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By Chan Yi Yi

Acupuncture in Treatment of Heroin Withdrawal Syndrome: A Systemic Review and Meta-analysis 针刺疗法治疗海洛因戒断综合症的 Meta 分析. By Chan Yi Yi. Introduction 1 : Heroin abuse. 13 million opiate addicts including 9 million heroin users throughout the world

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By Chan Yi Yi

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  1. Acupuncture in Treatment of Heroin Withdrawal Syndrome: A Systemic Review and Meta-analysis针刺疗法治疗海洛因戒断综合症的Meta分析 By Chan Yi Yi

  2. Introduction 1:Heroin abuse • 13 million opiate addicts including 9 million heroin users throughout the world • A high risk of AIDS and other serious diseases in this population • Social costs due to crime and poverty may exceed most other drug abuses A priority of health and social problem in Mainland China and Hong Kong

  3. Introduction 2:Acupuncture therapy (AT) • Dr. H.L. Wen (1972) firstly reported the effect of acupuncture therapy (AT) to treat heroin dependence in Hong Kong • So far a number of randomized clinical trials (RCTs) have been conducted to identify the practice value of AT in heroin detoxification

  4. Introduction 3:Evidence-based medicine (EBM) • EBM can provide the highest standard evidence (current best evidence) for medical science • Scientists need to be aware by the evidence to correct their researches and clinical practices

  5. Introduction 3:The Levels of EBM (Oxford Centre of EBM) Systemic Reviews & Meta-analysis From: med.fsu.edu/informatics/EBMTutorial.asp

  6. Introduction 3:The process of EBM Modified by Delfini Group, LLC (www.delfini.org) from Leung GM. Evidence-based practice revisited. Asia Pac J Public Health. 2001;13(2):116-21

  7. Introduction 4:Aims of study (1) Assess the quality,and measurement/category data (2) Evaluate the efficacy and safety of AT in treatment of heroin withdrawal syndrome by a comparison betweenATand MT (medication therapy) (3) Analysis the most commonly used acupointsandmanipulationsin clinical application

  8. Methods 1:Study procedures Step 1: Framing Questions Step 2: Identifying Literatures Step 3: Assessing quality of literatures Step 4: Summarizing the evidence Step 5: Interpreting the findings

  9. Methods 2:Criteria & searching • Inclusive criteria: RCTs to compare the efficacy and safety of AT with MT for heroin detoxification • Exclusive criteria: (1) not clinical report: reviews or case reports (2) patients not in the acute stage (3) insufficient outcome data (4) not medicinal control • Search strategy (1) electronic searching (2) hand searching (3) additional searching

  10. Methods 3:Quality & meta-analysis • Quality assessment: Jadad scale: High-quality trials(3-5 points) and low-quality trials(1-2 points) • Meta-analysis: Category-data (C-data): AT alone vs. MT and AT plus MT vs. MT alone Estimated by odd ratio (OR) and 95% confidence interval (95% CI) Measurement-data (M-data): AT alone vs MT and AT plus MT vs MT alone Estimated by weight mean difference (WMD) and 95% CI Subgroup analysis: Heterogeneity, HAMA scores and relapse rate Computer program:Review Manager 4.2

  11. Result 1:Included trials • 20 trials (1072 treated with acupuncture in total of 2134 patients) that met the inclusive criteria were cited • 6 trials in them were assessed as high-quality trials • The rest were low-quality trials as poor description of randomization, blind-method and dropout reporting in study design

  12. Results 2:Efficacy 1(Compared AT alone with MT) 1.1 Patients’ detoxicated number (C-data): 4 RCTs (5 comparisons) no significant difference between 2 groups (P=0.52) no heterogeneity (P=0.88) 1.2 Withdrawal syndrome score (M-data on the Day 1 to 10): 5 RCTs (7 comparisons) AT was significantly lower than MT (P<0.005) Heterogeneity(P<0.02) 1.3 HAMA score (M-data): 1 RCT (1 comparison) AT was significantly lower than MT (P<0.05)

  13. Results 2:Efficacy 1.1 (C-data)

  14. Results 2:Efficacy 1.2 (M-data)

  15. Results 2:Efficacy 2(Compared AT plus MT with MT alone) 2.1 Patients’ detoxicated number (C-data): 8 RCTs (8 comparisons) AT plus MT was significantly higher than MT (P<0.00001) no heterogeneity (P=1.00) 2.2 Withdrawal syndrome score on the Day 1 to 10 (M-data): 6 RCTs (7 comparisons) AT plus MT was significantly lower than MT (P<0.02) Heterogeneity(P<0.00001) 2.3 HAMA score (M-data): 3 RCTs (3 comparisons) AT plus MT was significantly lower than MT (P=0.004) Heterogeneity(P=0.002) 2.4 Relapse rate (C-data): 3 RCT (3 comparisons) AT plus MT was significantly lower than MT (P<0.00001) No Heterogeneity (P=0.51)

  16. Results 2:Efficacy 2.1 (C-data)

  17. Results 2:Efficacy 2.2 (M-data)

  18. Results 2:Efficacy 2.3 (M-data) Hama Score

  19. Results 2:Efficacy 2.4 (C-data) Relapse rate

  20. Results 3:Safety • The incident of adverse effects caused by MT was significantly higher than AT • Only 1 trial in total 20 included trials reported a mild adverse effect that was local pain caused by needles

  21. Results 4:Commonly used meridians 23.5%

  22. Results 5:Commonly used acupoints 水溝 腎俞 外關 內關 神門 合谷 勞宮 足三里 陽陵泉 三陰交

  23. Results 5:Auricular points

  24. Results 5:Distribution of acupoints 18.8 28.1 18.8 53.1

  25. Results 6:Commonly used manipulations

  26. Results 7:Heterogeneity • A subgroup meta-analysis indicated that the difference manipulations was one of the key factors to interfere synthesis of measurement data in this study • However, the type of medications used as controls did not play a major role in introducing heterogeneity.

  27. Conclusions (1) AT is statistically more favorable than MT in relieving heroin withdrawal syndrome, combined AT with MT may be more effective in clinical application (2) AT is safe for treating patients clinically (3) However, more high quality trials of study design should be conducted to further verify the evidence in this study

  28. Acknowledgement • Supervised by: Dr. Xu Min andDr.Zhang Shi-ping • Supported by: a grant of the Beat Drugs Fund: BDF050001

  29. Thank You

  30. Electronic Databases • The Database of Chinese Science Journals, • The Database of Chinese Journals of TCM, • The Database of Chinese Biomedical Literatures (CBMdisc) • The Database of Chinese New Medications • Cochrane Library • MEDLINE • EMBASE • BIOSIS • CINAHL • World Cat • Article first

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