Systematic review and meta-analysis of thunder fire moxibustion as adjuvant therapy for lumbar disc herniation

Introduction: This systematic review aimed to evaluate the effectiveness and safety of thunder fire moxibustion as an adjuvant therapy for lumbar disc herniation. Methods: Seven databases were searched from inception to December 31, 2022, to identify randomized controlled trials (RCTs) involving thunder fire moxibustion used alongside other therapies for lumbar disc herniation. Primary outcomes were effectiveness rate and functional status using the Japanese Orthopaedic Association (JOA) score rating system for low back pain. Secondary outcomes were pain (measured by visual analogue scale), motor dysfunction (measured by Oswestry disability index) and quality of life (measured by the Short Form 36 Health Survey). The safety outcome was adverse event/effect. Data analysis was conducted using RevMan 5.4, and Cochrane's risk of bias tool was used to assess the quality of RCTs. The GRADE approach was used to assess the certainty of evidence. Results: A total of 12 RCTs were identified including 1063 adult participants. All trials were evaluated as high risk of bias. After pooling the results from two or more studies, it was found that there was low to very low certainty of evidence that TFM as an add-on therapy was more effective than tuina therapy alone (n = 245, RCT=3, RR=1.15, 95%CI 1.04 to 1.28), manipulation alone (n = 236, RCT=2, RR=1.21, 95%CI 1.08 to 1.35), and acupuncture alone (n = 210, RCT=2, RR=1.14, 95%CI 1.03 to 1.25) and improved the JOA score compared to acupuncture alone (n = 270, RCT=3, MD=3.83, 95%CI 2.21 to 5.45). Beneficial effects of TFM were found for all other primary and secondary estimates of effects. Risk of adverse events was uncertain as only one study reported them. Conclusion: Due to concerns with risk of bias and imprecision, low to very low certainty evidence suggested that thunder fire moxibustion may be effective as adjuvant therapy for lumbar disc herniation, although the additional clinical benefits may be marginal. Further rigorous, well-designed RCTs with larger sample sizes are required.