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Acupuncture For Sciatica

About sciatica

Sciatica, more accurately termed lumbar radiculopathy, is a syndrome involving nerve root impingement and/or inflammation that has progressed enough to cause neurological symptoms (e.g. pain, numbness, paraesthesia) in the areas that are supplied by the affected nerve root(s) (Tarulli 2007). Posterior sciatica involves pain that radiates along the posterior thigh and the posterolateral aspect of the leg, and is due to an S1 or L5 radiculopathy. When caused by S1 irritation, the pain may radiate to the lateral aspect of the foot, while pain due to L5 radiculopathy may radiate to the dorsum of the foot and to the large toe. Anterior sciatica involves pain that radiates along the anterior aspect of the thigh into the anterior leg, and is due to L4 or L3 radiculopathy. Pain due to L2 radiculopathy is antero-medial in the thigh, and pain in the groin usually arises from an L1 lesion. Sciatica is almost invariably accompanied or preceded by back pain, and mobility is often affected (Koes 2007). Indicators for sciatica include unilateral leg pain that is greater than low back pain; pain radiating to the foot or toes, numbness and paraesthesia; increased pain on straight leg raising, and neurological symptoms limited to one nerve root (Waddell 1998).


The prevalence of lumbar radiculopathy is around 3% to 5%, and equally common in men and women (Tarulli 2007), and an estimated 5%-10% of patients with low back
pain have sciatica (Health Council 1999). The annual prevalence of disc related sciatica in the general population is estimated at 2.2% (Younes 2006). In most
patients, the prognosis is good, but up to 30% will have pain for one year or longer (Weber 1993, Vroomen 2000).
Conventional management includes advice to stay active and continue daily activities; exercise therapy; analgesics (e.g. paracetamol, NSAIDs, an opioid);
muscle relaxants; corticosteroid spinal injections; and referral for consideration of surgery. However, there is a lack of strong evidence of effectiveness for most of
these interventions (Hagen 2007, Luijsterburg 2007).

References

Hagen KB et al. The updated Cochrane review of bedrest for low back pain and sciatica. Spine
2005; 30: 542-6.
Health Council of the Netherlands: management of the lumbosacral radicular syndrome (sciatica): Health Council of
the Netherlands, 1999; publication no. 1999/18.
Koes BW et al. Diagnosis and treatment of sciatica. BMJ 2007; 334: 1313-7.
Luijsterburg PAJ et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic
review. Eur Spine J 2007 Apr 6;(Epub ahead of print).
Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin 2007; 25(2): 387-405.
November 2014 page 2
Vroomen PCAJ et al. Conservative treatment of sciatica: a systematic review. J Spinal Dis 2000; 13: 463-9.
Weber H et al. The natural course of acute sciatica with nerve root symptoms in a double blind placebo-controlled trial
of evaluating the effect of piroxicam (NSAID). Spine 1993; 18: 1433-8.
Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.
Younes M et al. Prevalence and risk factors of disc-related sciatica in an urban population in Tunisia. Joint Bone
Spine 2006; 73: 538-42.

How acupuncture can help

There is substantial research to show that acupuncture is significantly better than no treatment and also at least as good, if not better than, standard medical care for back
pain (Yuan 2008, Furlan 2008; see the Fact Sheet on Acupuncture and Back Pain). There is less specific research on acupuncture for sciatica, but there is evidence to
suggest that it may provide some pain relief (Wang 2009, Chen 2009, Inoue 2008, Wang 2004). (see overleaf)

Acupuncture can help relieve back pain and sciatica by:
• stimulating nerves located in muscles and other tissues, which leads to release of
endorphins and other neurohumoral factors, and changes the processing of pain
in the brain and spinal cord (Pomeranz 1987, Zhao 2008).
• reducing inflammation, by promoting release of vascular and immunomodulatory
factors (Kavoussi 2007, Zijlstra 2003).
• improving muscle stiffness and joint mobility by increasing local microcirculation
(Komori 2009), which aids dispersal of swelling.
• causing a transient change in sciatic nerve blood flow, including circulation to the
cauda equine and nerve root. This response is eliminated or attenuated by
administration of atropine, indicating that it occurs mainly via cholinergic nerves
(Inoue 2008).
• influencing the neurotrophic factor signalling system, which is important in
neuropathic pain (Dong 2006).
• increasing levels of serotonin and noradrenaline, which can help reduce pain and
speed nerve repair (Wang 2005).
• improving the conductive parameters of the sciatic nerve (Zhang 2005).
• promoting regeneration of the sciatic nerve (La 2005)

