdName=x35042875, createdTime=Sun Apr 12 07:40:00 CST 2015, time=2015-04-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=19936, encodeId=6db2199368f, content=必须要有, beContent=null, objectType=article, channel=null, level=null, likeNumber=122, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/oLAjfB7s1ib06iaV3D9Tg5K3r6Ir8EADbw8kut6NgpfYKrksLd7rsf9GSZGCUZkpHosu8Jsibzk64KSuO8dFfOW7J5kW4bjib4eI/0, createdBy=d0201619051, createdName=吴颖, createdTime=Wed Apr 08 09:23:00 CST 2015, time=2015-04-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17304, encodeId=8fce1e304a6, content=不相信真有效, beContent=null, objectType=article, channel=null, level=null, likeNumber=110, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-03-01 CRAZYDAFF

    不相信真有效

    0

  9. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-02-19 orthoW

    很不错,学习了!

    0

  10. 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topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=11a91616246, createdName=CRAZYDAFF, createdTime=Sun Mar 01 22:31:00 CST 2015, time=2015-03-01, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=16493, encodeId=831d164936c, content=很不错,学习了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=62, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f2fb1607679, createdName=orthoW, createdTime=Thu Feb 19 21:22:00 CST 2015, time=2015-02-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=15972, encodeId=e53e159e2ed, content=谢谢分享!, beContent=null, objectType=article, channel=null, level=null, likeNumber=80, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=cce01615276, createdName=Johnny1989, createdTime=Mon Feb 16 15:17:00 CST 2015, time=2015-02-16, status=1, ipAttribution=)]
    2015-02-16 Johnny1989

    谢谢分享!

    0

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