The Quality of Evidence Supporting Acupuncture Treatment for Herpes Zoster Pain: An Umbrella Review of Systematic Reviews and Meta-analyses

ObjectiveAcupuncture 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 and provide clinical suggestions. MethodsEight databases were searched from their inception to Feb 2022. Methodological quality was evaluated by using the Assessment of Multiple Systematic Reviews 2, and the Grading of Recommendations Assessment Development and Evaluation was applied to evaluate the quality of the evidence. ResultsNineteen 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 in this review, and the results showed that 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 Jia ji acupoint was generally one of the most effective methods. ConclusionsOur study showed that fire needle, acupuncture at Jia ji, pricking collaterals and bloodletting are beneficial therapies for the clinical practice of herpes zoster. However, the methodological and evidence quality of the included studies were low. More rigorous design and comprehensive investigations by systematic reviews and meta-analyses are needed. Strengths and limitations of this studyThis study is a comprehensive review to assess the methodological and evidence quality of recent SRs/MAs on acupuncture for herpes zoster pain, we mainly focused on pain symptoms, for example VAS score, time for pain relief, incidence of PHN, with qualitative analysis of efficiency. Only systematic reviews published in Chinese and English were included, so the conclusions of this study may not be generalizable. Some gray documents may be omitted. Subjective factors could not be completely eliminated during screening and evaluation. PROSPERO registration number CRD42022304247.