Low Back Pain and Sciatica and Acupuncture

The ancient technique of acupuncture has become increasingly popular as a treatment for pain and other conditions. When low back pain and/or sciatica pain is caused by inflammation, acupuncture can be used to directly help reduce said inflammation. Acupuncture can help correct other more subtle internal imbalances that may be contributing to the low back pain and sciatica as well.

Read more details about Acupuncture.

Thus far, research has not produced clear evidence of acupuncture’s effectiveness for back pain.⁵² In a review of 23 randomized trials involving over 6,000 patients with chronic low back, researchers concluded that acupuncture is more effective than no treatment for short-term pain relief, but there was no significant difference between the effects of true and sham.⁷⁹

A 6-month, double-blind trial of 1,162 people with back pain compared real acupuncture, fake acupuncture, and conventional therapy.⁷² Both real and fake acupuncture were twice as effective as conventional therapy according to the measures used. However, there was only a minimal difference between real and fake acupuncture, which shows the significant power of the placebo effect.

Similarly, in a single-blind, sham-acupuncture, and no-treatment controlled study of 298 people with chronic back pain, use of real acupuncture failed to prove significantly more effective than sham-acupuncture.⁵⁸ Also, in a fairly large randomized trial involving 638 adults with chronic back pain, there was no difference in pain at one year in patients receiving real compared to fake acupuncture (with neither group improving significantly over standard care). Both real and simulated acupuncture were, however, associated with improved function at one year.⁸⁰ Other studies have failed to find benefit as well; in several controlled studies enrolling a total of over 300 people, real acupuncture again failed to prove more effective than sham-acupuncture or other placebo treatments.^19,29,32,53

One study compared the effects of acupuncture, massage, and education (such as videotapes on back care) for 262 people with chronic back pain over a 10-week period.28 The exact type of acupuncture and massage was left to practitioners, but only 10 visits were permitted. At the 10-week point, evaluations showed benefit with massage but not with acupuncture. One year later, massage and education were nearly equivalent, and both were superior to acupuncture.

Low level laser therapy (LLLT) is a technique similar to electro-acupuncture that uses precision laser energy instead of electricity conducted through a needle. In a detailed review of 7 randomized trials, researchers were unable to draw any conclusions regarding the effectiveness of LLLT for nonspecific low back pain.⁷³

Many other studies have compared acupuncture to such treatments as transcutaneous electrical nerve stimulation (TENS), physical therapy, chiropractic care, and massage.^14,33-37,59 In many of these trials, acupuncture provided benefits comparable to the other options tested. However, because TENS, physical therapy, and so forth, have not been proven effective for back pain, studies of this type cannot be taken as evidence that acupuncture is effective. One study did find acupressure massage more effective than standard physical therapy; however, it was performed in a Chinese population that may have had more faith in this traditional approach than in physical therapy.⁶⁰

Safety Issues

Serious adverse effects associated with the use of acupuncture are rare. ¹,² The most commonly reported problems include short-term pain from needle insertion, tiredness, and minor bleeding. There is one report of infection caused by acupuncture given to a person with diabetes. ³ Some acupuncture points lie over the lungs and insertion to excessive depth could conceivably cause a pneumothorax (punctured lung). Because acupuncturists are trained to avoid this complication, it is a rare occurrence.

A recent report from China contained an example of another complication caused by excessively deep needling. ⁴ A 44-year-old man was needled on the back of the neck at a commonly used acupuncture point just below the bony protuberance at the base of the skull. However, the acupuncturist inserted the needle too deeply and punctured a blood vessel in the skull. The client developed a severe headache with nausea and vomiting; a CAT scan showed bleeding in the brain, and a spinal tap found a small amount of blood in the cerebrospinal fluid. The severe headache, along with neck stiffness, continued for 28 days. The man was treated with standard pain medication, and the condition resolved itself without any permanent effects.

Infection due to the use of unclean needles has been reported in the past, but the modern practice of using disposable sterile needles appears to have eliminated this risk.

1. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 110(6):481-5.
2. MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ. 323(7311):486-7.
3. Shah N, Hing C, Tucker K, Crawford R. Infected compartment syndrome after acupuncture. Acupunct Med. 20(2-3):105-6.
4. Choo DCA, Yue G. Acute intracranial hemorrhage in the brain caused by acupuncture. Headache. 2000;40:397-398.

