Rédacteurs : Johan Nguyen, Martin Schvartzapel, Olivier Goret, Claude Pernice

Herpes Zoster

Zona : évaluation de l'acupuncture

Articles connexes: - conduites thérapeutiques - pathologie - acupuncture expérimentale - qigong -

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Coyle 2017 ☆

Coyle ME, Liang H, Wang K, Zhang AL, Guo X, Lu C, Xue CC. Acupuncture plus moxibustion for herpes zoster: A systematic review and meta-analysis of randomized controlled trials. Dermatol Ther. 2017. [191970].

BackgroundHerpes zoster is an acute inflammatory condition which can have a significant impact on quality of life. Antiviral therapies are effective, but do not meet patients' expectations of symptomatic relief. Acupuncture and moxibustion have been used for herpes zoster; this systematic review evaluated their efficacy and safety.
Methods Nine English and Chinese databases were searched from their inceptions to March 2016. Randomized controlled trials evaluating the combination of acupuncture plus moxibustion in adult herpes zoster were included. Outcomes included pain intensity and duration, quality of life and adverse events. Meta-analysis was performed using RevMan software (version 5.3).
ResultsNine studies (945 participants) were included. Studies were of low to moderate methodological quality based on risk of bias assessment. Pain intensity (visual analogue scale) was lower among those who received acupuncture plus moxibustion compared with pharmacotherapy (one study; MD -8.25 mm, 95% CI -12.36 to -4.14). The clinical significance of this result is yet to be established. Some benefits were seen for other pain and cutaneous outcomes, and global improvement in symptoms. Mild adverse events were reported in the intervention groups.
Conclusion Acupuncture plus moxibustion may improve pain and cutaneous outcomes, although current evidence is limited by the number of studies and methodological shortcomings.

1.1.2. Yu 2007 ☆☆

Yu Xm, Zhu Gm, Chen Yl, Fang M, Chen Yn. [Systematic assessment of acupuncture for treatment of herpes zoster in domestic clinical studies]. Chinese Acupuncture And Moxibustion. 2007;27(7):536-40. [146650]

ObjectiveTo assess the effectiveness of acupuncture for treatment of herpes zoster.
MethodsAccording to the requirement of evidence-based medicine, acupuncture, body acupuncture, electroacupuncture, head acupuncture, three edged needle, plum-blossom needle, fire needle , elongated needle, encircling needling, herpes zoster, etc. were selected as subject words to retrieve the relative medical database at home, and clinically randomized controlled trials were used as enrolled criteria, the treatment group were treated with acupuncture or acupuncture plus other therapies, and the control group with medicine, the cured rate and the time of killing pain for herpes zoster were used as assessment indexes. Altogether 43 papers were enrolled. Among them 10 papers were conducted for Meta-analysis by RevMan 4.2.9.
ResultsThe total OR was 4.27 with 95% CI [2.90, 6.29] of the clinically cured rate in the 10 studies, and the total OR was -7.64 with 95% CI: [-8.12, -7.15] of the time of killing pain in the 4 studies. The therapeutic effect in the treatment group on herpes zoster was superior to that of the western medicine (P < 0.01).
ConclusionAcupuncture therapy for herpes zoster is effective, but more high-quality studies are required to prove this view point.

1.1.3. Zhao 2007 ☆

Zhao Ting, Wang Ying-Hui. [Systematic Assessment of Randomized Controlled Trials of Acupuncture-moxibustion Treatment of Herpes Zoster ]. Shanghai Journal of Acupuncture and Moxibustion. 2007; 26(6):30-3. [181664].

Objective To assess the efficacy of acupuncture and moxibustion for treating herpes zoster.
Methods Randomized controlled trials of acupuncture-moxibustion treatment of herpes zoster were assessed systematically. A statistical analysis was performed using RevMan softwarc (version 4. 2. 8).
Results Seven randomized controlled trials of acupuncture treatment of herpes zoster conformed to inclusion criteria and were single-center studies. The number of included persons ranged from 40 to 120 and totaled 479. The sum of result measurement indices in accordance with posttreatment improvement in clinical symptoms and signs is OR 6. 97 (95% CI 4. 48 to 10. 84).
Conclusion Present studies conforming to inclusion criteria show that acupuncture has a certain curative effect on herpes zoster without obvious toxic side effects. But because included literature on the study are not much, many high quality studies are still needed for validation.

