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Chen HT. et al., 2023: Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies

Chen HT, Hung KC, Hsu YC, Kuo JR, Chang YJ, Chen IW, Sun CK.
Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan.
Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan.
Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.
Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan.
School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan.

Abstract

Background: This meta-analysis aimed at investigating the efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy (ESWL).

Methods: Randomized controlled trials comparing the efficacy of acupuncture with conventional treatments were retrieved from major electronic databases (e.g., MEDLINE, EMBASE, and Cochrane Library) until August 28, 2022. The primary outcome was the response rate (i.e., rate of pain relief), while secondary outcomes included stone-free rate, satisfaction rate, duration of ESWL, peri-/post-procedural pain score, and risk of adverse events.

Results: Thirteen eligible studies involving 1,220 participants published between 1993 and 2022 were analyzed. Pooled results indicated that acupuncture had a better response rate compared to conventional treatments (RR = 1.17, 95% CI: 1.06-1.3, p = 0.003, seven trials, n = 832). Despite no difference in ESWL duration (MD = 0.02 min, 95% CI: -1.53 to 1.57, p = 0.98, three trials, n = 141), stone-free rate (RR = 1.11, 95% CI: 1-1.25, p = 0.06, six trials, n = 498), and satisfaction rate (RR = 1.51, 95% CI: 0.92-2.47, p = 0.1, three trials, n = 334) between the two groups, the acupuncture group had a lower risk of adverse events (RR = 0.51, 95% CI: 0.33-0.79, p = 0.003, five trials, n = 327), peri- (MD = -1.91 points, 94% CI: -3.53 to -0.28, p = 0.02, four trials, n = 258 patient) and post-procedural (MD = -1.07, 95% CI: -1.77 to -0.36, p = 0.003, four trials, n = 335) pain score.

Conclusion: The results of this meta-analysis showed that the use of acupuncture in patients receiving ESWL was associated with a higher pain relief rate and a lower risk of adverse events, suggesting feasibility of its use in this clinical setting.

Front Med (Lausanne). 2023 Jun 2;10:1114485. doi: 10.3389/fmed.2023.1114485. eCollection 2023. PMID: 37332744 FREE ARTICLE

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Comments 1

Hans-Göran Tiselius on Friday, 23 February 2024 10:00

The development of modern lithotripsy has resulted in differences in terms of requirement of pain treatment. The goal of using as little analgesics and/or sedatives as possible has resulted in variable treatment results and variable patient experience. Decades of experience with SWL, however, clearly has shown that effective stone disintegration cannot be achieved without adequate pain treatment. It is problematic that this situation has been addressed by reducing the power levels and by narrowing the indications for SWL.
The present report is a meta-analysis of data reported in the literature – the modern way of doing urolithiasis research – with focus on the effect of acupuncture.

It is interesting that acupuncture was found to reduce pain experience during SWL. The problem with the current comparison, however, is that the control group was treated very heterogeneously. Some were given opioids whereas others were treated with sham acupuncture or no medication at all.

Unfortunately, there is a recent trend to treat patients with SWL using as little analgesics as possible. This means that in many patients SWL is not at all used to its full capacity and accordingly the results are suboptimal.

There is no information in this meta-analysis, how SWL was carried out, neither how the patients were randomized. Nevertheless the bottom-line is that it might be worthwhile, in selected cases, to use acupuncture, provided expertise for this method is available.

Hans-Göran Tiselius

The development of modern lithotripsy has resulted in differences in terms of requirement of pain treatment. The goal of using as little analgesics and/or sedatives as possible has resulted in variable treatment results and variable patient experience. Decades of experience with SWL, however, clearly has shown that effective stone disintegration cannot be achieved without adequate pain treatment. It is problematic that this situation has been addressed by reducing the power levels and by narrowing the indications for SWL. The present report is a meta-analysis of data reported in the literature – the modern way of doing urolithiasis research – with focus on the effect of acupuncture. It is interesting that acupuncture was found to reduce pain experience during SWL. The problem with the current comparison, however, is that the control group was treated very heterogeneously. Some were given opioids whereas others were treated with sham acupuncture or no medication at all. Unfortunately, there is a recent trend to treat patients with SWL using as little analgesics as possible. This means that in many patients SWL is not at all used to its full capacity and accordingly the results are suboptimal. There is no information in this meta-analysis, how SWL was carried out, neither how the patients were randomized. Nevertheless the bottom-line is that it might be worthwhile, in selected cases, to use acupuncture, provided expertise for this method is available. Hans-Göran Tiselius
Monday, 20 May 2024