The Efficacy of Acupuncture for the Treatment of Sciatica: A Systematic Review and Meta-Analysis

Mei Ji, Xiaoxia Wang, Meijuan Chen, Yan Shen, Xu Zhang, Jin Yang, Mei Ji, Xiaoxia Wang, Meijuan Chen, Yan Shen, Xu Zhang, Jin Yang

Abstract

Background. Sciatica is one of the most frequently reported complaints; it affects quality of life and reduces social and economic efficacy. Clinical studies on the efficacy of acupuncture therapy in sciatica are increasing, while systematic reviews assessing the efficacy of acupuncture therapy are still lacking. Objective. This study aims to assess the effectiveness of acupuncture therapy for sciatica. Methods. Comprehensive searches of 8 databases were conducted up until April 2015. Outcomes included effectiveness (proportion of patients who improved totally or partly in clinical symptoms), pain intensity, and pain threshold. Effect sizes were presented as risk ratio (RR) and mean difference (MD). Pooled effect sizes were calculated by fixed effects or random effects model. Results. A total of 12 studies (involving 1842 participants) were included. Results showed that acupuncture was more effective than conventional Western medicine (CWM) in outcomes effectiveness (RR 1.21, 95% CI: 1.16-1.25), pain intensity (MD -1.25, 95% CI: -1.63 to -0.86), and pain threshold (MD: 1.08, 95% CI: 0.98-1.17). Subgroup and sensitivity analysis found that the results did not change in different treatment method and drug categories substantially. The reported adverse effects were acceptable. Conclusions. Acupuncture may be effective in treating the pain associated with sciatica.

Figures

Figure 1
Figure 1
Flowchart of the trial selection process.
Figure 2
Figure 2
Quality assessment of included studies. (a) Risk of bias graph; (b) risk of bias summary.
Figure 3
Figure 3
Forest of comparisons of total effectiveness between acupuncture group and medication group.
Figure 4
Figure 4
Funnel plot on effectiveness to evaluate the publication bias of the literatures.
Figure 5
Figure 5
Forest of comparisons of pain intensity: acupuncture versus medication.
Figure 6
Figure 6
Forest of comparisons of pain threshold: acupuncture versus medication.

