In a randomised trial, acupuncture reduced pain and disability better than a sham procedure did.

Due to its perceived safety, acupuncture is sometimes used in treating patients with chronic sciatica despite limited evidence of efficacy. In this trial from China, 216 adults (mean age, 51 years) were randomised to undergo 10 sessions of acupuncture or sham procedures during four weeks. The sham procedure consisted of blunt needles inserted into adhesive foam pads placed over non-acupoints. All patients had moderate-to-severe unilateral leg pain attributed to imaging-confirmed disk herniation; the mean duration of symptoms was three years (range, 1.3 to 10 years). Patients taking pain-modifying medications or with prior lumbar disc surgery were excluded.

Patients who received acupuncture reported greater leg-pain relief at four weeks than did patients who received sham procedures (mean decrease on a 0 to 100mm visual analogue scale, 31mm vs 15mm), as well as greater improvement in disability (mean decrease, 13mm vs 5mm). Improvements in pain and disability scores from baseline began at week two and persisted to one year. Minor bleeding was more common in the acupuncture group (24% vs 5%), but no patient required medical attention.

Comment: Improvements in pain and function in this study suggest a clinically meaningful and durable effect of acupuncture in this patient population. However, some of that benefit could be explained by patients’ knowledge of their treatment, despite the comparison with sham procedures. Finally, generalising these findings might be problematic given the long duration of symptoms. When ‘sciatica’ has been the diagnostic label for years, some patients will have developed other musculoskeletal conditions that make teasing out the exact causes of their chronic back and leg pain difficult.

Rahul B. Ganatra, MD, MPH, Instructor in Medicine, Harvard Medical School; Director of Continuing Medical Education for the Medical Service, VA Boston Healthcare System, Boston, USA.

Tu J-F et al. Acupuncture vs sham acupunc- ture for chronic sciatica from herniated disk: a randomized clinical trial. JAMA Intern Med 2024 14 Oct; e-pub (https://doi.org/10.1001/jamainternmed.2024.5463).

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Neurology