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.

癌性疼痛是癌症患者常见并发症之一，临床上广泛应用三阶梯止痛疗法来缓解疼痛，但其疗效仍存在一定局限性，部分患者难以获得理想的镇痛效果。艾灸疗法在缓解癌性疼痛方面展现出良好疗效。然而，关于不同灸疗方案的优化选择仍缺乏系统性的研究，有待进一步探讨。

采用网状Meta分析方法，对不同灸法结合三阶梯疗法治疗癌性疼痛的疗效与安全性进行综合评价，旨在探索可能适用于癌性疼痛的最优艾灸组合方案。

计算机检索中国知网、万方数据知识服务平台、维普网、PubMed 、Web of Science、Embase和Cochrance Library数据库，全面搜集关于艾灸联合三阶梯疗法治疗癌性疼痛的随机对照试验，检索时限为建库至2024年9月。由2名研究者独立筛选文献、提取资料，采用Stata 16.0软件进行数据分析，并绘制相关图形。

最终纳入13项随机对照研究，包括988例患者，涉及3种灸法、3类艾灸时长和4类选穴方式。网状Meta分析结果显示，不同灸法联合三阶梯疗法有效率排序：艾条悬灸（97.1%）>艾炷灸（56.1%）>雷火灸（44.7%）>对照组（2.1%）。不同艾灸总时长有效率排序：<300 min（71.5%）好于>600 min（65.2%）好于300~600 min（57.8%）。不同选穴方式有效率排序：躯干部（83.5%）>阿是穴（68.4%）>四肢部（66.3%）>远近配穴（30.9%）。有3篇文献报告艾灸相关不良反应，包括水泡、晕灸、皮疹等，大多属于轻度，多数自行吸收或通过简单处理得到缓解。纳入研究的总脱落率为0.6%（6/988）。

艾灸联合三阶梯疗法可有效缓解癌性疼痛，且安全性良好。相较于其他灸法，艾条悬灸在改善癌性疼痛方面效果更优。实践操作中，建议总疗程艾灸时长不超过300 min，优先选取躯干部穴位，这可能是较为适宜的艾灸方案。上述结论仍需通过更高质量的随机对照试验加以验证。