有證據(jù)證明針灸能治療慢性疼痛

A new study of acupuncture - the most rigorous and detailed analysis of the treatment to date - found that it can ease migraines and arthritis and other forms of chronic pain.

一項有關(guān)針灸的新研究——迄今為止最嚴(yán)格和詳細(xì)的治療分析——表明，針灸能緩解偏頭痛、關(guān)節(jié)炎和其他形式的慢性疼痛。

The findings provide strong scientific support for an age-old therapy used by an estimated three million Americans each year. Though acupuncture has been studied for decades, the body of medical research on it has been mixed and mired to some extent by small and poor-quality studies. Financed by the National Institutes of Health and carried out over about half a decade, the new research was a detailed analysis of earlier research that involved data on nearly 18,000 patients.

這一發(fā)現(xiàn)為這項古老的治療方法提供了強(qiáng)有力的科學(xué)支持，估計每年大約有300萬美國人接受針灸治療。雖然針灸已經(jīng)被研究了數(shù)十年，但大多是小型低質(zhì)量的研究，因此使這類醫(yī)學(xué)研究陷入混亂。新的研究超過五年之久，由美國國家衛(wèi)生研究院(National Institutes of Health)資助，分析的早期研究數(shù)據(jù)涵蓋近1.8萬名患者。

The researchers, who published their results in Archives of Internal Medicine, found that acupuncture outperformed sham treatments and standard care when used by people suffering from osteoarthritis, migraines and chronic back, neck and shoulder pain.

研究人員已經(jīng)把結(jié)果發(fā)表在《內(nèi)科學(xué)文獻(xiàn)》(Archives of Internal Medicine)上，表明針灸在骨關(guān)節(jié)炎、偏頭痛，以及慢性背部、頸部和肩部疼痛的患者中，治療效果優(yōu)于安慰治療和標(biāo)準(zhǔn)護(hù)理。

"This has been a controversial subject for a long time," said Dr. Andrew J. Vickers, attending research methodologist at Memorial Sloan-Kettering Cancer Center in New York and the lead author of the study. "But when you try to answer the question the right way, as we did, you get very clear answers.

“長期以來，這都是一個有爭議的話題。” 紐約紀(jì)念斯隆-凱特琳癌癥中心(Memorial Sloan-Kettering Cancer Center)的主診研究方法論學(xué)者、也是本次研究的主要作者安德魯·J·維克斯博士(Dr. Andrew J. Vickers)這樣說：“但一旦你像我們這樣正確解答問題，答案就非常明晰了。”

"We think there's firm evidence supporting acupuncture for the treatment of chronic pain."

“我們認(rèn)為，有確鑿的證據(jù)支持針灸能治療慢性疼痛。”

Acupuncture, which involves inserting needles at various places on the body to stimulate so-called acupoints, is among the most widely practiced forms of alternative medicine in the country and is offered by many hospitals. Most commonly the treatment is sought by adults looking for relief from chronic pain, though it is also used with growing frequency in children. According to government estimates, about 150,000 children in the United States underwent acupuncture in 2007.

針灸，即將針插入身體不同部位刺激“穴位“的方法，是美國最常見的替代醫(yī)療(也稱非主流醫(yī)療)形式，很多醫(yī)院都提供這項治療。使用這項治療最多的是慢性疼痛的成人患者，但兒童應(yīng)用也越來越多了。根據(jù)政府的估計，2007年大約有15萬名兒童接受了針灸治療。

But for all its popularity, questions about its efficacy have long been commonplace. Are those who swear by it experiencing true relief or the psychological balm of the placebo effect?

但是，雖然針灸治療非常流行，關(guān)于其有效性的疑問也很普遍。那些聲稱自己疼痛緩解的人，是否只是被安慰劑效應(yīng)吻了吻心靈?

Dr. Vickers and a team of scientists from around the world - England, Germany, Sweden and elsewhere - sought an answer by pooling years of data. Rather than averaging the results or conclusions from years of previous studies, a common but less rigorous form of meta-analysis, Dr. Vickers and his colleagues first selected 29 randomized studies of acupuncture that they determined to be of high quality. Then they contacted the authors to obtain their raw data, which they scrutinized and pooled for further analysis. This helped them correct for statistical and methodological problems with the previous studies, allowing them to reach more precise and reliable conclusions about whether acupuncture actually works.

