疼痛程度对针刺治疗椎间盘源性坐骨神经痛疗效的影响

Influence of pain intensity on the effect of acupuncture for sciatica from a herniated disk

摘要

目的 探讨疼痛程度是否影响针刺治疗椎间盘源性坐骨神经痛的临床疗效。方法 将216例椎间盘源性坐骨神经痛受试者随机分配至针刺组（108例）和假针组（108例），针刺组采用半标准化选穴方案，包括大肠俞、关元俞及基于经络辨证选取的5个配穴；假针组选取7个非经穴点。2组均在4周内完成10次治疗。分别于治疗前、治疗第4周时使用视觉模拟量表（visual analogue scale，VAS）和Oswestry残疾指数量表（oswestry disability index，ODI）对患者进行评价。根据治疗前腿部疼痛严重程度将患者分为中度疼痛亚组（40 mm ≤ VAS ＜ 70 mm）和重度疼痛亚组（VAS ≥ 70 mm）。以疼痛程度和针刺干预为分组变量进行探索性亚组分析和交互作用分析。结果 共纳入中度疼痛患者160例（74.07%），重度疼痛患者56例（25.93%）。在两个疼痛程度亚组中，针刺组VAS评分和ODI评分改善情况均优于假针组，差异均有统计学意义（P ＜ 0.05）。治疗4周后，疼痛程度和针刺干预在VAS及ODI评分上均未显示出交互作用（P ＞ 0.05）。结论 针刺可改善不同疼痛程度椎间盘源性坐骨神经痛患者的疼痛和功能障碍，不受患者治疗前疼痛程度影响。

Abstract

Objective To investigate the impact of pain intensity on the effect of acupuncture in patients with sciatica from a herniated disk. Methods A total of 216 patients with sciatica from a herniated disk were randomly assigned to an acupuncture group (n = 108) or a sham acupuncture group (n = 108). The patients in the acupuncture group received a semi-standardized acupuncture scheme, including Dachangshu (BL25) and Guanyuanshu (BL26) supplemented by 5 acupoints selected according to meridian-based pattern differentiation. The patients in the sham acupuncture group received treatment at 7 non-acupoint locations. The patients in both groups underwent 10 sessions over 4 weeks. Pain intensity and functional disability were assessed before treatment and at week 4 using the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). Patients were stratified into a moderate pain subgroup (40 mm ≤ VAS ＜ 70 mm) and a severe pain subgroup (VAS ≥ 70 mm) according to leg pain intensity before treatment. Exploratory subgroup and interaction analyses were conducted with pain intensity and acupuncture intervention as grouping variables. Results Of the total 216 patients, 160 (74.07%) were classified into the moderate pain subgroup and 56 (25.93%) into the severe pain subgroup. In each pain intensity subgroup, improvements in VAS and ODI scores are greater in the acupuncture group compared with the sham group, and the differences between acupuncture and sham acupuncture groups were found statistically significant (P ＜ 0.05). No interaction effect was observed between pain intensity and acupuncture intervention on VAS or ODI outcomes after 4 weeks of treatment (P ＞ 0.05). Conclusion Acupuncture alleviates pain and improves functional outcomes in patients with sciatica from a herniated disk, regardless of pain intensity. The effect is not influenced by pain intensity before treatment.

关键词

椎间盘源性坐骨神经痛 / 针刺 / 疼痛程度 / 功能

Key words

sciatica from a herniated disk / acupuncture / pain intensity / function

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基金资助

北京中医药大学揭榜挂帅项目(2023-JYB-JBQN-028)

国家重点研发计划项目(2019YFC1712100)