关键词: 癌性疼痛, 灸法, 网状Meta分析, 有效率, 安全性

Abstract: Background:Cancer pain is one of the most common complications in cancer patients. Three-step analgesic therapy is widely used in clinical practice to relieve pain, but its curative effect is still limited, and some patients are difficult to obtain the ideal analgesic effect. Moxibustion therapy has shown good efficacy in relieving cancer pain. However, there is still a lack of systematic research on the optimal selection of different moxibustion treatment schemes, which needs to be further explored.Objective: To evaluate the efficacy and safety of different moxibustion methods combined with three-step therapy in the treatment of cancer pain by network Meta-analysis, in order to explore the best possible combination of moxibustion methods for cancer pain. Methods: The seven Chinese and English databases of CNKI, Wanfang, VIP, PubMed, Web of Science，EMbase and The Cochrance Library were searched by computer. A comprehensive collection of randomized Controlled Trials (RCTs) of moxibustion combined with three-step therapy for the treatment of cancer pain was conducted from inception to September 2024. The included studies were assessed for Risk bias using the Cochrane Risk of bias tool for randomized trials (RoB) recommended by the Cochrane Handbook 5.1.0. The network and mvmeta packages in Stata16.0 software were used to analyze the data and draw the related graphs. Results: A total of 13 randomized controlled trials involving 988 patients were included, involving 3 kinds of moxibustion methods, 3 kinds of moxibustion duration, and 4 kinds of acupoint selection methods. The results of network meta-analysis showed that: (1) The ranking of moxibustion methods: moxa stick suspension moxibustion (97.1%) > moxa cone moxibustion (56.1%) > thunder fire moxibustion (44.7) > control group (2.1%); (2) The total duration of moxibustion ranked as follows: within 300 min (71.5%) > over 600min (65.2%) > 300-600min (57.8%) > control group (5.5%); (3) The ranking of acupoint selection was trunk (83.5%) > Ashi (68.4%) > limbs (66.3%) > distally and distally matched acupoints (30.9%) > control group (0,9%). Three studies reported moxibustion related adverse reactions, including blisters, dizzy moxibustion, rash, etc. Most of them were mild, and most of them were absorbed by themselves or relieved by simple treatment. The total dropout rate of the included studies was 0.6%(6/988).. Conclusion: Moxibustion combined with three-step therapy can relieve cancer pain effectively and safely.Suspended moxibustion with moxa stick, the total treatment volume not more than 300 min, and the selection of shu and mu points of the trunk may be the most appropriate moxibustion scheme for patients with cancer pain.

Key words: Cancer pain, Moxibustion, Network Meta-analysis, Effectiveness, Security