About traditional acupuncture

Acupuncture is a tried and tested system of traditional medicine, which has been used in China and other eastern cultures for thousands of years to restore, promote
and maintain good health. Its benefits are now widely acknowledged all over the world, and in the past decade traditional acupuncture has begun to feature more
prominently in mainstream healthcare in the UK. In conjunction with needling, the practitioner may use techniques such as moxibustion, cupping, massage or electroacupuncture. They may also suggest dietary or lifestyle changes.

Traditional acupuncture takes a holistic approach to health and regards illness as a sign that the body is out of balance. The exact pattern and degree of imbalance is
unique to each individual. The traditional acupuncturist’s skill lies in identifying the precise nature of the underlying disharmony and selecting the most effective
treatment. The choice of acupuncture points will be specific to each patient’s needs. Traditional acupuncture can also be used as a preventive measure to strengthen the
constitution and promote general wellbeing.

An increasing weight of evidence from Western scientific research (see overleaf) is demonstrating the effectiveness of acupuncture for treating a wide variety of
conditions. From a biomedical viewpoint, acupuncture is believed to stimulate the nervous system, influencing the production of the body’s communication substances
- hormones and neurotransmitters. The resulting biochemical changes activate the body's self-regulating homeostatic systems, stimulating its natural healing abilities
and promoting physical and emotional wellbeing.

About the British Acupuncture Council


With over 3000 members, the British Acupuncture Council (BAcC) is the UK’s largest professional body for traditional acupuncturists. Membership of the BAcC guarantees
excellence in training, safe practice and professional conduct. To find a qualified traditional acupuncturist, contact the BAcC on 020 8735 0400 or visit
www.acupuncture.org.uk