1.2. Special Acupuncture Techniques

1.2.1. Moxibustion

1.2.1.1. Pang 2017

Pang Yuzhou, Lin Jiyong, Fang Gang, Liang Fengzhen, Huang Lan. [Meta-analysis for Effects of Medicated Threads Moxibustion of Zhuang Medicine to Herpes Zoster]. Liaoning Journal of Traditional Chinese Medicine. 2017;12. [52112].

Objective To evaluate the effects of the medicated threads moxibustion of Zhuang medicine for treatment of herpes zoster.
Methods We collected studies in CBM, CNKI, WANFANG DA-TA, VIP database, Cochrane Library, PubMed, Embase and Web of Science during January 2000 to July 2006 and the data by included and excluded standard. Furthermore, we extracted and analyzed the data which was collected. Jadad scale was used to evaluate the methodology of the included studies. Review manager 5. 3 software for Meta-analysis included studies.
Results Eleven RCTs were included in the study, a total of 911 patients, 470 cases in treatment group, 441 cases in control group. Meta-analysis results showed that the amount OR value and 95% CI were 4. 66, [3. 00, 7. 23]. There was significant statistical difference between treatment group and control group (P < 0. 00001). And the former efficiency (93. 8%) was better than the later (76. 9%). The effect of the medicated threads moxibustion of Zhuang medicine acupuncture in the treatment of herpes zoster comprehensive was better than that of the control group.
ConclusionCompared with the traditional treatment, the medicated threads moxibustion of Zhuang medicine acupuncture may have better effect on ascension herpes zoster, but the present study sample size was small and methodological quality was low. The curative effect of medicated threads moxibustion of Zhuang medicine to herpes zoster is still needed further verification.

1.2.2. Fire Needle

1.2.2.1. Li 2019

Li Dong, Mo Zhuo-mao, Zhang Ren-wen, et al. Is fire needle superior to Western medication for herpes zoster? A systematic review and meta-analysis. Journal of Acupuncture and Tuina Science. 2019;17(5):312. [202781].

Objective To compare the effectiveness of fire needle versus Western medicine in the treatment of herpes zoster.
Methods Randomized controlled trials comparing fire needle with Western medicine in the treatment of herpes zoster were identified using 8 databases. A meta-analysis was performed using RevMan 5.3 software.
ResultsEight trials involving 569 patients were included in this meta-analysis, and the results showed that fire needle was superior to Western medicine comparing the effective rate [risk ratio (RR)=1.13, 95% confidence interval (CI): 1.06 to 1.20; P=0.0002], the visual analog scale (VAS) score [mean difference (MD)=-7.95, 95% CI: -10.71 to -5.20; P<0.00001], time of pain disappearance (MD=-7.61, 95%Cl: -9.38 to -5.84; P<0.00001), time of blister-stop (MD=-1.34, 95%Cl: -1.51 to -1.18; P<0.00001), time of crusted scab (MD=-2.92, 95%Cl: -3.62 to -2.23; P<0.00001), and time of scab off (MD=-4.64, 95%Cl: -5.83 to -3.46; P<0.00001). In addition, a significantly lower incidence of postherpetic neuralgia was found in the fire needle group in 30 d (RR=0.23, 95%Cl: 0.11 to 0.51; P=0.0002) and 60 d (RR=0.33, 95%Cl: 0.12 to 0.91; P=0.03) after treatment.
Conclusion fire needle has a favorable effect in increasing the effective rate, relieving pain, recovering skin lesions and decreasing incidence of postherpetic neuralgia in the treatment of herpes zoster. However, considering the limitations in this study, the findings should be interpreted cautiously.
1.2.2.2. Wang 2019

Wang JX, Zhao WX, Zeng JC, Liu K, Li QJ, She YL, Lin GH. [Systematic review and sequential analysis on treatment of herpes zoster pain mainly by fire needle therapy]. Acupuncture Research. 2019;44(9):677-85. [201917].

