Therapeutic Efficacy and the Impact of the "Dose" Effect of Acupuncture to Treat Sciatica: A Randomized Controlled Pilot Study

Ching-Hsiung Liu, Yen-Ying Kung, Chun-Liang Lin, Jen-Lin Yang, Ta-Peng Wu, Hong-Chun Lin, Yang-Kai Chang, Ching-Mao Chang, Fang-Pey Chen, Ching-Hsiung Liu, Yen-Ying Kung, Chun-Liang Lin, Jen-Lin Yang, Ta-Peng Wu, Hong-Chun Lin, Yang-Kai Chang, Ching-Mao Chang, Fang-Pey Chen

Abstract

Purpose: To investigate the required sample size for and feasibility of a full-scale randomized controlled trial examining the impact of the "dose" effect of acupuncture in treating sciatica.

Patients and methods: Fifty-seven patients with sciatica, aged 35-70 years, were recruited and screened. Thirty-one participants were randomly assigned to receive "low-dose" manual acupuncture (MAL) (n= 15) or "high-dose" manual acupuncture (MAH) (n=16). The acupuncture treatment was administered twice weekly for 4 weeks. The primary outcome was the visual analog scale (VAS) score at baseline and after 4 weeks of acupuncture treatment. Secondary outcomes included the Roland Disability Questionnaire for Sciatica (RDQS), the Sciatica Bothersomeness Index (SBI), and the World Health Organization Quality of Life in the Brief Edition (WHOQOL-BREF) scores at baseline and after 4 weeks of acupuncture treatment.

Results: Thirty patients completed the study. For all patients, acupuncture achieved significant improvement in the VAS (5.48±2.0, p<0.001), RDQS (3.18±2.83, p=0.004), and SBI (2.85±3.23, p=0.008) scores, but not in the WHOQOL-BREF scores. In the between-group analysis, the assessed scales showed no significant differences between the MAL and MAH groups. However, based on the level of chronicity, the MAH group demonstrated greater improvement in the outcomes and a significant benefit in the physical subscale of the WHOQOL-BREF (p<0.05).

Conclusion: Results of this pilot study indicate that acupuncture is safe and may effectively relieve symptoms and disability in patients with non-acute sciatica. MAL was as effective as MAH in treating sciatica. A subsequent trial with a larger sample size (estimated at n=96) is required to confirm whether patients with a high level of chronicity would benefit from MAH treatment.

Trial registration: NCT03489681.

Keywords: acupoints; alternative medicine; analgesia; chronic pain; low back pain; noninvasive treatment.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2019 Liu et al.

Figures

Figure 1
Figure 1
Patient flowchart diagram. Abbreviations: VAS, visual analog scale; M, male patient; F, female patient; MAH, “high-dose” manual acupuncture treatment group; MAL, “low-dose” manual acupuncture treatment group.
Figure 2
Figure 2
Outcome measures in the two dose groups before and after acupuncture treatment. Abbreviations: MAH, “high-dose” manual acupuncture treatment group; MAL, “low-dose” manual acupuncture treatment group; SBI, Sciatica Bothersomeness Index; RDQS, Roland Disability Questionnaire for Sciatica; VAS, visual analog scale; Acup, acupuncture; *p<0.05; **p<0.01.
Figure 3
Figure 3
Impact of acupuncture treatment on various outcome measures at different levels of sciatica chronicity. (A) The total score of the WHOQOL-BREF scales before and after acupuncture treatment in sciatica groups with different levels of chronicity. (B) The four domains of the WHOQOL-BREF before and after acupuncture treatment in sciatica groups with different levels of chronicity. (C) Various outcome measures before and after acupuncture treatment in sciatica groups with different levels of chronicity. (D) The physical domain of the WHOQOL-BREF before and after acupuncture treatment at the two doses in sciatica groups with different levels of chronicity. Abbreviations: WHOQOL-BREF, World Health Organization Quality of Life in the Brief Edition; NCr, nonchronic sciatica group (pain duration, ≤12 months); Cr, chronic sciatica group (pain duration, >12 months); Phy, physical domain of the WHOQOL-BREF; Psy, psychological domain of the WHOQOL-BREF; Soc, social domain of the WHOQOL-BREF; Evn, environment domain of the WHOQOL-BREF; MAH, “high-dose” manual acupuncture treatment group; MAL, “low-dose” manual acupuncture treatment group; SBI, Sciatica Bothersomeness Index; RDQS, Roland Disability Questionnaire for Sciatica; VAS, visual analogue scale; Acup, acupuncture; *p<0.05; **p<0.01.