維克斯博士和來自世界各地的科學(xué)家團(tuán)隊——英國、德國、瑞典和其他地方——在多年的數(shù)據(jù)中挖掘出了答案。以往常用的薈萃分析是將之前的研究結(jié)果或結(jié)論平均化，但這不夠嚴(yán)謹(jǐn)。維克斯博士及其同事首先選出了他們認(rèn)為質(zhì)量較高的29個關(guān)于針灸的隨機(jī)研究，然后聯(lián)系作者得到了原始數(shù)據(jù)，再進(jìn)行仔細(xì)檢查和采集。這使他們避免了之前研究的統(tǒng)計學(xué)和方法學(xué)問題，從而對“針灸是否有用”得到了更精確可靠的結(jié)論。

All told, the painstaking process took the team about six years. "Replicating pretty much every single number reported in dozens of papers is no quick or easy task," Dr. Vickers said.

總之，這個艱苦的過程花費(fèi)了團(tuán)隊大概6年時間。“幾十篇論文中幾乎每個數(shù)字都抄一遍真不是個快速簡單的任務(wù)，”維克斯博士說。

The meta-analysis included studies that compared acupuncture with usual care, like over-the-counter pain relievers and other standard medicines. It also included studies that used sham acupuncture treatments, in which needles were inserted only superficially, for example, or in which patients in control groups were treated with needles that covertly retracted into handles.

這次薈萃分析包括了比較針灸與常規(guī)護(hù)理的研究，如非處方止痛藥和其他標(biāo)準(zhǔn)藥品。它也包括了偽針灸安慰治療，比如針刺入得非常淺，或者對照組患者的針會縮回手柄內(nèi)。

Ultimately, Dr. Vickers and his colleagues found that at the end of treatment, about half of the patients treated with true acupuncture reported improvements, compared with about 30 percent of patients who did not undergo it.

最終，維克斯博士和他的團(tuán)隊發(fā)現(xiàn)，在治療結(jié)束時，接受真正針灸治療的患者約有一半報告有改善，而未接受治療的患者約有30%有改善。

"There were 30 or 40 people from all over the world involved in this research, and as a whole the sense was that this was a clinically important effect size," Dr. Vickers said. That is especially the case, he added, given that acupuncture "is relatively noninvasive and relatively safe."

“在全球，有30到40位研究者參與了此項研究，總體來說感覺這是個具有臨床重要效應(yīng)的規(guī)模。”維克斯博士說。他補(bǔ)充說，考慮到針灸“是相對非創(chuàng)傷性和相對安全的”，這一點尤為重要。

Dr. Vickers said the results of the study suggest that people undergoing the treatment are getting more than just a psychological boost. "They're not just getting some placebo effect," he said. "It's not some sort of strange healing ritual."

維克斯博士說，研究結(jié)果表明，接受治療的患者不僅僅獲得了心理上的鼓勵。“他們不僅獲得了安慰效應(yīng)，”他說，“這不是什么怪異的治愈儀式。”

In an accompanying editorial, Dr. Andrew L. Avins, a research scientist at Kaiser Permanente who focuses on musculoskeletal pain and preventive medicine, wrote that the relationship between conventional medical care "and the world of complementary and alternative medicine remains ambiguous." But at least in the case of acupuncture, he wrote, the new study provides "robust evidence" that it provides "modest benefits over usual care for patients with diverse sources of chronic pain."

凱薩醫(yī)療機(jī)構(gòu)(Kaiser Permanente)專事研究肌肉骨骼疼痛和預(yù)防醫(yī)學(xué)的研究科學(xué)家安德魯·L·埃文斯博士(Dr. Andrew L. Avins)在文后的編者按中，把傳統(tǒng)醫(yī)療保健與“補(bǔ)充和替代醫(yī)學(xué)世界” 之間的關(guān)系描述為“含糊不清”，但他寫道，至少就針灸而言，新的研究提供了“強(qiáng)有力的證據(jù)”，“相比常規(guī)治療，針灸對于不同原因慢性疼痛的患者都有一定程度的益處。”