Cancer pain is one of the most common complications in cancer patients. Three-step analgesic therapy is widely used clinically to relieve pain, but its efficacy is still limited, and some patients fail to achieve the ideal analgesic effect. Moxibustion therapy demonstrates promising efficacy in relieving cancer pain. However, there is still a lack of systematic evidence on the optimal selection of different moxibustion therapy protocols, which needs to be further explored.

To comprehensively evaluate the efficacy and safety of different moxibustion therapies combined with three-step therapy for the treatment of cancer pain using network meta-analysis, aiming to identify the optimal moxibustion protocol.

Electronic searches were performed in databases including CNKI, Wanfang Data, VIP, PubMed, Web of Science, Embase, and Cochrane Library to comprehensively collect randomized controlled trials (RCTs) on moxibustion combined with the three-step therapy for cancer pain, spanning from inception to September 2024. Two researchers independently screened the literature, extracted data and used Stata 16.0 software to analyze the data and draw relevant graphs.

A total of 13 RCTs involving 988 patients were included, evaluating 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: the effective rates ranking of moxibustion methods: suspended moxibustion (97.1%) > moxa cone moxibustion (56.1%) > thunder-fire moxibustion (44.7%) > control group (2.1%); the effective rates ranking of the total duration of moxibustion ranked as follows: within 300 min (71.5%) > over 600 min (65.2%) > 300-600 min (57.8%); the effective rates ranking of acupoint selection was trunk (83.5%) > Ashi (68.4%) > limbs (66.3%) > distal-proximal matching (30.9%). Three studies reported moxibustion related adverse reactions, including blisters, moxibustion syncope and rash. 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).

Moxibustion combined with the three-step therapy can relieve cancer pain effectively and safely. Compared to other moxibustion methods, suspended moxibustion appears more effective in improving cancer pain. In practice, it is recommended that the total course of moxibustion duration should not exceed 300 minutes, prioritizing acupoints on the trunk, as this may be a more suitable moxibustion regimen. The above conclusions still need verification through higher-quality randomized controlled trials.