Acupuncture and Sciatica: Impact on Pain and Function in Middle-Aged Adults
The efficacy of acupuncture treatment for chronic pain is still widely debated. A new study evaluated its effect on one of the most treatment resistant forms of low back pain.
Sciatica pain typically resolves either without treatment or with conservative treatment but more than half of people with the condition have pain for at least 1 year and one-third have persistent pain after 2 years.
Treatment for sciatica follows a traditional pattern that begins with nonsteroidal anti-inflammatory drugs and opioids, moves to conservative treatments like physical therapy and epidural steroids, and then to surgery.
Study population: 216 middle-aged adults with low back pain from sciatica secondary to a bulging lumbar disk of at least 3 months duration. Participants randomly assigned to receive acupuncture or sham acupuncture.
Sciatica treatment protocol: 10 treatments spanning 4 weeks with treatment group acupoints selected based on the World Health Organization’s “Standard Acupuncture Locations”
Efficacy of acupuncture for sciatica was assessed after 2, 4, 8, 26, and 52 weeks of treatment using 4 standard validated tools: the Visual analog scale, Oswestry Disability Index, Sciatica Frequency and Bothersome Index, and Short Form Health Survey.
Acupuncture treatment for sciatica after 4 weeks was significantly more effective against pain and disability than sham acupuncture treatment.
Acupuncture vs sham acupuncture treatment for sciatica remained statistically significant 52 weeks after completion of one month of treatment. Magnitude of improvement did diminish and differences in effect narrowed between groups over time.
The most common adverse events reported with acupuncture for sciatica were subcutaneous hemorrhage and minor bleeding - affecting 24% of participants and deemed non-serious and self-limiting.
Acupuncture provided significant clinical benefits for sciatica 1 year after just 4 weeks of treatment with minimal adverse events compared to a sham procedure. The current study received support from editorial writers in JAMA Internal Medicine.
The safety of acupuncture is a significant advantage, in addition to its potential efficacy.
Acupuncture should be considered as a first-line treatment for pain from sciatica, study authors suggest.
Acupuncture access is limited by availability of licensed practitioners, a requirement for most forms of insurance coverage.
The cost of acupuncture may also be a limitation, given that not all insurance carriers cover the practice, potentially leaving patients to bear the expense out-of-pocket.
Sources
Study: 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. 2024. doi:10.1001/jamainternmed.2024.5463
Editorial: Kneifati-Hayek JZ, Katz MH. Moving the needle on acupuncture trials. JAMA Intern Med. 2024. doi:10:1001/jamainternmed.2024.545
The efficacy of acupuncture for chronic pain conditions has been the subject of a great deal of debate. Many still hold to the belief that whatever benefits this treatment provides are the result of a placebo effect. Studies have shown, however, that acupuncture can affect endorphin secretion and increase the bioavailability of serotonin and norepinephrine, 2 neurotransmitters that are believed to be involved in analgesia. Also the demonstrated benefits of veterinary acupuncture would appear to contradict the placebo theory.
Quality research has shown acupuncture to be beneficial for the pain of osteoarthritis
A recent study examined the potential benefits of acupuncture for the management of sciatica, pain radiating along the course of the sciatic nerve, related to herniated vertebral disks, the apparent cause of sciatica in approximately 85% of cases. The slides above highlight the study and the findings.
