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Large randomized placebo-controlled clinical trial supports acupuncture for chronic sciatica

Acupuncture

Sonya Collins

Effective, noninvasive treatments for chronic sciatic are limited. For patients whose condition is caused by a herniated disk, acupuncture may be a viable treatment strategy, according to a study by Tu and colleagues published in the December 2024 issue of JAMA Internal Medicine.

“The trial provides high-quality evidence that acupuncture is more effective than sham acupuncture for chronic sciatica caused by herniated lumbar discs,” said David Wang, PhD, LAc, MD, an assistant professor and acupuncturist at Ohio State University Wexner Medical Center.

Trial provides robust evidence for acupuncture

Researchers conducted a multicenter, two-arm randomized placebo-controlled clinical trial in six tertiary hospitals in China. A total of 216 patients with chronic sciatica from a herniated disk were randomized to receive ten sessions of acupuncture or sham treatment over the course of 4 weeks and then followed for 52 weeks.

Compared with those in the placebo group, patients in the acupuncture group experienced clinically significant reductions in leg pain, based on the visible analog scale for leg pain, and in disability as measured by the Oswestry Disability Index. Between-group differences in pain and disability were seen starting at week 2 and continued through the 52 weeks of follow up.

“This study makes significant contributions to the existing knowledge and evidence supporting acupuncture as a treatment for sciatica,” Wang said.

Among the study’s strengths, Wang cites the robust randomized controlled clinical trial design, the large sample size, its demonstration of long-term benefits, its use of validated tools to measure improvements in pain and disability, and the specific patient population it included. “The focus on chronic sciatica from herniated discs provides clarity,” Wang said. “Many prior studies have grouped different causes of sciatica and didn’t focus on chronic cases, leaving the efficacy in this subgroup unclear.”

Chinese medicine in the western world

While the trial design may bolster credibility of the study results in the eyes of western clinicians, it may also diminish the results.

“It is virtually impossible to study acupuncture the way that it is practiced,” said Jeff Gould, DiplOM, licensed acupuncturist at Johns Hopkins Integrative Medicine and Digestive Center.

Gould determines treatment protocol based on a patient’s entire constellation of symptoms, not just the primary complaint, such as chronic sciatica from a herniated disc.

“I may have 10 patients coming in for migraine and each one may get an entirely different treatment,” he said. In a randomized controlled clinical trial model, “with some exceptions, every patient gets the same treatment. If we were studying the treatment the way it is actually done, the results would be better.”

Administering Chinese acupuncture within the western clinical trial model, he said, “is not individualized medicine and so, in the strictest sense, is not really Chinese medicine but rather westernized acupuncture.”

Nevertheless, the trial presented sound results, which can strengthen the case for clinicians to include acupuncture in their recommendations for the management of chronic sciatica.

Counseling patients on acupuncture

For patients who are not receiving sufficient relief from medication, pharmacists may recommend some combination of acupuncture, chiropractic, physical therapy, massage, and osteopathic manipulation.

“They often work individually and tend to work even better in combination as they support each other,” Gould said.

There are several counseling points that pharmacists can communicate to their patients:

Point out that studies support the safety and efficacy of acupuncture for chronic sciatica.
Recommend that patients seek a licensed acupuncturist with at least 5 years’ experience who is covered by their health insurance.
Suggest patients schedule at least one visit per week for at least 4 weeks to start as effects can be cumulative and take a few weeks to be seen.
Pharmacists may also need to debunk some of the following commonly held misconceptions about acupuncture or check their own biases:
Acupuncture only works through the placebo effect.
Acupuncture will work after a single session. Results come from consistent treatment.
Acupuncture is pseudoscience.

“Pharmacists can explain that rigorous studies, including sham acupuncture trials, show real, measurable benefits beyond placebo,” Wang said. “And that acupuncture’s pain-relieving effects are supported by a growing body of clinical research, even if the exact mechanisms, such as stimulation of the nervous system or endorphin release, are still being studied.” ■