Effectiveness of moxibustion alone on lumbar disc herniation: a Meta-analysis of randomized controlled trials

OBJECTIVE: To evaluate the available evidence from randomized controlled trials (RCTs) of moxibustion alone for lumbar disc herniation (LDH) treatment.METHODS: A systematic search of 10 databases (until August 30, 2021) was used to identify studies that reported the response rate, visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score, and Oswestry Disability Index (ODI) score. Study selection and data extraction were independently performed by two reviewers. Cochrane criteria for risk of bias were used to assess the methodological quality of the trials. The Grading of Recommendations Assessment, Development, and Evaluation Methodology (GRADE) were also used to test the quality of the result evidence.RESULTS: Nineteen RCTs, including 1888 patients, met the inclusion criteria. Five studies showed no difference between moxibustion and acupuncture on response rate [risk ratio (RR) = 1.07, 95%CI (0.98, 1.16), P = 0.11]. Meanwhile, six studies suggested that there is no significant difference between moxibustion and acupuncture on VAS score [mean difference (MD) = -0.43, 95% CI (-0.91, 0.05), P = 0.08]. Eight studies implied that there is no significant difference between moxibustion and acupuncture on JOA score [MD = 0.84, 95% CI (-1.27, 2.96), P = 0.44]. Two studies indicated that moxibustion may have equivalent effects for treating LDH in the VAS score in comparison with drug therapy [MD = -1.16, 95%CI (- 2.63, 0.31), P = 0.12]. The evidence level of results was determined to be very low to low. CONCLUSIONS: Based on the existing evidence, moxibustion may not be suitable for treating LDH alone, but it may be applied as an adjuvant treatment. Furthermore, well-designed RCTs with high quality and larger samples are still needed to evaluate the efficacy and safety of moxibustion alone for LDH treatment.