1. Clinical Practice Guideline Number 14: Acute Low Back Problems in Adults. Rockville, Md: Agency for Health Care Policy and Research, US Dept of Health and Human Services; 1994. AHCPR publication 95-0642.

2. American Academy of Orthopaedic Surgeons website. Available at: http://www.orthoinfo.aaos.org. Accessed November 20, 2000.

3. Carey TS, Garrett J, Jackman A, et al. The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors, and orthopedic surgeons. The North Carolina Back Pain Project. N Engl J Med. 1995;333:913-917.

4. Kendrick D, Fielding K, Bentley E, et al. Radiography of the lumbar spine in primary care patients with low back pain: randomised controlled trial. BMJ. 2001;322:400-405.

5. Chrubasik S, Eisenberg E, Balan E, et al. Treatment of low back pain exacerbations with willow bark extract: a randomized double-blind study. Am J Med. 2000;109:9-14.

9. Hauser RA. Punishing the pain. Treating chronic pain with prolotherapy. Rehab Manag. 1999;12:26-28.

10. Liu YK, Tipton CM, Matthes RD, et al. An in situ study of the influence of a sclerosing solution in rabbit medial collateral ligaments and its junction strength. Connect Tissue Res. 1983;11:95-102.

11. Reeves KD. Prolotherapy: present and future applications in soft tissue pain and disability. Phys Med Rehab Clin North Am. 1995;6:917-926.

12. Ongley MJ, Klein RG, Dorman TA, et al. A new approach to the treatment of chronic low back pain. Lancet. 1987;2:143-146.

13. Klein RG, Eek BC, DeLong WB, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic, low back pain. J Spinal Disord. 1993;6:23-33.

14. Franke A, Gebauer S, Franke K, et al. Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers—a randomized controlled clinical trial in a 2×2 factorial design [in German; English abstract]. Forsch Komplementarmed Klass Naturheilkd. 2000;7:286-293.

15. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.

16. Glover JR, Morris JG, Khosla T. Back pain: a randomized clinical trial of rotational manipulation of the trunk. Br J Ind Med. 1974;31:59-64.

17. Triano JJ, McGregor M, Hondras MA, et al. Manipulative therapy versus education programs in chronic low back pain. Spine. 1995;20:948-955.

18. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860-2873.

19. Leibing E, Leonhardt U, Koster G, et al. Acupuncture treatment of chronic low-back pain—a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain. 2002;96:189-196.

20. Newswanger DL, Patel AT, Ogle A. Osteopathic medicine in the treatment of low back pain. Am Fam Physician. 2000;62:2414-2415.

21. Nielson WR, Weir R. Biopsychosocial approaches to the treatment of chronic pain. Clin J Pain. 2001;17:S114-127.

22. Hoehler FK, Tobis JS, Buerger AA. Spinal manipulation for low back pain. JAMA. 1981;245:1835-1838.

23. Pope MH, Phillips RB, Haugh LD, et al. A prospective randomized three-week trial of spinal manipulation, transcutaneous muscle stimulation, massage and corset in the treatment of subacute low back pain. Spine. 1994;19:2571-2577.

24. Hadler NM, Curtis P, Gillings DB, et al. A benefit of spinal manipulation as adjunctive therapy for acute low back pain: a stratified controlled trial. Spine. 1987;12:702-706.

25. Cherkin DC, Deyo RA, Battie M, et al. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med. 1998;339:1021-1029.

26. Shekelle PG, Adams AH, Chassin MR, et al. Spinal manipulation for low back pain. Ann Intern Med. 1992;117:590-598.

27. Gobel H, Heinze A, Ingwersen M, et al. Effects of Harpagophytum procumbens LI 174 (devil's claw) on sensory, motor and vascular muscle reagibility in the treatment of unspecific back pain. Schmerz. 2001;15:10-18.

28. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing traditional chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Arch Intern Med. 2001;161:1081-1088.

29. Mendelson G, Selwood TS, Kranz H, et al. Acupuncture treatment of chronic back pain. A double-blind placebo controlled trial. Am J Med. 1983;747:49-55.

30. Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Can Anaesth Soc J. 1976;23:303-306.

31. Baxter GD, Kerr DP, Walsh DM. Acupuncture in the management of chronic low back pain: a blinded randomised controlled trial [abstract]. FACT. 2001;6:70-71.

