Acupuncture and Moxibustion for Peripheral Neuropathic Pain: A Frequentist Ne...

chenyaoxin

Purpose. Acupuncture andmoxibustion techniques have been increasingly used to treat peripheralneuropathic pain (PNP). However, there is a paucity of comparative informationand cost-effectiveness assessment for techniques on PNP management. Patientsand Methods. Randomized controlled trials studying the acupuncture ormoxibustion treatments on PNP were identified from electronic databases. Thequality of the included studies and the potential risk of bias was evaluatedusing the ROB 2.0 assessment tool. The primary outcome was at least 20% painrelief. The treatment effects were pooled through a frequentist-based networkmeta approach. Subsequently, the cost-effectiveness measured by incrementalcost per additional responder (ICPR) was calculated. Results. One three-armtrial and 15 two-arm trials comprising 1308 participants that satisfy theeligibility criteria were identified. Among the included studies, 12.5% were atlow risk of bias, 68.75% had some concerns about the risk of bias, and 18.75%were at high risk of bias. The major sources of bias originated from therandomization processes of the studies. The patients were assigned to sevendifferent acupuncture or moxibustion interventions and two pharmaceuticaltreatments. Except for acupoint injection, all the included acupuncture andmoxibustion techniques showed superior improvements in PNP and were morecost-effective as compared to pharmaceutical treatments. Warm needling, fireneedling, and moxibustion were the most effective treatments. Fire needlingshowed the lowest ICPR relative to the nonsteroidal anti-inflammatory drugs inthe cost-effectiveness analysis of direct and indirect costs. Conclusion.Acupuncture and moxibustion techniques are beneficial and cost-effectiveapproaches for easing PNP and hence can be considered for PNP management.