Pei W, Zeng J, Lu L, et al. Is acupuncture an effective postherpetic neuralgia treatment? A systematic review and meta-analysis. J Pain Res. 2019 Jul 16;12:2155-2165. doi: 10.2147/JPR.S199950. eCollection 2019. (Systematic review)

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.

Discipline Area Score
Physician 5 / 7
Comments from MORE raters

Physician rater

All the studies were done in China or Cuba. There may be cultural differences in pain reporting. The control group was a non-standard approach to pain control with multiple different approaches between the trials. I would assess control clinical heterogeneity in the control arms as a barrier to meta analysis.

Physician rater

Interesting manuscript on the use of acupuncture in post-herpetic neuralgia. This highlights the paucity of English language trials on this subject. The main problem I found with this meta-analysis was the heterogeneity of the trials involving acupuncture that included manual acupuncture, electroacupuncture, bloodletting and cupping. These co-interventions produce a lack of clarity in the effect of acupuncture on post-herpetic neuralgia.

Physician rater

This study is very small to decide whether acupuncture is useful or not. It’s not clear to me how the blinding took place. It seems that only one study used sham acupuncture.

Physician rater

Studies on the argument are performed only in China, this can be a bias.
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