References

    1. Kim M, Guilfoyle MR, Seeley HM, Laing RJ. A modified Roland-Morris disability scale for the assessment of sciatica. Acta Neurochir. 2010;152(9):1549–1553; discussion 1553. doi:10.1007/s00701-010-0679-5
    1. Stirling ER, Patel MS, Sell PJ. Sciatica. Br J Hosp Med. 2016;77(11):C180–C183. doi:10.12968/hmed.2016.77.11.C180
    1. Korovessis P, Repantis T, Zacharatos S, Baikousis A. Low back pain and sciatica prevalence and intensity reported in a Mediterranean country: ordinal logistic regression analysis. Orthopedics. 2012;35(12):e1775–e1784. doi:10.3928/01477447-20121120-24
    1. Konstantinou K, Dunn KM. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33(22):2464–2472. doi:10.1097/BRS.0b013e318183a4a2
    1. Davis D, Vasudevan A. Sciatica StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from
    1. Stafford MA, Peng P, Hill DA. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. Br J Anaesth. 2007;99(4):461–473. doi:10.1093/bja/aem238
    1. Bernstein IA, Malik Q, Carville S, Ward S. Low back pain and sciatica: summary of NICE guidance. BMJ. 2017;356:i6748. doi:10.1136/bmj.i6748
    1. Birch S, Lee MS, Alraek T, Kim TH. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. J Altern Complement Med. 2018;24(8):752–769. doi:10.1089/acm.2018.0092
    1. Deare JC, Zheng Z, Xue CC, et al. Acupuncture for treating fibromyalgia. Cochrane Database Syst Rev. 2013;5:Cd007070.
    1. Yang Y, Que Q, Ye X, Zheng G. Verum versus sham manual acupuncture for migraine: a systematic review of randomised controlled trials. Acupunct Med. 2016;34(2):76–83. doi:10.1136/acupmed-2015-010903
    1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654
    1. Yang A, Wu HM, Tang JL, Xu L, Yang M, Liu GJ. Acupuncture for stroke rehabilitation. Cochrane Database Syst Rev. 2016;8:Cd004131.
    1. Liu CH, Hsieh YT, Tseng HP, et al. Acupuncture for a first episode of acute ischaemic stroke: an observer-blinded randomised controlled pilot study. Acupunct Med. 2016;34(5):349–355. doi:10.1136/acupmed-2015-010825
    1. Omura Y. Patho-physiology of acupuncture treatment: effects of acupuncture on cardiovascular and nervous systems. Acupuncture Electrother Res. 1975;1(1–2):51–141.
    1. Cao X. Scientific bases of acupuncture analgesia. Acupuncture Electrother Res. 2002;27(1):1–14. doi:10.3727/036012902816026103
    1. He BS, Li Y, Gui T. Preliminary clinical evaluation of acupuncture therapy in patients with postpartum sciatica. J Midwifery Womens Health. 2018;63(2):214–220. doi:10.1111/jmwh.12681
    1. Zhang X, Wang Y, Wang Z, Wang C, Ding W, Liu Z. A randomized clinical trial comparing the effectiveness of electroacupuncture versus medium-frequency electrotherapy for discogenic sciatica. Evid Based Complement Alternat Med. 2017;2017:9502718. doi:10.1155/2017/9502718
    1. Qiu L, Hu XL, Zhao XY, et al. A randomized controlled clinical trial of treatment of lumbar disc herniation-induced sciatica by acupuncture stimulation of sciatic nerve trunk. Zhen Ci Yan Jiu. 2016;41(5):447–450.
    1. Fernandez M, Ferreira PH. Acupuncture for sciatica and a comparison with Western medicine (PEDro synthesis). Br J Sports Med. 2017;51(6):539–540. doi:10.1136/bjsports-2016-096203
    1. Qin Z, Liu X, Wu J, Zhai Y, Liu Z. Effectiveness of acupuncture for treating sciatica: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:425108. doi:10.1155/2015/425108
    1. Ji M, Wang X, Chen M, Shen Y, Zhang X, Yang J. The efficacy of acupuncture for the treatment of sciatica: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2015;2015:192808. doi:10.1155/2015/192808
    1. Zhao L, Chen J, Liu C-Z, et al. A review of acupoint specificity research in China: status quo and prospects. Evid Based Complement Alternat Med. 2012;2012:16. doi:10.1155/2012/543943
    1. Armour M, Smith CA. Treating primary dysmenorrhoea with acupuncture: a narrative review of the relationship between acupuncture ‘dose’ and menstrual pain outcomes. Acupunct Med. 2016;34(6):416–424. doi:10.1136/acupmed-2016-011110
