AUTHOR=Zhang Zhihui , Hu Tingting , Huang Peiyan , Yang Mengning , Huang Zheng , Xia Yawen , Zhang Xinchang , Zhang Xiaolin , Ni Guangxia 

TITLE=The efficacy and safety of acupuncture therapy for sciatica: A systematic review and meta-analysis of randomized controlled trails

JOURNAL=Frontiers in Neuroscience

VOLUME=Volume 17 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2023.1097830

DOI=10.3389/fnins.2023.1097830

ISSN=1662-453X

ABSTRACT=Background and Objective: Sciatica is a common type of neuropathic pain disease, which carries a grave financial burden on patients’ life. For patients with sciatica, acupuncture has been recommended as an effective method for pain relief, while there is currently insufficient evidence to support its efficacy and safety. In this review, we aim to critically assess the published clinical evidence on the efficacy and safety of acupuncture therapy for treating sciatica.
Methods: An extensive literature search strategy was established in 7 databases from their inception to 31 March 2022. Two independent reviewers performed the literature search, identification, screening. Data extraction was performed on studies meeting inclusion criteria, and further quality assessment was performed according to the Cochrane Handbook and STRICTA recommendations. Summary risk ratio and standardized mean differences with 95% confidence interval were calculated using fixed-effects or random-effects. Heterogeneity in effect size across studies was explored using subgroup analysis and sensitivity analysis. The quality of evidence was estimated following GRADE approach.
Results: A total of 30 randomized controlled trials involving 2,662 participants were included in the meta-analysis. The results of integration of clinical outcomes showed that the clinical efficacy of acupuncture was superior to medicine treatment in improving total effective rate (RR=1.25, 95%CI [1.21, 1.30]; moderate certainty of evidence), reducing VAS pain score (SMD=-1.72, 95% CI [-2.61, -0.84]; very low certainty of evidence), increasing pain threshold (SMD=2.07, 95% CI [1.38, 2.75]; very low certainty of evidence), and decreasing recurrence rate (RR=0.27, 95% CI [0.13, 0.56]; low certainty of evidence). In addition, few adverse events (RR=0.38, 95% CI [0.19, 0.72]; moderate certainty of evidence) were reported during the intervention, which suggested a safe treatment options.
Conclusions: This systematic review and meta-analysis demonstrated that acupuncture was an effective and safe treatment approach for sciatica, and it could be considered to be a suitable replacement for medicine treatment. However, given the high heterogeneity and low methodological quality of previous studies, the future RCTs should be well designed according to the rigorous methodology.