Objective To assess the therapeutic effect and safety of fire needle therapy in the treatment of herpes zoster pain.
Methods We collected randomized controlled trials about treatment of herpes zoster pain mainly by fire needle therapy (published from the date of establishment of each database to Dec 1 of 2018) from databases of CNKI, Wanfang, VIP, Chinese Biomedical Document Service System (SinoMed), PubMed, Embase, Cochrane Library by using key words of “ fire needle ” “burnt needle” “red-hot needle” “herpes zoster” “postherpetic neuralgia” and “herpetic neuralgia”. Then, we conducted Meta-analysis and sequential analysis about the outcomes of studies met our inclusion criteria using RevMan5.3.5 and TSA0.9.10 Beta softwares and employed GRADE profiler 3.6.1 to grade the quality of evidence.
Results A total of 25 studies including 2 024 patients were brought into the present analysis. Outcomes of the qualitative analysis indicated that the fire needle therapy has a higher effective rate than the western medicine group. Meta-analysis showed that after the treatment mainly with fire needle therapy, 1) the VAS score is evidently lower [WMD=-0.96, 95% CI(-1.22, -0.71), P<0.000 01], 2) the duration of 30% pain relief is obviously shorter [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], 3) the duration of pain is evidently shorter { fire needle combined with electroacupuncture [WMD=-11.53, 95% CI(-14.57, -8.48), P<0.000 01]; fire needle combined with cupping [WMD=-4.75, 95% CI (-7.99, -1.51), P=0.004]; pure fire needle therapy [WMD=-1.82, 95% CI (-2.46, -1.18), P<0.000 01], and 4) the occurrence rate of post-herpetic neuralgia is considerably lower [RR=0.16, 95% CI (0.09, 0.30), P<0.000 01]. The occurrence and management of adverse events were not mentioned in all the included studies, suggesting no safety problem of the therapy, but the publication bias has not been taken seriously.
Conclusion In the treatment of herpes zoster pain, fire needle as the main treatment approach can significantly relieve pain, shorten the pain duration, and reduce the incidence of post-herpetic neuralgia.
1.2.2.3. Zhao 2019 ☆

Zhao Nanqi , Lily Lai, Xiao Wang, Liyan Jia, Jianping Liu. Fire needling for herpes zoster: A systematic review and meta-analysis of randomized clinical trials. Journal of Traditional Chinese Medical Sciences. 2019;6(1):3-12. [197254].

Objective To evaluate the effectiveness and safety of fire needling for herpes zoster from randomized clinical trials (RCTs).
Methods We searched Cochrane Central Register of Controlled Trials, Pubmed, Sino-Med, CNKI, VIP, WanFang databases, and conference proceedings to November, 2017. RCTs were eligible if they tested fire needling for treating herpes zoster more than 3 times. Two authors screened all references, assessed the risk of bias, extracted data, independently, and analyzed data using Trial Sequential Analysis (TSA). Treatment effects were presented as risk ratio (RR) for binary data and standardized mean difference (SMD) for continuous data with 95% confidence interval (CI).
Results We included 27 RCTs with a total of 1933 participants. Only one RCT had low risk of bias, and the others were of high or moderate risk of bias. For total effectiveness rate (proportion of total number of people who were cured or significant symptom improved), there was no significant difference between Western medicine (acyclovir, valacyclovir, adenosine cobalamin) and fire needling (risk ratio 1.05, 95% CI 0.98 to 1.12; n = 5). For pain relief (VAS scale): fire needling used alone showed lower scores than Western medicine (SMD -1.37, 95% CI -1.77 to −0.97; n = 2) or external medicine (diclofenac) (SMD-2.23, 95% CI -2.81 to −1.64; n = 1). Combination of fire needling and Western medicine was better than Western medicine alone in relieving pain (VAS scale) (SMD-2.19, 95% CI -3.40 to −0.97, I2 = 94%; n = 4). Patients receiving fire needling had lower incidence of neuralgia than those receiving Western medicine (3.3% vs 26.7%, RR 0.09, 95% CI 0.01 to 0.82; n = 1) at follow up for 30 days. No serious adverse events such as infection were reported.
Conclusion Fire needling appears to offer relief for alleviating pain in herpes zoster. As the sample size of included trials was small and the quality of studies was generally low, rigorous clinical trials with robust reporting and appropriate outcome measures are still needed.

