OBJECTIVE: To evaluate the efficacy and safety of acupuncture for discogenic sciatica.
DESIGN: Single-center, parallel, randomized controlled sham acupuncture trial.
METHODS: Twelve sessions of acupuncture or sham acupuncture at the same traditional acupoints over four weeks. The primary outcome was change from baseline in weekly mean leg pain, measured by the visual analog scale (VAS) over the four-week treatment period. The secondary outcomes were determined by the change from baseline in mean VAS scores for leg pain, VAS scores for low back pain, Oswestry Disability Index (ODI) scores, and 36-Item Short Form Health Survey (SF-36) scores. Patients were followed for 28 weeks.
RESULTS: Forty-six patients were enrolled in this study between June 2017 and January 2018, of which 23 were in the acupuncture group and 23 were in the sham acupuncture group. The between-group difference in weekly mean leg pain measured by the VAS over the four-week treatment period was -7.28 mm (95% confidence interval = -13.76 to -0.80, P = 0.029), which is larger than the minimum clinically important difference of 5 mm. The between-group differences in mean VAS scores for low back pain, ODI scores, and SF-36 scores were not significant in the study period (P > 0.05 for all). The proportion of acupuncture-related adverse events was 4.3%, and all adverse events were mild and transient.
CONCLUSIONS: Twelve sessions of acupuncture showed short-term clinical benefits in relieving the symptoms of leg pain for patients with chronic discogenic sciatica compared with sham acupuncture. Acupuncture is safe in treating chronic discogenic sciatica. Further studies with larger sample sizes, a longer treatment period, and long-term follow-up should be conducted to verify these results.
|Rehab Clinician (OT/PT)|
This is a very interesting study. The use of random allocation and blind assessment are the main strength of this trial. The use of intent to treat statistical analysis increase the validity of this study. This study showed that acupuncture will give short-term clinical benefits in relieving the symptoms of leg pain. Acupuncture is safe in treating chronic discogenic sciatica. Further studies with larger sample sizes and longer follow up are warranted.
Several problems with the study: 1. blinding seems questionable; 2. VAS reduction was significantly different at only one time point, which might be by chance; 3. Bonferroni correction should have been applied and would result in the loss of significance.
This is a small study with positive short term benefit for a chronic condition. Hopefully, this will lead to a larger study looking at long term (12 to 24 months) outcomes.
As a neurologist, I would have expected these results. The benefit of this article to me is that it provides evidence when I am asked to give an opinion or advice to my colleagues.
There are already some studies demonstrating the short term benefits of needling for back pain. This is perhaps a more specific cohort of patients, but the terms sciatica and sciatic pain are now less common in the currently literature of pain science. A stronger powered study with longer follow up may provide a greater awareness of the true efficacy between groups, as their MCID is questionable.
The study was well designed, with the exception of the lack of a control group. The "sham" acupuncture still counts as "treatment", in that the patients were seen by a medical practitioner, listened to, an had blunt tipped needles applied to their skin. A control group would have make the small differences between the groups more interesting.
There is very good concealed allocation but the subjective outcome measure is useless in people that are very confident in the treatment efficacy. Maybe a little performance test would be more significant.