Acupuncture For Sciatica

The evidence

Research Conclusion
Reviews - low back pain
Yuan J et al. Effectiveness of
acupuncture for low back pain: a
systematic review. Spine 2008;
33(23): E887-900.
Systematic review and meta-analysis of 23 trials involving
6,359 patients, which looked at acupuncture in the treatment
of low back pain. It found moderate evidence that
acupuncture is more effective than no treatment and strong
evidence that acupuncture is a useful supplement to other
forms of conventional therapy. The reviewers concluded that
acupuncture should be advocated for the treatment of chronic
low back pain.
Furlan AD et al. Acupuncture and
dry-needling for low back pain.
Cochrane Database Syst Rev 2005;
(1): CD001351.
Systematic review and meta-analysis of 35 trials involving
2,861 patients, which assessed acupuncture for low back
pain. The reviewers concluded that for chronic low back pain,
acupuncture is more effective for pain relief and functional
improvement than no treatment or sham treatment, and that
acupuncture may be a useful adjunct to other therapies for
chronic low back pain.
Ammendolia C et al. Evidenceinformed management of chronic
low back pain with needle
acupuncture. Spine J 2008 Jan-Feb;
8(1): 160-72.
Review article on management of chronic low back pain with
acupuncture, which explains theories on the mechanisms of
action on pain with acupuncture. It concludes that the most
consistent evidence is for the addition of acupuncture to other
therapies.
Clinical trials - sciatica
Wang ZX. [Clinical observation on
electroacupuncture at acupoints for
treatment of senile radical sciatica].
Zhongguo Zhenjiu 2009; 29(2): 126-8.
A randomised trial that compared therapeutic effects of
electroacupuncture and TENS on radical sciatica in a total of
139 patients. At the end of the first course of treatment, the
cure rate was greater (41.4%) in the electroacupuncture
group than the TENS group (29.0%, p<0.05), and at the end
of second course, was still greater (80.0% vs. 44.9%,
p<0.005). The researchers concluded that the therapeutic
effect of electroacupuncture on senile radical sciatica is
significantly better than TENS.
Chen M-R et al. The warming
acupuncture for treatment of sciatica
in 30 cases. Journal of Traditional
Chinese Medicine 2009; 29(1): 50-
53.
A clinical study to observe the relationship between the pain
threshold and the therapeutic effects of acupuncture for
sciatica. Ninety sciatica patients were randomised to an
acupuncture group (needles warmed with moxa), a western
medicine group (nimesulide) or a point-injection group
(anisodamine). Pain threshold was tested before treatment
and after the first, second and third treatment courses.
Acupuncture had better therapeutic effects than the other two
groups, with significant differences in the change in pain
threshold and the improvement of clinical symptoms and
signs (p<0.01). The researchers concluded that acupuncture
can relieve the symptoms of sciatica with an increase in pain
threshold.
Inoue M et al. Acupuncture
treatment for low back pain and
lower limb symptoms - The relation
between acupuncture or
electroacupuncture stimulation and
sciatic nerve blood flow. Evidencebased Complementary and
Alternative Medicine 2008; 5(2):
133-43.
A clinical trial to investigate the efficacy of acupuncture for
lumbar spinal canal stenosis and herniated lumbar disc, and
an animal study to clarify the mechanisms of acupuncture on
sciatic nerve blood flow. In the clinical trial, patients were
divided into three treatment groups: needling of acupuncture
points on either side of the spine, electroacupuncture on the
pudendal nerve or electroacupuncture at the nerve root.
Primary outcome measurements were pain and dysaesthesia
[evaluated with a visual analogue scale (VAS)] and continuous
walking distance. About half the patients in the spinal
acupuncture points group had improvement in symptoms,
while electroacupuncture on the pudendal nerve was effective
for the symptoms that had not improved with that treatment.
Considerable immediate and sustained relief was observed in
patients who received electroacupuncture at the nerve root.
In the animal study, sciatic nerve blood flow was measured
with laser-Doppler flowmetry at, before and during three kinds
of stimulation (manual acupuncture on lumber muscle,
electrical stimulation on the pudendal nerve and electrical
stimulation on the sciatic nerve) in anesthetised rats. Increase
in sciatic nerve blood flow was observed in 56.9% of the
animals given lumber muscle acupuncture, 100% with
pudendal nerve stimulation and 100% with sciatic nerve
stimulation. Sciatic nerve stimulation sustained the increase
longer than pudendal nerve stimulation.
The researchers concluded that one mechanism of action of
acupuncture and electrical acupuncture stimulation could be
that, in addition to its influence on the pain inhibitory system, it
participates in causing a transient change in sciatic nerve blood
flow, including circulation to the cauda equine and nerve root.
Wang B-X, La J-L. Therapeutic
effects of electro-acupuncture and
diclofenac on herniation of lumbar
intervertebral disc. Chinese Journal
of Clinical Rehabilitation 2004;
8(17): 3413-5.
A randomised trial to compare the effects of
electroacupuncture and diclofenac treatment in 40 patients
with sciatica caused by herniation of an intervertebral disc. The
main outcome measures were Laseque's sign, and tenderness
and numbness of the buttock, posterior side of the thigh, and
the leg. After the treatment, the angle of Laseque's sign in the
acupuncture group was significantly greater than that in the
medication group (p<0.05). Also, the mean score of buttock
tenderness was significantly lower in the acupuncture group
than in the medication group (p<0.05). However, the mean
scores of tenderness relief in the posterior side of the thigh and
of the leg were not significantly different between the two
groups. There was no significant difference in alleviation of
numbness of the feet between the two groups (p>0.05). The
researchers concluded that electro-acupuncture is more
effective than diclofenac for increasing the Laseque's sign
angles and relieving tenderness at needled sites in patients
with sciatica.
Animal Studies
Inoue M et al. The effect of electrical
stimulation of the pudendal nerve on
sciatic nerve blood flow in animals.
Acupuncture in Medicine 2008;
26(3): 145-8.
An animal study that investigated the mechanism of the clinical
effect of electroacupuncture of the pudendal nerve on the
lumbar and lower limb symptoms caused by lumbar spinal
canal stenosis. Electrical stimulation of the pudendal nerve
significantly increased blood flow in the sciatic nerve,
transiently and without increasing heart rate and systemic
blood pressure. The significant increase in the sciatic nerve
blood flow disappeared after administration of atropine,
indicating that it occurs mainly via cholinergic nerves.
Dong Z-Q et al. Down-regulation of
GFRalpha-1 expression by
antisense oligodeoxynucleotide
attenuates electroacupuncture
analgesia on heat hyperalgesia in a
rat model of neuropathic pain. Brain
Research Bulletin 2006; 69(1): 30-6.
An animal study that found the endogenous glial cell linederived neurotrophic factor signalling system (important in
neuropathic pain) is involved in the effects of
electroacupuncture analgesia on neuropathic pain in rats.
Wang S et al. Effects of acupuncture
on monoamine neurotransmitters in
brain tissue of experimental rat
models of sciatic nerve
compression. Chinese Journal of
Clinical Rehabilitation 2005; 9(33):
94-6.
An animal study that looked at the influence of acupuncture on
the level of monoamine neurotransmitters in brain tissue of rat
models of sciatic nerve compression, and how this affects
analgesia and repair of nerve injury. Electroacupuncture
resulted in significantly higher levels of serotonin and
noradrenaline, which can help reduce pain and speed nerve
repair.
Zhang W-G et al. Effect of
acupuncture on the recovery of
injured sciatic nerve in rats
quantitatively evaluated with the
changes of electrophysiological
parameters. Chinese Journal of
Clinical Rehabilitation 2005. 9(25):
140-1.
An animal study that observed the effect of acupuncture on
injured sciatic nerves. It found that every conductive parameter
of the sciatic nerve improved after acupuncture.
La J-L et al. Morphological studies
on crushed sciatic nerve of rabbits
with electroacupuncture or
diclofenac sodium treatment.
American Journal of Chinese
Medicine 2005; 33(4): 663-9.
An animal study that compared the effects of
electroacupuncture with diclofenac and a control on the
regeneration of crushed sciatic nerves in rabbits.
Electroacupuncture was found to promote nerve regeneration
more effectively than diclofenac and the control (p<0.01 and
p<0.001, respectively).
Komori M, Takada K, Tomizawa Y,
Nishiyama K, Kondo I, Kawamata
M, Ozaki M. Microcirculatory
responses to acupuncture
stimulation and phototherapy.
Anesth Analg. 2009 Feb;108(2):635-
40.

