Acupuncture for restless legs syndrome

 

Abstract

Background

Restless legs syndrome (RLS) is a common movement disorder for which patients may seek treatment with acupuncture. However, the benefits of acupuncture in the treatment of RLS are unclear and have not been evaluated in a systematic review until now.

Objectives

To evaluate the efficacy and safety of acupuncture therapy in patients with RLS.

Search methods

We searched the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (January 1950 to February 2007), EMBASE (January 1980 to 2007 Week 8), Chinese Biomedical Database (CBM) (1978 to February 2007), China National Knowledge Infrastructure (CNKI) (1979 to February 2007), VIP Database (1989 to February 2007), Japana Centra Revuo Medicina (1983 to 2007) and Korean Medical Database (1986 to 2007). Four Chinese journals, relevant academic conference proceedings and reference lists of articles were handsearched.

Selection criteria

Randomized controlled trials and quasi-randomized trials comparing acupuncture with no intervention, placebo acupuncture, sham acupuncture, pharmacological treatments, or other non-acupuncture interventions for primary RLS were included. Trials comparing acupuncture plus non-acupuncture treatment with the same non-acupuncture treatment were also included. Trials that only compared different forms of acupuncture or different acupoints were excluded.

Data collection and analysis

Two authors independently identified potential articles, assessed methodological quality and extracted data. Relative risk (RR) was used for binary outcomes and weighted mean difference for continuous variables. Results were combined only in the absence of clinical heterogeneity.

Main results

Fourteen potentially relevant trials were identified initially, but twelve of them did not meet the selection criteria and were excluded. Only two trials with 170 patients met the inclusion criteria. No data could be combined due to clinical heterogeneity between trials. Both trials had methodological and/or reporting shortcomings. No significant difference was detected in remission of overall symptoms between acupuncture and medications in one trial (RR 0.97, 95% CI 0.76 to 1.24). Another trial found that dermal needle therapy used in combination with medications and massage was more effective than medications and massage alone, in terms of remission of unpleasant sensations in the legs (RR 1.36, 95% CI 1.06 to 1.75; WMD -0.61, 95% CI -0.96 to -0.26) and reduction of RLS frequency (WMD -3.44, 95% CI -5.15 to -1.73). However, there was no significant difference for the reduction in either the longest or the shortest duration of RLS (WMD -2.58, 95% CI -5.92 to 0.76; WMD -0.38, 95% CI -1.08 to 0.32).

Authors' conclusions

There is insufficient evidence to determine whether acupuncture is an efficacious and safe treatment for RLS. Further well-designed, large-scale clinical trials are needed.

 

Plain language summary

There is insufficient evidence to support the use of acupuncture for the symptomatic treatment of restless legs syndrome.

Restless legs syndrome (RLS) is a sensorimotor movement disorder characterized by uncomfortable sensations in the legs and an urge to move them. The syndrome is very common and its lifestyle impacts justify a search for more effective and acceptable interventions.

Acupuncture is an ancient Chinese therapeutic method. It regulates the function of internal organs and rebalances body energies by stimulating certain acupoints. As a non-pharmacological therapy, it would be of potential value in the treatment of RLS.

This review investigated the efficacy and adverse effects of acupuncture in treating RLS. The review did not find consistent evidence to determine whether acupuncture is effective and safe in the treatment of RLS, based on the two trials identified. More high quality trials are warranted before the routine use of acupuncture can be recommended for patients suffering from RLS.

 

摘要

背景

不寧腿症候群的針灸療法

不寧腿症候群是常見的動作障礙疾患，有些患者可能會尋求針灸治療，但其療效還沒有經過證實。

目標

評估不寧腿症候群使用針灸治療的成效和安全性。

搜尋策略

搜尋的範圍包含有:Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 1, 2007), MEDLINE (January 1950 to February 2007), EMBASE (January 1980 to 2007 Week 8), Chinese Biomedical Database (CBM) (1978 to February 2007), China National Knowledge Infrastructure (CNKI) (1979 to February 2007), VIP Database (1989 to February 2007), Japana Centra Revuo Medicina (1983 to 2007) and Korean Medical Database (1986 to 2007). 以及蒐尋到所有文章的參考文獻，學術研討會的相關紀錄，以及四個中文期刊。

選擇標準

包含所有比較原發性不寧腿症候群進行針灸治療和不做治療或安慰劑,藥物或其他非針灸的治療方式的隨機對照試驗及半隨機試驗。或是同時使用針灸和非針灸的複方療法和單純使用非針灸治療的比較也會被收入。但若是同樣都是針灸療法，只是比較不同型態或是不同針灸位置的研究，則會被排除。

資料收集與分析

由二位作者分別獨立的選取研究，評估文獻的品質以及截取資料。連續變數分析時使用加權平均差，非連續變數時使用相對危險度分析。在不同研究若使用相同的治療方式，資料會合併分析。

主要結論

最後符合條件的只有二個試驗，總共170個病人。因為介入治療的方式不同，所以資料沒有合併分析。二個試驗都有方法或/和報告上的缺點。在其中一個試驗比較藥物治療和針灸治療，發現對於整體症狀的改善並沒有顯著差異(RR 0.97, 95% CI 0.76 to 1.24)。另外一個試驗發現按摩合併藥物治療，如果再加上針灸，其腿部不舒服的感覺，會比單純用按摩以及藥物治療更加改善(RR1.36, 95% CI 1.06 to 1.75; WMD −0.61, 95% CI −0.96 to −0.26)，不?腿發生的頻率也比較少(WMD −3.44,95% CI −5.15to −1.73)。但是對於單一次發生的時間長短並不影響，不管是最長時間或是最短時間(WMD2.58, 95% CI5.92 to 0.76; WMD −0.38, 95% CI −1.08 to 0.32)。

作者結論

目前所蒐集的證據並不足以證明針灸對於不寧腿症候群的療效和安全性。我們需要更大型且設計完善的研究。

翻譯人

本摘要由新光醫院王瑄翻譯。

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

總結

不寧腿症候群是一種包含運動及感覺障礙的疾病，患者的腿部會有不舒服的感覺以致於無法控制的得活動雙腳。此疾病的普遍性和對於生活的衝擊讓我們希望能夠找到有效且可被接受的治療方式。針灸是中國人傳統的療法，他藉由刺激特殊的針灸部位，調控身體的能量以及內臟功能，也可能對於不寧腿症候群有所幫助。這篇文章回顧了針灸治療對於不寧腿症候群的效果和副作用，但符合條件的二篇研究並沒有一致性的結果能證明其效果和安全性。我們需要更高品質的研究來支持將針灸療法使用在不寧腿症候群。