References

    1. Valat J.-P., Genevay S., Marty M., Rozenberg S., Koes B. Sciatica. Best Practice and Research: Clinical Rheumatology. 2010;24(2):241–252. doi: 10.1016/j.berh.2009.11.005.
    1. Konstantinou K., Dunn K. M. Sciatica: review of epidemiological studies and prevalence estimates. Spine. 2008;33(22):2464–2472. doi: 10.1097/brs.0b013e318183a4a2.
    1. Stafford M. A., Peng P., Hill D. A. Sciatica: a review of history, epidemiology, pathogenesis, and the role of epidural steroid injection in management. British Journal of Anaesthesia. 2007;99(4):461–473. doi: 10.1093/bja/aem238.
    1. Cook C. E., Taylor J., Wright A., Milosavljevic S., Goode A., Whitford M. Risk factors for first time incidence sciatica: a systematic review. Physiotherapy Research International. 2014;19(2):65–78. doi: 10.1002/pri.1572.
    1. Qiu Y. Clinical observation of 87 cases of sciatica treated by acupuncture. Guide of China Medicine. 2013;11(27):490–491.
    1. Zhang Y., Xing J. J., Li J., Zeng B. Y., Liang F. R. International Review of Neurobiology. chapter 1. Vol. 111. Elsevier; 2013. History of acupuncture research; pp. 1–23.
    1. Vickers A., Wilson P., Kleijnen J. Acupuncture. Quality and Safety in Health Care. 2002;11(1):92–97. doi: 10.1136/qhc.11.1.92.
    1. Jiang Y. G., Mu J. S., Zhang X. Y., Bai Q. L. Clinical observation on acupuncture treatment of 106 cases of trunk-sciatica. Journal of Traditional Chinese Medicine. 1984;4(3):183–185.
    1. Dorsher P. T. Acupuncture for chronic pain. Techniques in Regional Anesthesia and Pain Management. 2011;15(2):55–63. doi: 10.1053/j.trap.2011.04.002.
    1. Zhan W. Z., Liang X. W. Different methods for the treatment of 2100 cases of sciatica. Journal of GanSu College of TCM. 1993;10(2):p. 47.
    1. Zhu J. H., Chen H. Y., Chen J. Y. Treating 30 cases of backbone of sciatica by hip three-needle-based acupuncture. Clinical Journal of Chinese Medicine. 2011;3(5):78–79.
    1. Chen M. R., Wang P., Cheng G., et al. A clinical observation on acupuncture for 30 cases of sciatica. Journal of Traditional Chinese Medicine. 2007;48(3):238–240.
    1. van der Molen H. F., Hoonakker P. L. T., Lehtola M. M., et al. Writing a Cochrane systematic review on preventive interventions to improve safety: the case of the construction industry. Medicina del Lavoro. 2009;100(4):258–267.
    1. Qin Z., Liu X., Yao Q., Zhai Y., Liu Z. Acupuncture for treating sciatica: a systematic review protocol. BMJ Open. 2015;5(4) doi: 10.1136/bmjopen-2014-007498.e007498
    1. Dong Q. J., Wu B. H., Zhang Y. M. Observation on the therapeutic effect of searching-needling method of acupuncture for 60 cases of primary sciatica. New Medical Science. 2008;7(4):135–136.
    1. Chen W. K. Clinical study of acupuncture in sciatica patients [M.S. thesis] Guangdong, China: Guangzhou University of Chinese Medicine; 2010.
    1. Zhang Z. Clinical observation of 145 cases of sciatica treated by acupuncture. Chinese Journal of Modern Drug Application. 2012;6(4):124–125.
    1. Zhai L. H. Clinical observation of sciatica treated by acupuncture. Medical Information. 2012;25(2):p. 562.
    1. Liu B. L. Clinical analysis of 80 cases of acupuncture and moxibustion for treatment of sciatica. Guide of China Medicine. 2012;10(24):590–591.
    1. Huang W. D. Clinical observation of 76 cases of sciatica treated by acupuncture. Contemporary Medicine Forum. 2014;12(1):178–179.
    1. Wang C. H. Clinical observation of sciatica treated by acupuncture. Asia-Pacific Traditional Medicine. 2014;10(6):94–95.
    1. Ye X. C., Zhao P., Wang L., et al. Clinical observation on the treatment of root scitica by electro acupuncture at Jiaji point. Information on Traditional Chinese Medicine. 2015;32(1):108–111.
    1. Yang L., Yang Z., Yu H., Song H. Acupuncture therapy is more effective than artificial tears for dry eye syndrome: evidence based on a meta-analysis. Evidence-Based Complementary and Alternative Medicine. 2015;2015:11. doi: 10.1155/2015/143858.143858
    1. Macpherson H., Altman D. G., Hammerschlag R., et al. Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the consort statement. PLoS Medicine. 2010;7(6) doi: 10.1371/journal.pmed.1000261.e1000261
    1. Higgins J. P. T., Altman D. G., Sterne J. A. C. Assessing risk of bias in included studies. In: Higgins J. P. T., Green S., editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. chapter 8. The Cochrane Collaboration; 2011.
    1. Higgins J. P. T., Thompson S. G. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002;21(11):1539–1558. doi: 10.1002/sim.1186.
    1. Wei R.-L., Teng H.-J., Yin B., et al. A systematic review and meta-analysis of buyang huanwu decoction in animal model of focal cerebral ischemia. Evidence-Based Complementary and Alternative Medicine. 2013;2013:13. doi: 10.1155/2013/138484.138484
    1. Witt C. M., Pach D., Brinkhaus B., et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forschende Komplementärmedizin. 2009;16(2):91–97. doi: 10.1159/000209315.
    1. Wang C. Y., Ma J., Xiao L. Treatment of 50 cases of sciatica by needling zanzhu and fengchi. Journal of Traditional Chinese Medicine. 2003;23(1):51–52.
    1. Koes B. W., Van Tulder M. W., Peul W. C. Diagnosis and treatment of sciatica. British Medical Journal. 2007;334(7607):1313–1317. doi: 10.1136/.
    1. Hollisaz M. T. Use of electroacupuncture for treatment of chronic sciatic pain. Internet Journal of Pain, Symptom Control and Palliative Care. 2007;5:p. 7.
    1. Zhao Z.-Q. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. 2008;85(4):355–375. doi: 10.1016/j.pneurobio.2008.05.004.
    1. Chon T. Y., Lee M. C. Acupuncture. Mayo Clinic Proceedings. 2013;88(10):1141–1146. doi: 10.1016/j.mayocp.2013.06.009.
    1. Inoue M., Kitakoji H., Yano T., Ishizaki N., Itoi M., Katsumi Y. Acupuncture treatment for low back pain and lower limb symptoms—the relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow. Evidence-Based Complementary and Alternative Medicine. 2008;5(2):133–143. doi: 10.1093/ecam/nem050.
    1. Cheng K. J. Neuroanatomical basis of acupuncture treatment for some common illnesses. Acupuncture in Medicine. 2009;27(2):61–64. doi: 10.1136/aim.2009.000455.
    1. Goldman N., Chen M., Fujita T., et al. Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture. Nature Neuroscience. 2010;13(7):883–888. doi: 10.1038/nn.2562.
    1. Kaptchuk T. J. Acupuncture: theory, efficacy, and practice. Annals of Internal Medicine. 2002;136(5):374–383. doi: 10.7326/0003-4819-136-5-200203050-00010.
    1. Inoue M., Hojo T., Yano T., Katsumi Y. Electroacupuncture direct to spinal nerves as an alternative to selective spinal nerve block in patients with radicular sciatica—a cohort study. Acupuncture in Medicine. 2005;23(1):27–30. doi: 10.1136/aim.23.1.27.
    1. La J.-L., Jalali S., Shami S. A. Morphological studies on crushed sciatic nerve of rabbits with electroacupuncture or diclofenac sodium treatment. American Journal of Chinese Medicine. 2005;33(4):663–669. doi: 10.1142/S0192415X05003259.
    1. Gao Y., Chen S., Xu Q., et al. Proteomic analysis of differential proteins related to anti-nociceptive effect of electroacupuncture in the hypothalamus following neuropathic pain in rats. Neurochemical Research. 2013;38(7):1467–1478. doi: 10.1007/s11064-013-1047-7.
    1. Lv Z. T., Song W., Wu J., et al. Efficacy of acupuncture in children with nocturnal enuresis: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine. 2015;2015:12. doi: 10.1155/2015/320701.320701

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