Evaluating the Evidence Quality Supporting the Role of Acupuncture for Herpes Zoster Pain: An Umbrella Review of Systematic Reviews and Meta-analyses

Abstract

Objective: Acupuncture is one of the most effective means to treat herpes zoster, especially during the acute stage. It can shorten the duration of pain, with a low incidence of residual neuralgia. The aim of this review was to assess the methodological and evidence quality of systematic reviews and meta-analyses on acupuncture for herpes zoster pain. Methods: Eight databases were searched from their inception to Feb 2022. Methodological and evidence quality was evaluated by using the Assessment of Multiple Systematic Reviews 2, and the Grading of Recommendations Assessment Development and Evaluation. Results: Nineteen SRs/MAs were included according to the inclusion criteria. Assessment of Multiple Systematic Reviews 2 results showed that the methodological quality was low for 16 studies and very low for 3 studies. According to the Grading of Recommendations Assessment Development and Evaluation, 43 outcome indicators were evaluated, the evidence quality was high in three, medium in twelve, low in twenty-three, and very low in five. Compared with drugs for herpes zoster, acupuncture can reduce pain and the incidence of postherpetic neuralgia. Acupuncture at Huatuo Jiaji points (EX-B2) was generally one of the most effective methods. Conclusions: Our study showed that acupuncture therapies including fire needles, acupuncture at Huatuo Jiaji points (EX-B2), pricking collaterals, and bloodletting may be beneficial for the clinical practice of herpes zoster pain. However, the quality of methodological report and evidence of the included studies was low, this conclusion must be interpreted with caution. More rigorous designs and comprehensive investigations by systematic reviews and meta-analyses are needed.