External application of traditional Chinese medicine in combination with threestep analgesic ladder therapy for cancer-induced bone pain:a systematic review and meta-analysis  

中药外敷联合三阶梯镇痛药物治疗癌性骨痛:一项系统评价和meta分析

作　　者：Fei WANG Guihua LAI Fang ZHOU Duorui NIE Xiongtao CHENG Yue WANG Jianxiong CAO 王菲;赖桂花;周芳;聂多锐;程雄涛;王岳;曹建雄(湖南中医药大学研究生院,湖南长沙410208;南华大学第一附属医院康复科,湖南衡阳421001;湖南中医药大学第一附属医院肿瘤科,湖南长沙410007)

机构地区：[1]Graduate School,Hunan University of Chinese Medicine,Changsha,Hunan 410208,China [2]Department of Rehabilitation,The First Affiliated Hospital of University of South China,Hengyang,Hunan 421001,China [3]Department of Oncology,The First Hospital of Hunan University of Chinese Medicine,Changsha,Hunan 410007,China

出　　处：《Digital Chinese Medicine》2025年第1期59-75,共17页数字中医药(英文)

基　　金：Provincial Key Research and Development Project of Hunan(2018SK2127);Hunan Province Traditional Chinese Medicine Research and Development Project(201946).

摘　　要：Objective To systematically evaluate the overall efficacy of external application of traditional Chinese medicine(EA-TCM)in combination with oral three-step analgesic ladder therapy for patients suffering from cancer-induced bone pain(CIBP).Methods We conducted a literature search of randomized controlled trials on the combination of EA-TCM and three-step analgesic ladder therapy for CIBP across ten databases and two registration systems.It included four Chinese databases[Chinese Biomedical Literature Database(SinoMed),China National Knowledge Infrastructure(CNKI),Wanfang Database,and China Science and Technology Journal Database(VIP)],six English databases(Scopus,Embase,Web of Science,PubMed,Cochrane Library,and OpenGrey),and two registration systems(Chinese Clinical Trial Registry and ClinicalTrials.gov).The timeframe for the literature search extended from the inception of each database to December 31,2023.Meta-analysis was performed using RevMan(v5.4.1),and the outcome indicators(pain relief rate,analgesic duration,quality of life,pain intensity,breakthrough pain frequency,and adverse reactions)were graded using GRADE profiler(v3.6).Results According to the established inclusion and exclusion criteria,a total of 43 studies was deemed eligible,involving 3142 participants with CIBP.The results of meta-analysis showed that compared with oral three-step analgesic ladder therapy alone,the combined therapy of EA-TCM and three-step analgesic ladder has a significant improvement in pain relief rate[risk ratio(RR)=1.32,95%confidence interval(CI):1.24 to 1.41,P<0.00001],analgesic duration[mean difference(MD)=1.33,95%CI:0.97 to 1.69,P<0.00001],and quality of life(MD=5.66,95%CI:4.88 to 6.44,P<0.00001).Furthermore,the combined therapy significantly reduced pain intensity(MD=-1.00,95%CI:-1.19 to-0.80,P<0.00001),breakthrough pain frequency(MD=-0.43,95%CI:-0.51 to-0.36,P<0.00001),and adverse reactions(RR=0.60,95%CI:0.53 to 0.68,P<0.00001)in CIBP patients.Based on the GRADE assessment,the level of evidence varied from low to 目的对中药外敷联合口服三阶梯镇痛药物对癌性骨痛患者的总体疗效进行系统评价。方法我们在10个数据库和2个注册系统中检索了关于中药外敷联合三阶梯镇痛疗法治疗癌性骨痛的随机对照试验,其中包括4个中文数据库:中国生物医学文献数据库(SinoMed)、中国知网(CNKI)、万方数据库、维普数据库(VIP),6个英文数据库(Scopus、Embase、Web of Science、PubMed、Cochrane Library和OpenGrey)和2个注册系统(中国临床试验注册中心和ClinicalTrials.gov)。文献检索的时间范围从各数据库建立之日至2023年12月31日。使用RevMan(v5.4.1)进行meta分析,并使用GRADEprofiler(v3.6)对结局指标(疼痛缓解率、镇痛持续时间、生活质量、疼痛强度、爆发痛次数及不良反应)进行证据质量分级。结果根据既定的纳入和排除标准,共43项研究符合条件,包括3142名癌性骨痛患者。meta分析结果表明,中药外敷联合三阶梯镇痛药物与单独口服三阶梯镇痛药物相比,疼痛缓解率[风险比(RR)=1.32,95%置信区间(CI):1.24~1.41,P<0.00001]、镇痛持续时间[平均差(MD)=1.33,95%CI:0.97~1.69,P<0.00001]和生活质量(MD=5.66,95%CI:4.88~6.44,P<0.00001)均有显著改善。中药外敷联合口服三阶梯镇痛药物还可显著降低癌性骨痛患者的疼痛强度(MD=-1.00,95%CI:-1.19~-0.80,P<0.00001)、爆发痛发生频率(MD=-0.43,95%CI:-0.51~-0.36,P<0.00001)和不良反应(RR=0.60,95%CI:0.53~0.68,P<0.00001)。根据GRADE评估,证据等级从低到中不等。结论中药外敷联合三阶梯镇痛药物可有效缓解癌性骨痛患者的疼痛症状,提高其生活质量。此外,中药外敷还能有效降低三阶梯镇痛药物的不良反应发生率。

关 键 词：External application of traditional Chinese medicine(EA-TCM) Three-step analgesic ladder therapy Cancer-induced bone pain(CIBP) Systematic review META-ANALYSIS 

分 类 号：R730.5[医药卫生—肿瘤]