Experimental study on rabbits in which acupuncture stimulation
was directly observed to increase diameter and blood flow
velocity of peripheral arterioles, enhancing local
microcirculation.
General review articles of acupuncture
Zhao ZQ. Neural mechanism Review article that discusses the various peripheral and
underlying acupuncture analgesia.
Prog Neurobiol 2008; 85(4): 355-
75.
central nervous system components of acupuncture
anaesthesia in detail.
Kavoussi B, Ross BE. The
neuroimmune basis of antiinflammatory acupuncture. Integr
Cancer Ther 2007; 6(3): 251-7.
Review article that suggests the anti-inflammatory actions of
traditional and electro-acupuncture are mediated by efferent
vagus nerve activation and inflammatory macrophage
deactivation.
Zijlstra FJ, van den Berg-de Lange I,
Huygen FJ, Klein J. Antiinflammatory actions of
acupuncture. Mediators Inflamm.
2003 Apr;12(2):59-69.
An article that suggests a hypothesis for anti-inflammatory
action of acupuncture: Insertion of acupuncture needles initially
stimulates production of beta-endorphins, CGRP and
substance P, leading to further stimulation of cytokines and NO.
While high levels of CGRP have been shown to be proinflammatory, CGRP in low concentrations exerts potent antiinflammatory actions. Therefore, a frequently applied 'low-dose'
treatment of acupuncture could provoke a sustained release of
CGRP with anti-inflammatory activity, without stimulation of proinflammatory cells.
Pomeranz B. Scientific basis of
acupuncture. In: Stux G, Pomeranz
B, eds. Acupuncture Textbook and
Atlas. Heidelberg: Springer-Verlag;
1987:1-18.
Needle activation of A delta and C afferent nerve fibres in
muscle sends signals to the spinal cord, where dynorphin and
enkephalins are released. Afferent pathways continue to the
the midbrain, triggering excitatory and inhibitory mediators in
spinal cord. Ensuing release of serotonin and norepinephrine
onto the spinal cord leads to pain transmission being inhibited
both pre- and postsynaptically in the spinothalamic tract.
Finally, these signals reach the hypothalamus and pituitary,
triggering release of adrenocorticotropic hormones and betaendorphin.



Terms and conditions
The use of this fact sheet is for the use of British Acupuncture Council members and is subject to the strict conditions imposed by the British Acupuncture Council details of which can be found in the members area of its’ website www.acupuncture.org.uk.

For more information on acupuncture and how it can help with nerve root inflammation, contact Elaine Collins at 0141 585 7904 or fill in our Contact form, and we will get back to you.