Acupuncture Represents Effective Nonpharmacologic Treatment for Sciatica Pain Management

Acupuncture may result in less pain and improved function in patients with chronic sciatica from herniated disk, according to new research published in JAMA Internal Medicine.¹ Based on these findings, investigators recommend acupuncture as a potential therapy for individuals with the condition.

Sciatica, often caused by herniated lumbar discs, is a condition characterized by intense pain that can lead to significant disability. Individuals with sciatica typically experience more severe discomfort than those with low back pain alone. Although many patients with sciatica recover naturally or through conservative treatment, those whose symptoms persist are at greater risk of adverse outcomes and increased reliance on health care services.

Pain medications such as paracetamol, nonsteroidal anti-inflammatory drugs, and opioids are frequently prescribed for sciatica, but conservative, nonpharmacological approaches are preferred due to their minimal side effects. Acupuncture is a popular treatment among patients with chronic sciatica, but scientific evidence of its efficacy is limited.

Investigators aimed to clarify the efficacy and safety of acupuncture compared to sham acupuncture in patients with chronic sciatica from herniated disk.

The current study was a multicenter randomized clinical trial involving 2 groups of patients with chronic sciatica from herniated disk. The trial was conducted at 5 tertiary-level hospitals in China between March 25, 2021, and September 23, 2021. Participants were followed up until September 22, 2022, and data analysis was performed from December 2022 to March 2023.

Participants were eligible if they were at least 18 years old, had unilateral sciatica from herniated disk for more than 3 months, and had moderate or severe leg pain intensity.

A total of 220 participants were randomly assigned in a 1:1 ratio, with one receiving 10 sessions of acupuncture and the other receiving 10 sessions of sham acupuncture over a 4-week period. Participants, outcome assessors, and statisticians were blinded.

For the acupuncture group, acupuncturists used disposable stainless-steel needs of various sizes, depending on the specific acupoint and location of pain. In the sham acupuncture group, acupuncturists inserted needles into non-acupoints, or points that are not considered to have any therapeutic effect.

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The primary outcomes were changes in leg pain intensity, measured using the Visual Analog Scale (VAS), and disability, measured using the Oswestry Disability Index (ODI), from baseline to week 4. Secondary outcomes were adverse events. Acupuncture was considered effective only if both primary outcomes showed statistically significant improvements.

Efficacy measures were recorded at baseline and at weeks 2, 4, 8, 26, and 52. Quality of life was assessed using the 36-tem Short Form Health Survey at baseline and at weeks 4, 8, 26, and 52. Patients’ overall assessment of their condition was measured using a 7-point Likert scale ranging from “completely recovered” to “vastly worse” at weeks 4, 26, and 52.

At week 4, the VAS for leg pain decreased by 30.8 mm in the acupuncture group and by 14.9 mm in the sham acupuncture group (mean difference, -16.0; 95% CI, -21.3 to -10.6). Similarly, the ODI decreased by 13.0 points in the acupuncture group and by 4.9 points in the sham acupuncture group at week 4 (mean difference, -8.1; 95% CI, -11.1 to -5.1). For both VAS and ODI, the difference between the two groups became evident in week 2 (mean difference, -7.8; 95% CI, -13.0 to -2.5 for VAS; mean difference, -5.3; 95% CI, -8.4 to -2.3 for ODI) and persisted through week 52.

Among the 108 participants in each group, adverse events occurred in 26 participants in the acupuncture and 5 participants in the sham acupuncture group. Subcutaneous hemorrhage and minor bleeding were the most common adverse events, and all were mild.

Acupuncture, a practice with thousands of years of history, has become increasingly accepted in mainstream medicine. In recognition of its benefits, Medicare now covers up to 12 acupuncture treatments with a 90-day period,² and the US Department of Veterans Affairs has approved acupuncture since 2018.³ The current study contributes to the growing body of evidence supporting acupuncture's effectiveness as a non-pharmaceutical option for managing sciatica pain.⁴

READ MORE: Nonopioid Pain Management Resource Center

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References

1. Tu J, Shi G, Yan S, et al. Acupuncture vs sham acupuncture for chronic sciatica from herniated disk: A Randomized Clinical Trial. JAMA Intern Med. Published online October 14, 2024. doi:10.1001/jamainternmed.2024.5463

2. Acupuncture. Fact sheet. US Centers for Medicare and Medicaid Services. Accessed October 18, 2024. https://www.medicare.gov/coverage/acupuncture

3. Acupuncture. Fact sheet. US Department of Veterans Affairs. Accessed October 18, 2024. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2825070

4. Kneifati-Hayek, JZ, Katz MH. Moving the needle on acupuncture trials. JAMA Internal Medicine. October 14, 2024. Accessed October 18, 2024. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2825070