Study On Influencing Factors Of Clinical Efficacy Of Acupuncture And Moxibustion In The Treatment Of Postherpetic Neuralgia

Background:Postherpetic neuralgia(PHN)usually occurs in the cephalosome or chest and back of trigeminal nerve and intercostal nerve.Its clinical manifestations are burning pain,deep pain,jumping pain,acupuncture like pain,knife cutting pain,abnormal pain and hyperalgesia distributed along the peripheral nerve,accompanied by autonomic nerve instability.The pain can last for months to years or even decades,Persistent pain seriously affects the daily activities and quality of life of patients,resulting in sleep disorders,fatigue,anorexia,depression,anxiety and other symptoms,and even suicide.The expert consensus on herpes zoster related pain released in 2021 points out that moxibustion,acupuncture and cupping can be used for the treatment of herpes zoster and its postherpetic neuralgia,and there are many domestic clinical studies on acupuncture and moxibustion in the treatment of PHN.Almost all studies have proved that acupuncture and moxibustion is effective in the treatment of PHN,but the curative effects of different doctors using different therapies on different patients are different.In order to further improve the curative effect,we should consider which factors have an impact on the curative effect and the size of the effect in the future.However,at present,there is no relevant research on the influencing factors of the curative effect of acupuncture and moxibustion in the treatment of PHN.Therefore,this study will use semi-structured interview,logistics regression and meta regression to confirm the influencing factors of curative effect.Objective:Semi-structured interview,Logistic regression and Meta regression were used to explore the factors affecting the clinical efficacy of acupuncture and moxibustion in the treatment of PHN,so as to provide reference for further improving the clinical efficacy of acupuncture and moxibustion in the treatment of PHN in the future.Methods:1.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Semi-structured interview.Using the semi-structured interview method in the qualitative research,the doctors who used acupuncture and moxibustion to treat PHN in the hospital were selected by the methods of convenient sampling and snowball sampling.The interview was conducted from the aspects of treatment methods,patients’general conditions,disease characteristics and doctors’ qualifications.The whole interview was recorded.Each doctor was interviewed for about 20-60 minutes.After the interview,the recording would be transcribed into text data,The text data were coded and summarized by subject analysis,and the factors that may affect the treatment of PHN by acupuncture and moxibustion would be summarized.2.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Logistic regressionRetrieve the medical record information of PHN patients treated with acupuncture from eight hospitals from January 1,2021 to December 31,2021.For the visual analog scale/score(VAS)of pain in the medical record,calculate the minimum clinical important difference(MCID)according to the anchoring method and distribution method.According to the MCID,it was divided into valid and invalid groups as dependent variables;Other data in the medical record can be divided into three categories of influencing factors:treatment mode,general situation and disease characteristics of patients,and qualification of acupuncturists.The influencing factors in the three aspects were extracted as the initial independent variables.The initial independent variables were screened by directed acyclic graph method,effect change method and single factor Logistic regression method to obtain the final independent variables that can be included in the model,Binary logistic regression analysis would be performed.3.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Meta regressionSeven commonly used Chinese and English databases will be searched by computer.The retrieval time range was from the establishment of the database to December 31,2021.The randomized controlled trial(RCT)of acupuncture and moxibustion treatment of PHN will be included.The data of the included studies will be extracted and meta regression analysis will be carried out by Using Stata 14.0 and Revman 5.3 software.Taking the effect value(MD)of the outcome index of pain VAS score as the dependent variable(Y),that is,the difference of VAS score between the treatment group and the control group,and taking the patient’ s disease characteristics and possible factors in the treatment as the covariate(X),the restricted maximum likelihood method was used to fit the meta regression model.Results:1.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Semi-structured interview.Finally,17 acupuncturists from 13 hospitals were interviewed.The interview lasted between 24 and 60 minutes.All respondents signed informed consent,and the interview information has reached saturation.The researchers transcribed the recorded data of 17 respondents,combined with on-site notes,sorted out about 110000 words of manuscripts,incorporated them into nvivo12 software for coding,and obtained 149 original codes.The original codes were summarized by topic analysis method,and obtained 3 themes and 19 sub themes.2.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Logistic regressionIn this study,the medical records of 231 PHN patients were collected from eight hospitals.The doctors who treated them were residents,attending physicians,deputy chief physicians and chief physicians.The treatment methods included manual acupuncture,electroacupuncture,fire milli-acupuncture,fire acupuncture,plum blossom acupuncture,warm needle moxibustion,puncture and cupping.According to the anchor method and distribution method,the MCID value of VAS score is 2.401.With this boundary value,the outcome classification is taken as the dependent variable,and the screened factors are analyzed as the independent variable.Logistics regression analysis shows that age has a significant effect on the efficacy of acupuncture and moxibustion in the treatment of PHN,and the difference has statistical significance(OR=0.897;95%CI:0.826,0.973;P<0.05);The longer the course of disease,the worse the curative effect of acupuncture and moxibustion,and the difference was statistically significant(OR=0.993;95%CI:0.989,0.998;P<0.05).The more basic diseases were combined,the worse the curative effect of acupuncture and moxibustion,and the difference was statistically significant(OR=0.152;95%CI:0.031,0.747;P<0.05);Compared with local acupoint selection only,remote acupoint selection plus local acupoint selection has better curative effect,and the difference is statistically significant(OR=4.331;95%CI:1.375,13.642;P<0.05).The more the total times of acupuncture and moxibustion treatment,the more effective it may be,and the difference is statistically significant(OR=1.085;95%CI:1.002,1.175;P<0.05).3.Influencing factors of acupuncture and moxibustion in the treatment of PHN:Meta regressionA total of 49 RCTs met the inclusion and exclusion criteria,including 3621 PHN patients.Meta regression analysis showed that age was significantly correlated with the MD value of VAS score,and the difference was statistically significant[Coef=0.036,95%CI(0.0005,0.071),P<0.05].The effect of different acupoint selection methods on the curative effect was statistically significant[Coef=-0.241,95%CI(-0.477,-0.005),P<0.05].Conclusions:In the process of acupuncture treatment of PHN,age and acupoint selection method are the factors affecting the clinical efficacy.The older the patient is,the lower the possibility of effective acupuncture treatment is;Compared with local acupoint selection,remote acupoint selection plus local acupoint selection is more effective.