1.2.3. Warm Needle

1.2.3.1. Wang 2009 ☆☆

Wang Jing-Hua, Chen Hong-Pei. [systematic review of randomized controlled trial on treating herpes zoster by fire needle ]. Journal of Clinical Acupuncture and Moxibustion. 2009;25(6):16. [154265]

等医学数据库,同时手检中医各类杂志和综合期刊,纳入有关火针治疗带状疙疹 的随机对照试验文献,质量评价按照Cochrane 系统评价员手册4.2.2 版推荐的质量评价标准评价纳入 研究质量,并进行Meta 分析。结果:6 篇研究(共435 例患者)符合纳入标准,除2 篇研究质量为B 级外, 其余4 篇均为C 级。Meta 分析结果显示,与西药组相比,火针组带状疤疹的痊愈率升高,结痴时间、脱 痴时间、止痛时间减少,差异有统计学意义。结论:从现有临床证据来看,火针治疗带状疙疹优于杭病毒 治疗,但目前的研究病例总数较小,且纳入试验的方法学质量普遍较低,为得出更加可靠的结论,有必要 进一步开展大样本、高质量的临床试验。 .

Traduction automatique
Objectif évaluer l'efficacité clinique du traitement incendie Aiguille du zona et de la sécurité.
Méthode En utilisant des méthodes d'examen systématique Cochrane, la récupération de l'ordinateur CBM-S CNKI … VIP .. Wangfan DATAS PUBMED CENTRAL.S Business Source Premier … HSRPROJ- Essais cliniques, bases de données et d'autres bases de données médicales, et toutes sortes de bases de Médecine Chinoise. Magazines et périodiques complets, intégrés dans la technique de l'aiguille de feu, des essais contrôlés randomisés, l'évaluation de la qualité en conformité avec les évaluateurs Cochrane Manuel Version 4.2.2 des critères d'évaluation de la qualité recommandée pour évaluer la qualité des études incluses, et méta-analyse.
Résultats Six études (un total de 435 cas de patients) répondaient aux critères d'inclusion, en plus de deuxième année la qualité de la recherche B, les quatre autres sont C grade. La méta-analyse a montré que, par rapport au groupe de la médecine occidentale, le taux de guérison de zoster groupe aiguille de feu accrue, le temps de la douleur est réduite, la différence était statistiquement significative.
Conclusion A partir des données cliniques existantes, la thérapie par aiguille de feu de l'herpès est supérieure à Hangzhou, mais le nombre total de cas de l'étude en cours est faible et la qualité méthodologique des essais inclus généralement plus faible pour tirage des conclusions plus fiables, il est nécessaire de poursuivre un grand échantillon d'essais cliniques de haute qualité.

1.2.4. Cupping

1.2.4.1. Cao 2010

Cao H, Zhu C, Liu J. Wet Cupping Therapy for Treatement of Herpes Zoster: A Systematic Review of Randomised Controlled Trials. Altern Ther Health Med. 2010;16(6):48-54 (eng) [157058]

BackgroundWet cupping is a traditional Chinese medicine therapy commonly used in treating herpes zoster in China, and clinical studies have shown that wet cupping may have beneficial effect on herpes zoster compared with Western medication
MethodsWe included randomized controlled trials (RCTs) on wet cupping for herpes zoster. We searched PubMed, the Cochrane Library (Issue 3, 2008), China Network Knowledge Infrastructure (CNKI), Chinese Scientific Journals Fulltext Database VIP, and Wan Fang Database. All searches ended in February 2009. Two authors extracted data and assessed the trials' quality independently. RevMan 5.0.18 software (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark) was used for data analysis with effect estimate presented as relative risk (RR) and mean difference (MD) with a 95% confidence interval (CI)
ResultsEight RCTs involving 651 patients were included, and the methodological quality of trials was generally fair in terms of randomization, blinding, and intention-to-treat analysis. Meta-analyses showed wet cupping was superior to medication in the number of cured patients (RR 2.49, 95% CI 1.91 to 3.24, P < .00001), the number of patients with improved symptoms (RR 1.15, 95% CI 1.05 to 1.26, P = .003), and reducing the incidence rate of postherpetic neuralgia (RR 0.06, 95% CI 0.02 to 0.25, P = .0001). Wet cupping plus medication was significantly better than medication alone on number of cured patients (RR 1.93, 95% CI 1.23 to 3.04, P = .005) but demonstrated no difference in symptom improvement (RR 1.00, 95% CI 0.92 to 1.08, P = .98). There were no serious adverse effects related to wet cupping therapy in the included trials
ConclusionWet cupping appears to be effective in the treatment of herpes zoster. However, further large, rigorously designed

1.2.5. Acupoint Bloodletting

1.2.5.1. Lin 2020

Lin Li. [A meta-analysis of randomized controlled trials of acupuncture bloodletting for shingles ]. Journal of Hainan Medical University. 2020. [212870].