    1. Liu C-H, Chen F-P. Therapeutic approach of acupuncture for sciatica: a brief review. Neuropsychiatry. 2017;7(2):149–155. doi:10.4172/Neuropsychiatry.1000191
    1. Huskisson EC. Measurement of pain. Lancet. 1974;2(7889):1127–1131. doi:10.1016/S0140-6736(74)90884-8
    1. Collins SL, Moore RA, McQuay HJ. The visual analogue pain intensity scale: what is moderate pain in millimetres? Pain. 1997;72(1–2):95–97. doi:10.1016/S0304-3959(97)00005-5
    1. Roland M, Morris R. A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983;8(2):141–144. doi:10.1097/00007632-198303000-00004
    1. Grovle L, Haugen AJ, Keller A, Natvig B, Brox JI, Grotle M. The bothersomeness of sciatica: patients’ self-report of paresthesia, weakness and leg pain. Eur Spine J. 2010;19(2):263–269. doi:10.1007/s00586-009-1042-5
    1. Grovle L, Haugen AJ, Natvig B, Brox JI, Grotle M. The prognosis of self-reported paresthesia and weakness in disc-related sciatica. Eur Spine J. 2013;22(11):2488–2495. doi:10.1007/s00586-013-2871-9
    1. Yao G, Wu CH. Factorial invariance of the WHOQOL-BREF among disease groups. Qual Life Res. 2005;14(8):1881–1888. doi:10.1007/s11136-005-3867-7
    1. Tang S, Mo Z, Zhang R. Acupuncture for lumbar disc herniation: a systematic review and meta-analysis. Acupunct Med. 2018;36(2):62–70. doi:10.1136/acupmed-2016-011332
    1. Gore S, Nadkarni S. Sciatica: detection and confirmation by new method. Int J Spine Surg. 2014;8:15. doi:10.14444/1015
    1. Harris RE, Tian X, Williams DA, et al. Treatment of fibromyalgia with formula acupuncture: investigation of needle placement, needle stimulation, and treatment frequency. J Altern Complement Med. 2005;11(4):663–671. doi:10.1089/acm.2005.11.663
    1. Paterson C. Patients’ experiences of Western-style acupuncture: the influence of acupuncture ‘dose’, self-care strategies and integration. J Health Serv Res Policy. 2007;12 Suppl 1:S1-39-45. doi:10.1258/135581907780318356
    1. White A, Cummings M, Barlas P, et al. Defining an adequate dose of acupuncture using a neurophysiological approach – a narrative review of the literature. Acupunct Med. 2008;26(2):111–120. doi:10.1136/aim.26.2.111
    1. Smith CA, Zaslawski CJ, Zheng Z, et al. Development of an instrument to assess the quality of acupuncture: results from a Delphi process. J Altern Complement Med. 2011;17(5):441–452. doi:10.1089/acm.2010.0457
    1. Ceccherelli F, Marino E, Caliendo A, Dezzoni R, Roveri A, Gagliardi G. 3,5,11 needles: looking for the perfect number of needles – a randomized and controlled study. Acupunct Electrother Res. 2014;39(3–4):241–258. doi:10.3727/036012914X14109544776097
    1. Armour M. The role of treatment timing and mode of stimulation in the treatment of primary dysmenorrhea with acupuncture: an exploratory randomised controlled trial. PLoS One. 2017;12:7. doi:10.1371/journal.pone.0180177
    1. Rajapakse D, Liossi C, Howard RF. Presentation and management of chronic pain. Arch Dis Child. 2014;99(5):474. doi:10.1136/archdischild-2013-304207
    1. Wang CK, Myunghae Hah J, Carroll I. Factors contributing to pain chronicity. Curr Pain Headache Rep. 2009;13(1):7–11. doi:10.1007/s11916-009-0003-3
    1. Sullivan MJ, Sullivan ME, Adams HM. Stage of chronicity and cognitive correlates of pain-related disability. Cogn Behav Ther. 2002;31(3):111–118. doi:10.1080/165060702320337988
    1. Buchner M, Neubauer E, Zahlten-Hinguranage A, Schiltenwolf M. The influence of the grade of chronicity on the outcome of multidisciplinary therapy for chronic low back pain. Spine. 2007;32(26):3060–3066. doi:10.1097/BRS.0b013e31815cde5a
    1. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355–375. doi:10.1016/j.pneurobio.2008.05.004
    1. Chae Y, Lee YS, Enck P. How placebo needles differ from placebo pills? Front Psychiatry. 2018;9:243. doi:10.3389/fpsyt.2018.00243
    1. Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455–474. doi:10.1016/j.jpain.2017.11.005

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe