Eacupuncture For Sciatica

ISPUB.
COM The Internet Journal of Pain, Symptom Control and

Palliative Care
Volume 5 Number 1
Use of Electroacupuncture for Treatment of Chronic Sciatic

Pain
M Hollisaz
Citation
M Hollisaz. Use of Electroacupuncture for Treatment of Chronic Sciatic Pain. The Internet Journal of Pain, Symptom
Control and Palliative Care. 2006 Volume 5 Number 1.
Abstract
Introduction: Chronic sciatic pain is one of the most common complaints of patients referring to orthopaedic, neurosurgery, and
physiatric clinics. In most cases, common treatment modalities may be employed. However, in many, the results are not be
consistent. Electroacupuncture has been recommended as an appropriate alternative in such cases.
Aim: To assess the effect of electroacupuncture on chronic refractory sciatic pain, we conducted a single-blind clinical trial
comparing it to physiotherapy and a placebo.
Material and methods: 119 randomly allocated subjects (59 males, 65 females) were chosen and classified in three treatment
groups consisting of: Electroacupuncture (EA), physiotherapy (PT), and a placebo(SO). Pain intensity and related complications
were assessed before and after the 5th, 10th and 15th treatment sessions using a visual analog scale.
Results: The pain reduction percentage in the (EA), (PT), and (SO) groups were as follow: 62.1% 18.6%, 52.5% 17.5%, and
17.5% 12.7% (P<0.05) respectively. The contentment in the EA group was significantly higher than the other two groups
(P<0.01). The complication reduction percentage in EA, PT, and SO groups were 89.3%, 51.8%, and 31.9%, respectively
(P<0.05). EA was more effective than PT in ameliorating buttock pain, lower limb paresthesia, gastrosoleus muscle pain, lateral
calf pain, cold feet, increased lordosis and gait disturbance (P<0.05).
Conclusion: Electroacupuncture is a semi-invasive and effective method in controlling chronic sciatic pain and complications and
may thus be used as a good treatment alternative in indicated cases.
INTRODUCTION exercises, activity modification, behavioral modification)

Prevalence of chronic pains in the society is estimated to be that can reduce symptoms. Nonprescription medication is
about 7% and increases with age. Chronic sciatic pain efficacious for mild to moderate pain. Nonsteroidal anti-
constitutes one of the main motives for referral of afflicted inflammatory drugs, alone or in combination with muscle
patients to physiotherapy, orthopedics, and neurosurgery relaxants, relieve pain and improve overall symptoms of
clinics. Such pains affect life quality and reduce social and acute low back pain (Braddon, 1996). Exercise therapy has
economical efficacy. Treatment and control of such pains are limited value for acute low back pain, but strong evidence
costly and unfortunately, in most cases, unsatisfactory. The supports exercise therapy in the management of chronic low
most prevalent therapy for these pains (excluding analgesic back pain. Moderately strong evidence supports the use of
medications), is physiotherapy; notwithstanding its different manipulation in acute back pain. Evidence is weak for the
therapeutic effects, it has no prime effect on decrease and use of epidural corticosteroid injections in patients with
controlling pains in all cases of sciatalgia (Braddon, 1996). acute low back pain, strong for short-term relief of chronic
A variety of nonsurgical treatment alternatives exists for low back pain, and limited for long-term relief of chronic
acute and chronic low back pain. Patients should receive low back pain. The use of facet injections in the
appropriate education about the favorable natural history of management of acute low back pain is not supported by
low back pain, basic body mechanics, and methods (eg, evidence (Shen,et al., 2000; Flowerdew and Gadsby, 2006).
1 of 4
Use of Electroacupuncture for Treatment of Chronic Sciatic Pain
Acupuncture has a history dating back to 500 BC. Today it group. Similar to other studies the intensity of pain, type and
is considered as a cure for many ailments and disorders. It intensity of complications and restrictions caused by sciatic
has been shown that by inserting needles, small myelinated pain were registered For pain intensity assessment, MMPC
nerve fibers, located in muscles, can be activated sending visual scale was used and the measurement was made at the
stimuli to the spinal cord activating the midbrain and beginning and after 5th, 10th and 15th sessions. Patients
hypophysis-hypothalamus axis thereby inducing analgesic were classified in to 4 groups according to the preliminary
effects (Stux et al.,1987). More recently, instead of using the pain intensity: mild (0 to 25), moderate (25 to 50) , severe
conventional hand-stimulating method for needles, short (50 - 75), very severe (75 to 100). Then, the response rate to
frequency electrical stimulation (2-4 Hz) is used called therapy was studied in these groups. The pain reduction
electroacupuncture (EA) which obviates the need for percentage was made by calculating differences of pain
acupuncture specialists to continuously stimulate the needles intensity in the last session with that at the onset of therapy,
by hand during treatment sessions (Stux et al.,1987; Ter Riet and dividing it by the preliminary pain intensity. By
et al., 1990 ). Conflicting evidence exists regarding the use registering all complications and limitations at the first and
of transcutaneous electrical nerve stimulation. In order to last sessions of therapy, it was noted which complications
rate the effectiveness of this method in controlling pain in resolved in each patient and the percent of resolved
patients suffering from refractory chronic sciatic pain, we complications was calculated by dividing this number by
conducted a randomised single-blind controlled trial to their preliminary number. All the evaluations were made by
compare this method with physiotherapy and a placebo. a physician who was blinded to patient's therapy group. At
the end of 5th , 10th , and 15th sessions, the patient's therapy
PATIENTS AND METHODS contentment rate was registered. For each patient, the highest
Study design: This study was a randomized single-blind value was calculated for variables of pain reduction and
placebo-controlled trial. The target population included all contentment.
patients referring to neurosurgery and orthopedic clinics at
two major referral centers. All patients were under Treatment groups: 1. Electroacupuncture group (EA); in
supervision of their physician (orthopedist, neurosurgeon, each session, 10-15 needles were inserted in painful and
physiatrist), and clinical and paraclinical diagnostic methods suitable points to an approximate depth of l to 5cm. Each
(examination, MRI, etc.) were used to diagnose and confirm session took up to 20 min and a current with an intensity of
the sciatical origin of their pain and only those patients in 2-10 mA and 4 HZ frequency was transferred.
which surgery was not indicated and pain was not controlled 2.Physiotherapy(SO); each therapy session took up to 30
by analgesic medications were included in this study. Before min and hot packs , ultrasound, short wave diathermy,
commencing the study, it was first approved by the medical interferential transcutaneous electric nerve stimulation and
ethics committee of the research department of our hospital other instruments for strengthening muscles were used.
and informed consents were also obtained from the patients.
3. Placebo group (SO); sessions were held as in the EA
Inclusion criteria : 1. More than 20 yrs of age; 2. low back group, but instead of inserting needles in the body , they
pain; 3. at least a 6-month pain duration; 4. confirmed were set on the intended points by adhesive , and after
sciatical origin of pain. turning the machine on, the current intensity was zero.
Therapy sessions were held every other day for 1 month.
Exclusion criteria: 1. Indication for surgery; 2. Patient's
reluctance to take part in the study; 3. Attendance of less Analysis of data: Data analysis was done using SPSS.PC
than 5 treatment sessions; 4. More than 50 yrs of age; 5. software. In analysis of the findings , in addition to
Acupuncture contraindications such as systemic disease, descriptive methods, other methods, such as t-test, analysis
existence of prosthesis, cutaneous infections, or of variance, cross tabulation, and Chi-square were
coagulopathy. conducted, and for analyzing differences of non-parametric
variables or when the distribution was not normal, the
Examinations and Measurements: The patients were Kruskal-Wallis and Mann- Whittney-U-tests were used. The
classified into three treatment groups at random; these confidence interval was assumed 95% and P<0.05 was
groups were: 1. Electroacupuncture; 2. Physiotherapy; 3. considered significant.
Placebo. Before commencement, all the patients were
examined by a physician who was blinded as to the therapy
2 of 4
RESULTS 8%1.8 in SO. By analysis of variance by the modified LSD

