Acupuncture Relieves Opioid-Induced Constipation in Clinical Cancer Therapy – A Meta-Analysis and Systematic Review

Figures & data

Table 1 Characteristics and Main Outcomes of Included Studies

Studies	Sample Sizes		Interventions		Acupuncture Points	Treatment Sessions	Main Outcome_ the Treatment Efficacy for OIC Between 2 Groups										P values of Main Outcome
							Cured		Obvious Remission		Effective Remission		Limited/No Remission		Total Remission Rate
	Control	Treat	Control	Treat			Control	Treat	Control	Treat	Control	Treat	Control	Treat	Control	Treat
Zhu, (2018)^Citation22	100	98	Lactulose	TEAS	Tianshu (ST25) and Zhongwan (RN12)	30 mins pd 14 days			21	30	49	45	30	23	0.70	0.77	0.299
Zhang, (2009)^Citation23	33	33	Citrated mosapride tablet	EA	Zusanli (ST36) and Tianshu (ST25)	30 mins pd 5 days	1	2	2	3	26	27	4	1	0.88	0.97	>0.05
Song, (2020)^Citation24	41	40	Polyethylene glycol electrolyte	EA + gel patch	Tiansu (ST25)	30 mins pd 14 days	0	2	15	18	17	13	9	7	0.78	0.83	>0.05
Jiang, (2010)^Citation25	30	30	Glycerine Enema	Handle acupuncture	“Tianshu”, “Zhigou”, “Shangjuxu”, “Zusanli”, “Sanyinjiao”, “Qihai”	30 mins pd 7 days	1	4	7	14	13	10	9	2	0.70	0.93	<0.05
Cai, (2019)^Citation11	127	124	Lactulose	TENS + Lactulose	“Guanyuan”, “Qihai”, “Tianshu”, “Zusanli”, and “Shangjuxu”	30 mins pd 14 days	13	12	28	40	71	62	18	10	0.86	0.92	0.013

Figure 1 PRISMA diagram of the review. The diagram describes the procedures conducted for meta-analyses, including literature searches, review processes, records excluded in each process, and the final studies included for data extraction and analyses.

Figure 2 Risk of bias assessment for included studies. The evaluation of all included studies on their reporting biases according to the Cochrane risk of bias tool.

Figure 3 Remission rates of constipation symptoms in OIC patients. RRs were calculated to estimate the therapy outcomes of acupuncture in comparison with Control groups. (A) Overall remission rate including cured cases, obvious remissions, and effective remissions; (B) cured rate; (C) rate of obvious remissions; (D) rate of effective remissions.

Figure 4 The funnel plot of cured or remission rate data. Grey rectangles represent included studies.

Figure 5 Meta-analyses of symptom scores and subgroup analyses for studies with or without co-intervention. (A) The overall symptom scores calculated with standardized mean difference referring to the control group. (B) The subgroup analyses of symptom scores defining by acupuncture with or without other co-intervention strategies.

Figure 6 Contour-enhanced funnel plot of acupuncture versus control for symptom scores. Black dots represent included studies. Gradient grey colors indicate different significant levels.

Figure 7 Meta-analyses of quality of life scores and subgroup analyses for studies with or without co-intervention strategies. (A) The overall quality of life scores calculated with standardized mean difference comparing to the control group. (B) The subgroup analyses of the quality of life scores defining by acupuncture with or without co-interventions. No quality of life score was reported in Zhang, F.L.’s paper; therefore, a 0.00% weight was allocated in the analyses.

Figure 8 Contour-enhanced funnel plot of acupuncture versus control for quality of life scores. Black dots represent included studies. Gradient grey colors indicate different significant levels.

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