A Systematic Review Of External Applications Combined With Three—step Analgesic Therapy In Treating Primary Liver Cancer Pain

Objective:To evaluate the safety and therapeutic effect of external applications(TCM)combined with three-step analgesic therapy in treating primary liver cancer pain.Design a systematic review of randomized controlled trials.To provide powerful evidence-based medical data for TCM adjuvant treatment of pain in primary liver cancer,and carry forward the Chinese medicine culture.To summarize the law of application of topical Chinese medicine.Methods:Search databases as CNKI,WANGFANG,CBM,VIP,PubMed,Cochrane Library,Embase(The search time was January 2019),relevant journals,and the literature of RCTs were all enrolled.The quality of RCTs was assessed bias risk use the Cochrane system evaluator' s Manual.Data were extracted and Meta analysis and system evaluation were performed using Review Manager5.3.With the help of "TCM inheritance assistance system",the composition of the formulas included in the study was analyzed,such as medication frequency statistics,prescription composition rules based on association rules,and evolution of new prescriptions.Result:Fourteen Chinese articles were enrolled.1640 patients were included.All the subjects included in the study were primary liver cancer.The baseline were consistent.Test group used external applications(TCM)combined with three-step analgesic therapy,while control group used only three-step analgesic therapy.1?Twelve RCTs mentioned pain relief rates.The inter-group heterogeneity was low and fixed effect model was adopted.The data showed that external application of traditional Chinese medicine combined with three steps analgesic method could improve the cancer pain relief rate in patients with primary liver cancer(Z=7.13,P<0.00001),RR=1.20[1.14,1.26].2?Eight of the studies mentioned pain scores,and eight of the studies were heterogeneous(Chi2=424.67,P<0.00001,I2=98%).The results were divided into two subgroups,with heterogeneity in subgroup 1(Chi2=363.86,P<0.00001,I2=99%).There was heterogeneity in subgroup 2(Chi2=9.97,P=0.007,I2=80%).There is heterogeneity between subgroups(Chi2=467.16,P<0.00001,I2=99%).There were significant differences in pain scores between the treatment group and the control group(Z=6.53,P<0.00001),MD=-2.01(-2.61,-1.41).Sensitivity analysis was initiated and the heterogeneity was reduced after sensitivity analysis(Chi2=1.37,P=0.51,I2=0%).There was significant difference between the two groups(Z=6.71,P<0.00001),MD=-1.04(-1.34,-0.73).3?The indicator results which used descriptive analysis:Three RCTs observed the change of morphine dosage in the two groups during the treatment.There were significant differences in morphine dosage between the two groups(P<0.05).1 article mentioned the onset time of pain relief,duration of pain relief,and number of pain episodes,there were significant differences between the two groups(P<0.05).The data showed that external application of traditional Chinese medicine combined with three-step analgesic method may reduce the dose of morphine used in patients with liver cancer,shorten the onset time of analgesic effect,prolong the duration of pain relief and reduce the outbreak of pain.4?Three studies reported improvement in the Carlisle scale,with homogeneity,fixed effect model is adopted.Meta-analysis results showed that external application of traditional Chinese medicine combined with three-step analgesic method could improve the patients' carnitine score(Z=2.87,P=0.004),R=1.32,[1.09,1.60].5?Four studies mentioned the incidence of gastrointestinal adverse reactions,which was homogeneous between the groups.The results showed that the intervention measures in the experimental group reduced the incidence of gastrointestinal adverse reactions(Z=3.41,P=0.00007),OR=0.33[0.17,0.62].Four studies mentioned the incidence of adverse reactions in the nervous system,which was homogeneous between the two groups.The results indicated that there was no difference in the incidence of adverse reactions in the nervous system between the two groups(Z=0.00,P=1>0.05),OR=1.00,[0.32,3.10].Local adverse reactions of external application of traditional Chinese medicine were mild.6?Rule analysis shows that the formulas "frankincense,myrrh,yanhusuo" is a high frequency of the three traditional Chinese medicine(TCM),the commonly used medicine for "frankincense,myrrh","yanhusuo,myrrh,frankincense","rhubarb,cortex phellodendri",evolved a new prescription for "pinellia,borneol,Oriental arborvitae,rhubarb","nux vomica powder,turmeric,cortex phellodendri,frankincense,kusnezoff monkshood".Conclusion:At present,the evidence shown that the combination of external applications(TCM)and the three-step analgesic therapy in treating primary liver cancer pain is superior to the three-step analgesic therapy.However,we need more high-quality RCTS to improve the research.