Moxibustiontherapyonmyofascialpainsyndrome:Anevidence-basedclinicalpracticeguideline

Myofascial pain syndrome (MPS) is a chronic systemic pain disorder characterized by muscle and fascia inflammation, often triggered by factors such as wind chill, fatigue, trauma, or inadequate sleep. The condition primarily affects people between ages 30 and 50, with clinical manifestations including chronic muscle pain, tenderness, and weakness. According to cited investigations, the incidence of MPS ranges from 30% to 93.0%, and the number of affected individuals is increasing both in China and internationally. Current treatments include muscle relaxants, benzodiazepines, nonsteroidal anti-inflammatory drugs, antidepressants, and topical analgesics, but these medications carry significant side effects that limit their practical application.

Moxibustion, a traditional Chinese medicine therapy involving the burning of mugwort to generate heat and infrared radiation, has demonstrated significant analgesic effects for MPS with less trauma, lower risk, and fewer adverse reactions. Despite its therapeutic potential, no clinical practice guidelines (CPGs) existed specifically for moxibustion treatment of MPS, creating an urgent need for standardized, evidence-based recommendations to guide clinicians.

The authors developed a protocol for creating the first evidence-based clinical practice guideline for moxibustion therapy in MPS treatment. The guideline development process adhered to multiple international standards: the Institute of Medicine principles, the World Health Organization guideline handbook, the GRADE (Grade of Recommendations Assessment, Development, and Evaluation) system, the AGREE II (Appraisal of Guidelines for Research & Evaluation II) instrument, and the RIGHT (Reporting Items for practice Guidelines in Healthcare) checklist. The working group, established in March 2020, comprised 20 professionals including acupuncturists, medical clinicians, a general surgeon, traditional Chinese medicine physicians, physiotherapists, a nurse, a health economist, and an editor. The group was structured into three components: a Guideline Steering Group (6 members), a Guideline Development Group, and a Guideline Secretary Group (5 members).

The team formulated clinical questions using the PICO framework (Population, Intervention, Comparison, Outcomes), addressing seven key questions including whether moxibustion can be applied to MPS patients, comparisons with non-moxibustion treatment, conventional drug treatment, and acupuncture, as well as optimal treatment timing and dosage. Evidence retrieval involved systematic searches across seven databases (PubMed, MEDLINE, Cochrane Library, SinoMed, CNKI, WangFang Database, and Chinese Scientific Journal Database) from inception to March 31, 2020. The team planned to use PRISMA guidelines for evaluating systematic reviews, CONSORT for original studies, and the Cochrane risk of bias tool for quality assessment. Recommendations would be developed using GRADE methodology and refined through 2-3 rounds of Delphi expert consensus, with a 75% agreement threshold required for consensus.

As this is a study protocol, no actual results or findings from the guideline development process are reported. The paper describes the planned methodology and anticipated outputs. The authors state that the guidelines will be published in relevant peer-reviewed journals, with both English and Chinese versions expected in 2023. The protocol was registered with the International Practice Guideline Registry Platform (IPGRP-2020CN030).

The authors acknowledge several limitations in their discussion: most included study sites are in China, requiring further research on moxibustion application in other countries and regions; and differences in moxibustion operation methods between countries need consideration. They highlight three main contributions: this represents the first CPG protocol for moxibustion therapy in MPS; the results will benefit acupuncturists and physicians in treatment decision-making; and the findings will help identify correct moxibustion operation methods and the relationship between therapeutic effect, treatment timing, and total treatment amount.

This protocol represents an important step toward standardizing moxibustion treatment for myofascial pain syndrome, a condition affecting millions worldwide. For patients with MPS, the eventual guideline could provide clearer guidance on whether moxibustion is appropriate for their condition, what treatment parameters to expect, and how moxibustion compares to conventional treatments they may already be using. The rigorous methodology incorporating GRADE evidence assessment, international reporting standards, and multidisciplinary expert input suggests the final guideline will be methodologically sound and clinically practical.

For clinicians, particularly acupuncturists and traditional Chinese medicine practitioners, this guideline will offer evidence-based recommendations for patient selection, treatment techniques, and dosing parameters. The inclusion of patient values and preferences in the recommendation development process is noteworthy, as it addresses a common criticism of traditional medicine guidelines. The planned dissemination through conferences, official health websites, and peer-reviewed publications should facilitate broad adoption. However, clinicians should note the acknowledged geographic limitation of the evidence base and consider whether recommendations fully apply to their specific patient populations and practice settings.

The planned three-year update cycle will be important for incorporating new evidence as the field evolves.