Traditional acupuncture has an entirely different approach to that used by conventional medicine. 'Traditional' in this instance means that the practitioner is trained to used an approach to diagnosis and treatment that is based on the principle of qi or vital energy which is present in all of us.
Once the practitioner has diagnosed the nature and cause of the imbalance a treatment plan will be devised which will be unique and specific to the patient. The treatment is then carried out by inserting ultra fine sterile disposable needles into selected acupuncture points on the body. Traditionally-trained acupuncturists may also use a heat treatment (moxabustion), cupping therapy or other forms of physical stimulation
Is it Safe?
In 2000, a prospective study was conducted by the University of York which looked at the safety of acupuncture treatment, and was published by the BMJ in 2001.
The study took place over a 4 week period, during which time a total of 574, (out of 1848 invited), professionally trained traditional acupuncturists practising in the UK. Nearly two thirds of these had been practising for more than 5 years. The practitioners were asked to give details of adverse events they considered 'significant', including those that were unusual or dangerous. They reported on over 34000 treatments, out of which no serious adverse events were reported, at a 95% confidence level.
Even with the possibility that self-reporting can give biased results, this study provides important evidence on public health & safety given that over 2 million acupuncture treatments are administered each year in the UK. When comparison is made with the adverse effects of over use of drugs such as NSAIDs, acupuncture is a relatively safe form of treatment, and as we will see, potentially very effective.
What evidence exists for the effectiveness of traditional acupuncture to treat sciatica?
Each year 2.3 million traditional acupuncture treatments are carried out in the UK, making this one of the most popular complementary therapies. People seek acupuncture for a variety of conditions, from chronic illness to part of a health maintenance regime. Acupuncture is a holistic treatment, and so seeks to look at the person as a whole. Any symptoms observed give clues to the internal environment of the body and will be observed together to make the diagnosis. The research available for the use of acupuncture to address sciatica shows there is substantial research that traditional acupuncture is significantly better than no treatment and at least as effective as standard medical care for back pain. In addition to this NICE, the National Institute for Health and Care Excellence, published a clinical guideline in May 2009 giving guidance to GP's that they offer a curse of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain.
The evidence available comes from both systematic reviews and clinical trials. Two reviews of particular interest are one published in 2008 in the journal Spine, which discusses a systematic review and meta-analysis that looked at the then, most recent clinical studies examining acupuncture treatment for low back pain. It collected the results from 23 trials involving 6359 patients, and it revealed moderate evidence for acupuncture being more effective than no treatment, and strong evidence that it can be a useful supplementary treatment to other forms of conventional therapy.
The other was published several years earlier, in 2005 in the Cochrane database. Again it is a systematic review and meta-analysis. It examined 35 trials involving 2861 patients, all assessing acupuncture for low back pain. The conclusion drawn showed that when measuring pain relief and functional improvement, acupuncture appeared to be more effective than no treatment, and that it has the potential to combine effectively with other therapies to address this condition.
Among the several clinical studies available, one of the highlights is a study published in 2009 in the Journal of Traditional Chinese Medicine. In discusses a clinical study conducted to observe the relationship of acupuncture treatment for sciatica, between pain threshold and therapeutic effects. 90 patients with sciatica were randomised to 3 groups, including an acupuncture group, and a pain relief medication group. The pain threshold was tested before treatment and after the first, second and third treatment courses.
The conclusion was that the acupuncture group showed better therapeutic effects than the other groups and a there was a significant increase in pain threshold for the acupuncture group.
Clinical Guideline 88 - May 2009. www.nice.org.uk/CG88
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.
Furlan AD, et al. Acupuncture for Low back pain. A systematic Review. Cochrane Database, Systematic Review 2005; (1): CD001351.
Hugh Macpherson, et al. The York Acupuncture Safety Study: Prospective Survey of 34000 Tx's by Traditional Acupuncturists. BMJ. Sept. 1, 2001; 323(7311): 486-487.
Tranmer MR, Moore RA, et al. Quantitative Estimation of rare adverse events which follow a biological progression: a new model applied to chronic NSAID use. Pain. 2000; 85: 169-182 - on PubMed
Yuan J, Purepong N, et al. Effectiveness of Acupuncture for Low Back Pain: A Systematic Review. Spine. 2008, Nov 1; 33 (23): E887-900.