Can Chinese herbal medicine assist in managing pain in cancer palliative care?
Date of publication of the systematic review: February 2016
Design
Systematic review of 14 randomized controlled trials (RCTs).
Participants
A total of 878 participants (mean age range: 31 to 73 years, overall male % range: 56.4 to 100%) with cancer or cancer treatment-related pain.
Intervention
Chinese herbal medicine (CHM) plus conventional treatment with duration ranged from 7 days to 60 days daily.
Comparator
Comparison 1: CHM plus conventional treatment versus control = conventional treatment only for pain reduction.
Major Outcomes
Outcome 1: Pain reduction in Numeric Rating Scale (NRS), measured with a 0 (no pain) to 10 (most intolerable pain).
Settings
The reviewers did not state whether the study was conducted in in-patient or out-patient settings.
Comparison    CHM plus conventional treatment versus conventional treatment for pain reduction
Main Results
Patients in CHM plus conventional treatment group had significantly lowered pain score (pooled weighted mean difference: -0.90, 95% Cl: -1.69 to -0.11) compared those in conventional treatment group.
Comparison: CHM plus conventional treatment versus conventional treatment for pain reduction
Outcomes (unit) No. of studies (Total no. of participants) Mean pain reduction (SD)/ No. of participants Heterogeneity test (I2) Pooled WMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NRS) 3 (249) Not reported/Not reported Not reported/Not reported 88% -0.90 ( -1.69 to -0.11) Moderate
Keys: NRS= numerical rating scale; SD= standard deviation; WMD: weighted mean difference; CI: confidence interval.
Comparison    CHM plus conventional treatment versus conventional treatment for pain reduction
Main Results
Patients in CHM plus conventional treatment group had significantly lowered pain score (pooled weighted mean difference: -0.90, 95% Cl: -1.69 to -0.11) compared those in conventional treatment group.
Comparison: CHM plus conventional treatment versus conventional treatment for pain reduction
Outcomes (unit) 1 (NRS)
No. of studies (Total no. of participants) 3 (249)
Mean pain reduction (SD)/ No. of participants Intervention Not reported/Not reported
Comparator Not reported/Not reported
Pooled WMD (95% CI) -0.90 ( -1.69 to -0.11)
Overall quality of evidence* Moderate
Keys: NRS= numerical rating scale; SD= standard deviation; WMD: weighted mean difference; CI: confidence interval.
Conclusion
Benefits
CHM plus conventional treatment is superior to conventional treatment only in reducing pain among patients with cancer. For outcome 1, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
As compared to conventional treatment only, patients who used additional CHM also experienced similar adverse events of vomiting, dizziness, drowsiness, abdominal discomfort and skin allergy.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/26886628
The synopsis is based on the following article:
Chung VC, Wu X, Lu P, Hui EP, Zhang Y, Zhang AL, Lau AY, Zhao J, Fan M, Ziea ET, Ng BF. Chinese herbal medicine for symptom management in cancer palliative care: Systematic review and meta-analysis. Medicine. 2016 Feb;95(7).


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.