Acupuncture for Sciatica: An Alternative to Pain Meds

Multiple different spinal conditions can cause sciatic pain. In each of these conditions, the nerve roots originating in the lumbar spine become compressed and irritated (1, 2). This causes pain in the large sciatic nerve, which forms from the lumbar nerve roots and runs from the buttock to the back of the leg, and then emanates to a number of other nerve branches in the calf.

The most common cause of sciatica is a lumbar disc herniation, in which a spinal disc tears and its internal fluid leaks out onto the nearby nerve root. About 90% of all sciatica cases result from lumbar disc herniations (4).

Other potential causes of sciatic pain include:

• Lumbar spinal stenosis: a narrowing of the spinal canal due to degenerated discs or spinal arthritis (5).
• Spondylolisthesis: a fracture in one part of the vertebra which causes forward movement (6).
• Pregnancy: increased pressure on all structures in the lumbar spine (7).

Sciatic pain may also arise due to piriformis syndrome. In most individuals, the sciatic nerve travels either above or below the piriformis muscle. If the piriformis muscle tightens and spasms, it can directly press on the sciatic nerve, leading to the buttock and leg pain associated with sciatica (8).

Acupuncture is a component of Traditional Chinese Medicine (TCM). Practitioners of TCM believe that irregularities along key channels in the body called meridians results in pain and disability. The goal of acupuncture is to relieve such irregularities (3, 4).

Acupuncture treatment involves placing thin, sterile needles along carefully selected acupuncture points, based on the patient’s symptoms. The idea is to unblock the flow of qi within the meridian associated with those acupuncture points, in order to restore normal function and health (3).

Traditional acupuncture includes manual acupuncture, in which the acupuncturist manually inserts the needles into the acupuncture points anywhere along the associated meridian they want to target. However, other methods of stimulating acupuncture points for similar therapeutic purposes include (4, 9):

• Electroacupuncture: gentle electrical current administered through the acupuncture needles.
• Acupressure: Application of manual pressure at an acupoint rather than pressure applied with a needle.
• Laser acupuncture: Application of lasers at acupuncture points rather than needles.
• Moxibustion: Heating an acupuncture needle by burning an herb called moxa.
  

Scientists are still investigating exactly how acupuncture works, but extensive research on acupuncture as a pain management approach provides relatively strong support for its therapeutic effectiveness (4, 9). However, we still don't fully understand the mechanism by which acupuncture relieves pain. Some proposed mechanisms include:

• Endorphin release: Several studies on acupuncture indicate that the body releases its own natural substances called endorphins in response to needle insertion, providing pain relief and improving mood (3, 4, 9).
• Stimulated blood flow: Research also indicates that acupuncture stimulates blood flow at the site of treatment, allowing for muscle relaxation, reduction of inflammation, and improved healing (10).
• Central Nervous System reaction: Preliminary research suggests that acupuncture may stimulate a response in the brain that blocks pain signals and alters the way the body perceives pain (4, 9, 11).

Of the proposed mechanisms of action, endorphin release has the strongest research support.

Lower back pain is one of the ailments that acupuncturists frequently treat, including cases in which low back pain is accompanied by sciatica (3). Several studies investigating the efficacy of acupuncture show its success in treating both acute and chronic sciatica symptoms (2, 4, 12).

Studies show that acupuncture can often outperform NSAIDs in treating sciatica, while also resulting in fewer side effects (2, 4).

Continued medical innovation has also yielded several advancements in acupuncture technique, which have improved outcomes. For example, electroacupuncture shows strong promise and has outperformed other forms of electrotherapy, while recent research suggests that needle insertion directly targeting the sciatic nerve can improve on traditional acupuncture (13, 14).

While acupuncture is generally safe, you should be aware of possible side effects so you can decide if acupuncture is right for you.

• Discomfort and pain from the needles: Acupuncture often causes soreness, numbness, and feelings of compression during the procedure (11, 15).
• Bleeding after treatment: Bleeding can occur after the needles are removed from the patient’s skin. On rare occasions, a hematoma can develop at the puncture site. People who have bleeding disorders shouldn’t receive acupuncture (15, 16).
• Feelings of fatigue and drowsiness (15).
• Nerve injury or lung puncture: Acupuncturists receive extensive training on how to avoid these complications as part of their credentialing, but they are still possible (15).
  

In most cases of sciatica, the symptoms will either resolve on their own or with conservative treatment (1). There are many conservative treatment methods available which you should try before considering surgery.

In this section, we'll cover a few conservative treatment approaches for sciatic pain that have strong research support:

• Physical Therapy: Physical therapy treatment for sciatica includes modalities such as manual (hands-on) therapy, traction therapy, ultrasound, TENS, and hot/cold packs to relieve pain. Physical therapy also incorporates strengthening and stretching exercises for improved strength, mobility, and function. Like acupuncture, physical therapy carries few side effects.
• Chiropractic care: This care approach revolves around using spinal manipulation to correct any postural abnormalities and spinal subluxations which affect the function of the spine and extremities. 
• Non-opioid medications: Anti-inflammatory medications such as NSAIDs, or nerve pain medications such as gabapentin, can help manage sciatic pain particularly when combined with other treatment modalities like acupuncture and physical therapy (2). These medications do carry some side effects, so you should collaborate with a healthcare provider to design a good treatment plan.
• Epidural steroid injections: If sciatic symptoms don’t initially respond to NSAIDs or other treatments, your physician may inject a strong anti-inflammatory steroid medication directly into the spinal space where the irritated nerve root is. This targets the inflamed nerve root faster than oral medications and has moderate research support for its effectiveness (17).

If you find that your sciatica persists or worsens after conservative treatment, you may want to consider surgery to prevent further nerve damage. However, you should think very carefully about this decision, since studies show that conservative care often results in similar long-term outcomes as surgery (1).

Compared to other alternative treatments, acupuncture is supported by a relatively strong body of clinical research. It also carries few side effects compared to other conventional care approaches and surgery.

If you’re struggling with sciatica and have interest in incorporating acupuncture into your treatment plan, consult your physician about the possible benefits and drawbacks for your pain.