Comparison of Needle-Warming Moxibustion and Other Physical Therapies for Lumbar Disc Herniation: A Meta-analysis.

Background: Needle-warming moxibustion (NWM) demonstrates a controversial effect on lumbar disc herniation (LDH). This study is aimed at comparing the efficacy of NWM and conventional acupuncture or other physical therapies on LDH through a meta-analysis.

Methods: Potentially eligible literatures were retrieved and screened from electronic databases. The subject of the literature was a comparison of NWM and conventional acupuncture or other physical therapies for LDH. The methodological quality was evaluated by the Jadad scale. The chi-square test was used for the heterogeneity test. Subgroup analysis was used to explore the source of heterogeneity. Risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI) was used to describe the effect size. The publication bias was evaluated by Egger's test.

Results: The effective rate of NWM in the treatment of LDH was significantly higher than that of conventional acupuncture (RR = 1.27, 95%CI [1.18, 1.36], < 0.00001) and lumbar traction (RR = 1.12, 95%CI [1.06, 1.18], < 0.0001) There was no significant difference in the effective rate between NWM and electric acupuncture for LDH (RR = 1.06, 95%CI [0.98, 1.14], = 0.17). VAS of LDH patients treated with NWM was lower than conventional acupuncture (MD = -1.51, 95%CI [-1.70, -1.31], < 0.00001) and lumbar traction (MD = -2.64, 95%CI [-2.79, -2.49], < 0.00001) but statistically insignificant with electric acupuncture (MD = -0.31, 95%CI [-0.72, 0.09], = 0.13). JOA scores of LDH patients treated with NWM were higher than those with conventional acupuncture (MD = 2.24, 95%CI [1.04, 3.45], = 0.0003) and lumbar traction (MD = 10.76, 95%CI [10.45, 11.07], < 0.00001) but statistically insignificant with electric acupuncture (MD = 0.25, 95%CI [-0.95, 1.45], = 0.69). The long-term effective rate of NWM on LDH was higher than that of conventional acupuncture (MD = 3.13, 95%CI[2.12, 4.61], < 0.00001). In this study, no heterogeneity ( > 0.10, < 50%) and publication bias ( > 0.05) among the literature were noted.

Conclusion: The effect of NWM on LDH was superior to traction therapy and conventional acupuncture therapy, but similar to electric acupuncture for LDH. High-quality randomized controlled trials were still needed to confirm the results.