Acupuncture for Treating Sciatica
By Dr. Zongshi Qin
Sciatica is a common neuralgia characterised by pain radiating into the leg; it is usually caused by nerve root compression and irritation or inflammation of the sciatic nerve, and is often accompanied by lower back pain and neurological deficits in the lower limb.1 The pain is often associated with tingling, numbness and weakness of the leg; it may be sudden in onset and then persist for days or weeks.2 Frymoyer3 reported that sciatica is very common, with a lifetime incidence varying from 13% to 40% and a corresponding annual incidence of sciatica episodes of 1–5%.4
Sciatica commonly affects people between the ages of 30 and 50 years, with the pain of sciatica significantly damaging health.5 Thus, according to a report from Younes,6 sciatica in Tunisia has become a major cause of work absenteeism and a financial burden to society. Previous research has indicated that 60% of patients with sciatica suffer from a mild disability. On the basis of questionnaires (given at the 3rd through 12th months of symptom exhibition), it is believed that 30% of patients live with sciatica for more than 1 year, which results in an obvious decrease in the quality of life.7 The current management of sciatica can be classified into pharmacological and non-pharmacological treatment. One article supports the effectiveness of non-opioid medication, epidural injections and disc surgery. It also suggests that spinal manipulation, acupuncture and experimental treatments, such as anti-inflammatory biological agents, may be considered. 8 The use of pharmacological products such as anaesthetics or corticosteroids has associated adverse effects including sedation, dizziness, ataxia and nausea, and their effectiveness decreases with long-term use.9 Although according to the prior systematic review epidural injections are more effective for pain reduction than non-opioids,8 related adverse effects to epidural injections have been reported.10–12 To date, there is no strong evidence-based medicine proving that non-pharmacological conservative treatment of Western medicine is effective13 ,14; also, surgical procedures are invasive, expensive and may cause neurological complications.15
In China, sciatica is a primary cause for hospitalisation and it is commonly used for managing neuralgia pain.16 Acupuncture is reported to be effective in treating many types of musculoskeletal pain including lower back pain,17 fibromyalgia,18 osteoarthritis19 and sciatica.20–24 However, the ability of acupuncture to successfully manage sciatica, either as a monotherapy or as an adjunct to Western medical care, remains unclear.
This systematic review aims to assess the effectiveness and safety of acupuncture for treating sciatica. To this end, we will pose the following question: What is the comparative effectiveness and safety of acupuncture compared with sham acupuncture, usual care or no treatment to reduce pain intensity in patients diagnosed with sciatica? Is there a definitive advantage of acupuncture compared with Western medication? With the resulting evaluation aiming to help clinicians make decisions on treating sciatica, and to help patients seeking further treatment options.
Sciatica causes significant suffering for the individual, yet most of the currently available treatment options are not adequate to control pain. Pharmacological methods have associated adverse effects, while surgery is expensive and is not appropriate for every patient. Acupuncture has been used for 3000 years in China and is generally regarded as a safe and effective measure to alleviate pain. However, when the effectiveness of acupuncture for a condition remains unclear, it is difficult for clinicians to make appropriate recommendations. The mechanism of acupuncture analgesia is gradually becoming known. Han2,8 found that acupuncture can promote release of neurotransmitter such as 5-hydroxytryptamine and in addition it generates neuropeptide through electrical stimulation of different frequencies that has significantly effect to pain reduction.
This is a protocol for a systematic review that aims to assess the safety and effectiveness of acupuncture for sciatica. As there has been no prior systematic review related to acupuncture for sciatica published in English, we hope this systematic review will help clinicians make decisions in practice and promote the progress of acupuncture research.