Therapeutic efficacy of acupuncture point stimulation for stomach cancer pain: a systematic review and meta-analysis

Abstract

Purpose: In recent years, traditional Chinese medicine has received widespread attention in the field of cancer pain treatment. This meta-analysis is the first to evaluate the effectiveness and safety of acupuncture point stimulation in the treatment of stomach cancer pain.

Methods: For this systematic review and meta-analysis, we searched PubMed, Web of Science, Cochrane Library, Embase, WANFANG, China National Knowledge Infrastructure (CNKI), and Chinese Journal of Science and Technology (VIP) databases as well as forward and backward citations to studies published between database creation to July 27, 2023. All randomized controlled trials (RCTs) on acupuncture point stimulation for the treatment of patients with stomach cancer pain were included without language restrictions. We assessed all outcome indicators of the included trials. The evidence from the randomized controlled trials was synthesized as the standardized mean difference (SMD) of symptom change. The quality of the evidence was assessed using the Cochrane Risk of Bias tool. This study is registered on PROSPERO under the number CRD42023457341.

Results: Eleven RCTs were included. The study included 768 patients, split into 2 groups: acupuncture point stimulation treatment group (n = 406), medication control group (n = 372). The results showed that treatment was more effective in the acupuncture point stimulation treatment group than in the medication control group (efficacy rate, RR = 1.63, 95% CI 1.37 to 1.94, p < 0.00001), decreasing in NRS score was greater in acupuncture point stimulation treatment group than in the medication control group (SMD = -1.30, 95% CI -1.96 to -0.63, p < 0.001).

Systematic review registration: https://clinicaltrials.gov/, identifier CRD42023457341.

Keywords: acupuncture point stimulation; meta-analysis; stomach cancer pain; therapeutic efficacy; traditional Chinese medicine.

Figure 1

Flow diagram showing the screening and selection process of reports to be included in the meta-analysis.

Figure 2

The figure represents the risk of bias assessment for the studies selected in the meta-analysis. (A) RoB graph: risk of bias graph—provides a visual summary of bias risk across studies, with green (low risk), yellow (unclear), and red (high risk) segments for bias categories. (B) RoB summary: risk of bias summary—details bias risk for each study in the meta-analysis, using colored circles (+ for low risk,? for unclear, and − for high risk) for bias categories.

Figure 3

Forest plots of NRS score of stomach cancer pain after acupressure point stimulation treatment. The plot lists the included studies by the first author and publication year, showing the mean NRS scores for both experimental and control groups, along with their standard deviations and total number of participants. The weight of each study in the meta-analysis is indicated, reflecting its contribution to the overall effect size.

Figure 4

Forest plots of significantly efficient of stomach cancer pain after acupressure point stimulation treatment. The plot lists the included studies by the first author and publication year, showing the significantly efficient for both experimental and control groups, along with their risk ratio and total number of participants. The weight of each study in the meta-analysis is indicated, reflecting its contribution to the overall effect size.

Figure 5

Forest plots of efficient of stomach cancer pain after acupressure point stimulation treatment. The plot lists the included studies by the first author and publication year, showing the efficient for both experimental and control groups, along with their risk ratio and total number of participants. The weight of each study in the meta-analysis is indicated, reflecting its contribution to the overall effect size.

Figure 6

Forest plots of the adverse effects after treatment. (A) Forest maps of nausea. (B) Forest maps of vomiting.

Figure 7

Forest plot for subgroup analysis with significant efficiency impact. This figure shows a forest plot of the different studies included in the meta-analysis assessing the effect of treatments such as acupuncture, acupoint injections and moxibustion on stomach cancer pain. Each study is listed by first author and year of publication, showing the total number of events in the trial and control groups and the corresponding weights. Risk Ratio (RR) and corresponding 95% confidence intervals (CI) provided a quantitative assessment of the effect size of each study.

Figure 8

Forest plot for subgroup analysis with efficiency impact. This figure shows a forest plot of the different studies included in the meta-analysis assessing the effect of treatments such as acupuncture, acupoint injections and moxibustion on stomach cancer pain. Each study is listed by first author and year of publication, showing the total number of events in the trial and control groups and the corresponding weights. Risk Ratio (RR) and corresponding 95% confidence intervals (CI) provided a quantitative assessment of the effect size of each study.

Figure 9

The reticulation that occurs at different acupoints during treatment. This figure represents the network relationship between different acupuncture points. Each circle represents a specific acupuncture point, e.g., “Neiguan” or “Zusanli,” and the lines between them indicate interactions or correlations. The thickness of the lines may represent differences in the strength of the association, but this is not explicitly stated in the figure notes. The overall network diagram provides a visual way to understand and analyze the possible synergistic effect or combination of different acupuncture points in treatment.