Of the 119 subjects, 54 (45.4%) were male and 65 (54.67%) method for 0.05 P value, the difference among the three
were female. There were 41 groups was significant. Pain reduction percent in EA, PT,
patients in the EA, 38 in the PT and 40 in the SO group. In and SO groups was: 62.1% 18.6%, 52.5% 17.5 and 17.5%
all groups, age, duration of 12.7 respectively and the difference among the three
ailment, preliminary pain intensity and complications, were groups was significant. There was a significant difference in
the same. The physician's patient satisfaction from therapy among the three groups; in
diagnosis of the origin of sciatic pain, in order of decreasing EA, it was the most and in SO, the least. This difference was
frequency, was: confirmed by conducting Kruskal-Wallis test (Chi Square
osteoarthritis, discopathy of L4-L5 and L5-S1, canal 41.94, P<0.0001). There was a significant difference in the
stenosis, sacralisation, number of complications resolved among the three groups:
osteoporosis, and scoliosis. There was no significant In EA group, it was 5.8 2.5 in PT, 3.73.5, and in SO,
difference in pain etiology in 22.3. By performing analysis of variance with modified
influencing the therapy groups. The most common LSD method for 0.05 value, the difference was significant
complications in the patients were: among the groups. The percentage of resolved complications
Buttock pain, paravertebral muscle spasms, lower limb was obtained by dividing the number of resolved complaints
paresthesia, and gastrosoleus muscle pain, respectively. by their preliminary number; and for EA,PT and SO groups,
Other complications and their prevalence are listed in table was as follow: 89.3% 21.3; 51:8% 44.7; and 31.9%
1. 35.9 respectively. The difference between these three
values was significant also. Pain reduction in females was
Figure 1 significantly greater than males (49.7%24 versus
Table 1: Prevalence of complications at the beginning of the 37.2%25.3; P<0.001), but the percentage of resolved
study in each treatment group complications and patient's therapy contentment did not
reveal any differences between genders. The etiology of
sciatic pain had no association with therapy response. The
most responsive complications were: weakness and atrophy
of lower limb muscles, increased lordosis, reduced Achilles
reflex, gait disturbance and cold feet. Percentage of resolved
complications in the population and in each treatment group
individually is listed in table 2. EA was more effective than
PT in resolving gait disturbance, paresthesia, cold feet,
buttock pain, lumbar lordosis , gastrosoleus muscle pain, and
lateral calf pain. PT was only significantly more effective
than SO in controlling complications of buttock pain,
reduced Achilles and quadriceps reflexes.
The number of treatment sessions was different in the

treatment groups: 9.2%1 in EA, 11.7%1.9 in PT and
3 of 4
Figure 2 Patient contentment in the severe pain group was greater

Table 2: Percentage of resolved complications in each than the others, but no significant correlation was observed
treatment group in therapy response parameters and preliminary pain
intensity. Pain reduction in this group was also greatest
(29% in mild group, 37.1% in moderate, 51.6% in severe
and 50.5% in very severe group). Pain reduction in the
severe pain group and very severe groups were significantly
more than the mild group (P<0.05). Percent of resolved
complications did not differ significantly in these 4 pain
groups. Regarding patient's pain intensity, a significant
difference existed in pain reduction, (60.4%11.7 in severe
group versus 38.8% 18.6 in the moderate pain group;
4 of 4

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ISPUB.

COM The Internet Journal of Pain, Symptom Control and

Use of Electroacupuncture for Treatment of Chronic Sciatic

INTRODUCTION exercises, activity modification, behavioral modification)

RESULTS 8%1.8 in SO. By analysis of variance by the modified LSD

The number of treatment sessions was different in the

Figure 2 Patient contentment in the severe pain group was greater

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