Auricular acupuncture for cocaine dependence

 

Abstract

Background

Auricular acupuncture (insertion of acupuncture into a number, usually five, of specific points in the ear) is a widely-used treatment for cocaine dependence.

Objectives

To determine whether auricular acupuncture is an effective treatment for cocaine dependence, and to investigate whether its effectiveness is influenced by the treatment regimen.

Search methods

We searched the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 3, 2004); MEDLINE (January 1966 to October 2004) , EMBASE (January 1988 to October 2004); PsycInfo (1985 to October 2004); CINAHL (1982 to October 2004); SIGLE (1980 to October 2004) and reference lists of articles.

Selection criteria

Randomised controlled trials comparing a therapeutic regimen of auricular acupuncture with sham acupuncture or no treatment for reduction of cocaine use in cocaine dependents.

Data collection and analysis

Two authors independently extracted data from published reports and assessed study quality using the Drug and Alcohol CRG checklist. All authors were contacted for additional information; two provided data. Separate meta-analyses were conducted for studies comparing auricular acupuncture with sham acupuncture, and with no treatment. For the main cocaine use outcomes, analyses were conducted by intention to treat, assuming that missing data were treatment failures. Available case analyses, using only individuals who provided data, were also conducted.

Main results

Seven studies with a total of 1,433 participants were included. All were of generally low methodological quality. No differences between acupuncture and sham acupuncture were found for attition RR 1.05 (95% CI 0.89 to 1.23) or acupuncture and no acupuncture: RR 1.06 (95% CI 0.90 to 1.26) neither for any measure of cocaine or other drug use. However, the number of participants included in meta-analyses was low, and power was limited. Moderate benefit or harm is not ruled out by these results. Methodological limitations of the included studies may have also made the results open to bias.

Authors' conclusions

There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence. The evidence is not of high quality and is inconclusive. Further randomised trials of auricular acupuncture may be justified.

 

Plain language summary

Auricular acupuncture for cocaine dependence

There are no effective drugs for the treatment of cocaine dependence, and doctors do not agree on a best method of treatment. More than 400 substance abuse clinics in the USA and Europe offer a treatment for cocaine dependence called auricular acupuncture. In this treatment, needles are usually inserted into five specific points in the ear, but some clinics use only four or three of the points. In this Cochrane review the authors set out to discover whether auricular acupuncture is effective in treating cocaine dependence and whether the number of points used makes a difference. The authors searched the medical literature for studies called randomized controlled trials, in which one group of patients receives a treatment (such as acupuncture) and is compared with a similar group who receives a different treatment or no treatment (the control group). The authors found seven studies with a total of 1433 people. Most of the studies compared acupuncture with 'sham' acupuncture in which needles were inserted into random places in the ear but not into the specific points required for treatment. The studies used a variety of acupuncture techniques, using three, four, or five of the treatment points. The studies had a number of problems with the way their results were reported. The authors conclude that there is no evidence that any form of auricular acupuncture is effective for treating cocaine dependence. They recommend that better research be done, since it was difficult for them to draw conclusions from the few available studies.

 

摘要

背景

耳針用於可卡因(cocaine)依賴

耳針(插針入耳朵一個特殊的穴點，通常有5個)是一種廣泛使用於治療可卡因依賴的治療方法。

目標

確認耳針對可卡因依賴是否為一種有效的治療，並探討治療方案是否影響其效力。

搜尋策略

我們搜尋Cochrane Central Register of Controlled Trials(Cochrane Library第3期，2004年MEDLINE(1966年1月至2004年10月)，EMBASE(1988年1月至2004年10月 PsycInfo(1985年至2004年10月) CINAHL(1982年10月至2004年10月)SIGLE(1980年至2004年10月)各資料庫之文章和和文章中參考文獻。

選擇標準

在可卡因依賴者上比較以耳針療法相對偽針灸或不接受任何治療，其可卡因使用減少情形的隨機對照試驗

資料收集與分析

兩位作者各自從出版的報告獲取數據並使用毒品和酒精CRG檢查表評估研究的品質。並為獲得更多資料與所有納入研究之作者進行連繫有兩位提供數據。進行耳針對偽針灸以及耳針對沒有治療的獨立統合分析。對於可卡因使用的主要結果，進行治療意向分析，遺失的數據以治療失敗呈現。也進行只提供個人數據的個案分析。

主要結論

包含1433位參加者之七個研究被納入 不論是對可卡因或其他毒品使用的任何措施，針灸和偽針灸沒有區別，相對危險比率為1.05 (95 ％ CI為0.89到1.23)，針灸或沒有針灸沒有區別：相對危險比率1.06 (95 ％ CI為0.90至1.26)。然而，統合分析中之參與者太少，效力是有限的。 這些結果無法排除適度的利益或損害。研究方法的受限，可能產生結果的偏差。

作者結論

目前沒有證據証明耳針對於治療可卡因的依賴性是有效的。證據不是高品質，是不確定的。可能有足夠的理由顯示需要進一步的耳針隨機試驗。

翻譯人

本摘要由高雄榮民總醫院洪碧蓮翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

沒有有效的藥物治療可卡因依賴性，且沒有醫師沒有公認的最好的治療方法。在美國和歐洲超過400間物質濫用的診所，提供可卡因依賴的耳針治療。在此治療，針通常插入耳朵五個特別的點，但一些診所只使用4個或3個點。在這個Cochrane回顧系統，作者列出去發現是否耳針有效的治療可卡因的依賴，以及使用點的多寡是否有所差別。作者搜查了醫學研究所謂的隨機對照試驗的文獻，其中一組患者接受治療(如針灸)，比較類似的族群接受不同的治療，或者不接受任何治療(對照組)。研究人員發現包含1433位參加者之七個研究，其中大部分研究為比較針灸和‘偽’針灸(指針分別插入耳朵的任意地方，但並非是需要接受治療的特定要點)。沒有證據表明任何形式的耳針可有效治療可卡因的依賴。該研究採用了各種針灸技術，採用三，四，或五點的治療。這些研究對於他們結果報告的方法有若干問題。作者最後表示，沒有證據表明任何形式的耳針是有效治療可卡因的依賴。他們建議，更好的研究工作要做，因為他們難以從現有很少的研究得出結論。