■癌症引起的骨痛（CIBP）是一种特殊类型的癌症疼痛，缺乏安全有效的治疗方法。针灸是一种潜在的有价值的治疗方法，评估针灸对CI血压影响的研究显着增加，但针刺控制血压的安全性和有效性仍存在争议。
■提供第一个荟萃分析，以评估针灸在CIBP管理中的安全性和有效性。
■CNKI,CBM,万方,VIP数据库,PubMed,Embase,和Cochrane图书馆从成立到2022年6月1日进行了搜索。
■以原发性骨肿瘤患者或其他类型的原发癌伴骨转移为研究对象，评估单独针刺治疗或联合对照治疗的疗效。同时,RCT应选择疼痛评分作为主要结果和疼痛缓解率，突破性疼痛的频率，镇痛起效时间,镇痛持续时间，生活质量,和不良事件作为参考结果。
■我们设计了一个数据提取表格，用于从文章中提取关键信息。数据提取研究评估由两名评审员独立进行，第三位审稿人会解决任何分歧。偏差的风险是通过Cochrane协作的评估风险偏差的工具来评估的。主要结局的证据质量通过GRADE系统进行评估。平均差（MD），相对风险(RR)，计算95%置信区间(CI)。使用ReviewManager软件（5.3版本）进行森林地块。亚组分析用于调查潜在异质性的可能来源。在不可接受的临床异质性的情况下进行描述性分析。
■纳入了13个随机对照试验（1,069名患者），并且由于缺乏致盲或其他偏倚,所有研究均存在偏倚的高风险.11项研究评估了针灸作为补充疗法的有效性，并显示针刺加对照治疗（与对照治疗相比）与疼痛强度降低有关（MD=-1.34，95％CI-1.74至-0.94；Q<0.1；I2=98％，P<0.01)。基于穴位类型的亚组分析部分解释了潜在的异质性。结果还表明，针刺加对照治疗（与对照治疗相比）与减轻疼痛强度有关，增加疼痛缓解率，减少突破性疼痛的频率，缩短镇痛起效时间，延长镇痛持续时间，提高生活质量。我们没有足够的证据证明单独针灸的有效性。四个随机对照试验仅报告了与阿片类药物副作用相关的不良事件。由于方法学质量低，证据被认定为“非常低”，相当大的异质性，或纳入研究的数量较少。
■针灸作为补充疗法对CIBP的疼痛管理有一定的效果，这不仅减轻了疼痛强度，而且提高了生活质量，减少了阿片类药物副作用的发生率，尽管证据水平很低。在未来,需要更大的样本量和严格设计的RCT,以提供足够的证据来确定针灸作为CIBP治疗的有效性和安全性.
UNASSIGNED: Cancer-induced bone pain (CIBP) is a special type of cancer pain and lacks safe and effective treatments. Acupuncture is a potentially valuable treatment for CIBP, studies evaluating the effect of acupuncture on CIBP have increased significantly, but the safety and efficacy of acupuncture to control CIBP remains controversial.
UNASSIGNED: To provide the first meta-analysis to evaluate the safety and efficacy of acupuncture in CIBP management.
UNASSIGNED: CNKI, CBM, Wanfang, VIP Database, PubMed, Embase, and Cochrane Library were searched from their inception until 1 June 2022.
UNASSIGNED: RCTs with primary bone tumor patients or other types of primary cancer companied by bone metastases as the research subjects and to evaluate the efficacy of acupuncture treatment alone or combined with the control treatment were included. Meanwhile, RCTs should choose the pain score as the primary outcome and pain relief rate, frequency of breakthrough pain, analgesic onset time, analgesia duration, quality of life, and adverse events as reference outcomes.
UNASSIGNED: We designed a data-extraction form that was used to extract key information from the articles. Data extraction study evaluation was conducted independently by two reviewers, and a third reviewer would resolve any disagreements. The risk of bias was assessed by the Cochrane Collaboration\'s tool for assessing the risk bias. The quality of the evidence for main outcomes was evaluated by the GRADE system. Mean differences (MD), relative risk (RR), and 95% confidence intervals (CIs) were calculated. The forest plots were performed using the
Review Manager Software (5.3 version). Subgroup analysis was used to investigate the possible sources of potential heterogeneity. Descriptive analysis was performed in case of unacceptable clinical heterogeneity.
UNASSIGNED: Thirteen RCTs (with 1,069 patients) were included, and all studies were at high risk of bias owing to lack of blinding or other bias. Eleven studies evaluated the effectiveness of acupuncture as a complementary therapy, and showed that acupuncture plus control treatment (compared with control treatment) was connected with reduced pain intensity (MD = -1.34, 95% CI -1.74 to -0.94; Q < 0.1; I 2 = 98%, P < 0.01). Subgroup analyses based on acupoints type partly explain the potential heterogeneity. The results also showed that acupuncture plus control treatment (compared with control treatment) was connected with relieving pain intensity, increasing the pain relief rate, reducing the frequency of breakthrough pain, shortening analgesic onset time, extending the analgesic duration, and improving the quality of life. We have no sufficient evidence to prove the effectiveness of acupuncture alone. Four RCTs reported only adverse events related to opioids\' side effects. Evidence was qualified as \"very low\" because of low methodological quality, considerable heterogeneity, or a low number of included studies.
UNASSIGNED: Acupuncture has a certain effect as a complementary therapy on pain management of CIBP, which not only mitigates the pain intensity but also improves the quality of life and reduces the incidence of opioids\' side effects, although the evidence level was very low. In future, a larger sample size and rigorously designed RCTs are needed to provide sufficient evidence to identify the efficacy and safety of acupuncture as a treatment for CIBP.
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