ObjectiveTo systematically evaluate the clinical efficacy of acupuncture bloodletting therapy for herpes zoster.
Methods The computer searched the CNKI, WanFang, VIP, CBM, PubMed, and Cochrane Library databases. The time limit was from the establishment of the database to December 31, 2019. Relevant literatures on randomized controlled trials of spinal bloodletting for shingles were retrieved. Data were extracted and quality evaluated based on the Cochrane bias risk assessment method. Meta analysis was performed using Rev Man5. 3 and Stata15 statistical software.
Results (1) A total of 21 Chinese literatures were included, with a total of 1,533 patients ; (2) Meta-analysis was performed using a fixed effect model, and the results showed that the total effective rate of the experimental group (OR = 5. 11, 95% CI: (3. 48, 7. 50), Z = 8. 33, P <0. 00001) is better than the control group, the difference is statistically significant; (3) VAS score analysis using a random effects model (MD-2. 23, 95% CI (-2. 46, -1. 99), p <0. 0001) ( 4) The incidence of sequela neuralgia was analyzed using a random effects model (OR = 0. 21, 95% CI: (0. 09, 0. 51), Z = 3. 48, P = 0. 0005).
Conclusion The effect of spinal bloodletting on the treatment of shingles and VAS scores, symptomatic relief, and the incidence of sequela neuralgia have advantages.

1.2.6. Electro-acupuncture

1.2.6.1. Chen 2013 ☆☆

Chen Lizhi, Xie Weixiang, Fan Li, Liang Zhiwei, Zhang Hong. [Systematic review of randomized controlled trials of electro-acupuncture for herpes zoster]. Hebei Journal of Traditional Chinese Medicine. 2013;4:593-596. [186979].

Objective To evaluate the clinical efficacy and safety of electro-acupuncture on herpes zoster.
Methods Randomized controlled trials (RCTs) involving electro-acupuncture in the treatment of herpes zoster were identified from CBM, CNKI, VIP, Wanfang Database and Pubmed. Relevant journals of traditional Chinese medicine and comprehensive journals were manually searched. The data were extracted and evaluated by two reviewers independently with a specially designed extraction form. The Cochrane Collaboration’s RevMan5. 0 software was used for data analyses.
Results A total of 9 trials involving 560 patients were included. 1 trial was high quality, the other 8 trials were low quality. Systematic review showed that the clinical cure rate, the VAS scores, the clinical symptoms scores, the time of crusting, the duration of pain were superior to the western drugs group, no significant difference was noted between them.
Conclusion The profit treated by electro-acupuncture on herpes zoster is superior to that in the control group from the clinical evidence. But the incorporation of the limited number of documents and the quality was not very good. To get more reliable conclusions. Further large-scale trials are required to define the role of electro-acupuncture in the treatment of herpes zoster.

1.3. Specific outcome

1.3.1. Postherpetic Neuralgia

2. Overviews of Systematic Reviews

2.1. Yin 2020

Yin Zihan. [Acupuncture Treatment of Herpes Zoster and Postherpetic Neuralgia: An Overview of Systematic Reviews Online First]. Modernization of TCM and Materia Medica-World Science and Technology. 2020. [212888].

ObjectiveBased on the current systematic evaluation of acupuncture and moxibustion in the treatment of herpes zoster and its sequelae, the methodology and evidence quality were evaluated, so as to provide accurate clinical decisions for acupuncture and moxibustion in the treatment of herpes zoster and its sequelae.
Methods In the database of CNKI, WanFang, VIP, CBM, Embase, PubMed and Cochrane Library, Web of Science, systematic review literatures on acupuncture treatment of HZ and PHN were searched, and the methodological quality of the literature was evaluated by AMSTAR list. Meanwhile, the GRADE system was used to grade the quality of evidence.
Results A total of 20 systematic reviews were included, and the outcome was mainly due to the effectiveness and safety of acupuncture treatment of HZ and PHN. According to the AMSTAR score, there was one high quality study, 19 moderate quality studies, and no low quality study. The GRADE showed that acupuncture had a relatively good quality of evidence for herpes zoster and its sequelae. A total of 27 outcomes were very low quality; 19 were low quality, 12 were of moderate quality evidence, and there was no high quality evidence.
Conclusion Nowadays, acupuncture treatment of herpes zoster and its sequelae has certain efficacy and safety. The methodological quality is moderate to high, but the quality of evidence is low, mainly due to the poor quality of the original research.