32. Duplan B, Cabanel G, Piton JL, et al. Acupuncture st lombosciatique a la phase aigue. Semin Hop Paris. 1983;59:310-3114. Cited by: Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.

33. Grant DJ, Bishop-Miller J, Winchester DM, et al. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain. 1999;82:9-13.

34. Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbagia and ischialgia. Am J Chin Med. 1976;4:169-175.

35. Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther. 1999;22:376-381.

36. Ernst E, White AR. Acupuncture for back pain. A meta-analysis of randomized controlled trials. Arch Intern Med. 1998;158:2235-2241.

37. Wedenberg K, Moen B, Norling A. A prospective randomized study comparing acupuncture with physiotherapy for low-back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand. 2000;79:331-335.

38. Chrubasik S, Junck H, Breitschwerdt H, et al. Effectiveness of Harpagophytum extract WS 1531 in the treatment of exacerbation of low back pain: a randomized, placebo-controlled, double-blind study. Eur J Anaesthesiol. 1999;16:118-129.

39. Chrubasik S, Zimpfer CH, Schutt U, et al. Effectiveness of Harpagophytum procumbens in treatment of acute low back pain. Phytomedicine. 1996;3:1-10.

40. Andersson GB, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426-1431.

41. Aure OF, Hoel Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain: a randomized, controlled trial with 1-year follow-up. Spine. 2003;28:525-531.

42. Schiller L. Effectiveness of spinal manipulative therapy in the treatment of mechanical thoracic spine pain: a pilot randomized clinical trial. J Manipulative Physiol Ther. 2001;24:394-401.

43. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation and mobilisation for back and neck pain: a blinded review. BMJ. 1991;303:1298-1303.

44. Klein G, Kullich W. Reducing pain by oral enzyme therapy in rheumatic diseases [translated from German]. Wien Med Wochenschr. 1999;149:577-580.

45. Jayson MIV, Sims-Williams H, Young S, et al. Mobilization and manipulation for low-back pain. Spine. 1981;6:409-416.

46. Farrell JP, Twomey LT. Acute low back pain. Comparison of two conservative treatment approaches. Med J Aust. 1982;1:160-164.

47. Dechow E, Davies RK, Carr AJ, et al. A randomized, double-blind, placebo-controlled trial of sclerosing injections in patients with chronic low back pain. Rheumatology (Oxford). 1999;38:1255-1259.

48. Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy injections, saline injections, and exercises for chronic low-back pain: a randomized trial. Spine. 2004;29:9-16.

49. Assendelft WJJ, Morton SC, Yu EI, et al. Spinal manipulative therapy for low back pain. A meta-analysis of effectiveness relative to other therapies. Ann Int Med. 2003;138:871-881.

50. Ferreira ML, Ferreira PH, et al. Efficacy of spinal manipulative therapy for low back pain of less than three months' duration. J Manipulative Physiol Ther. 2003;26:593-601.

51. Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. J Manipulative Physiol Ther. 2004;27:388-398.

52. Cherkin DC, Sherman KJ, Deyo RA, et al. A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Int Med. 2003;138:898-906.

53. Kerr DP, Walsh DM, Baxter D. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. Clin J Pain. 2003;19:364-370.

54. Frerick H, Keitel W, Kuhn U. Topical treatment of chronic low back pain with a capsicum plaster. Pain. 2003;106:59-64.

55. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-1362.

56. Ernst E, Canter PH. The Alexander Technique: a systematic review of controlled clinical trials. Forsch Komplementarmed Klass Naturheilkd. 2003;10:325-329.

57. Santilli V, Beghi E, Finucci S. Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. Spine J. 2006;6:131-137

58. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006;166:450-457.

59. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]

60. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. 2006 Feb 17. [Epub ahead of print]

61. Kucera M, Barna M, Horacek O, et al. Topical symphytum herb concentrate cream against myalgia: a randomized controlled double-blind clinical study. Adv Ther. 2005;22:681-692.

62. Williams KA, Petronis J, Smith D, et al. Effect of Iyengar yoga therapy for chronic low back pain. Pain. 2005;115:107-117.

63. Sherman KJ, Cherkin DC, Erro J, et al. Comparing yoga, exercise, and a self-care book for chronic low back pain. A randomized, controlled trial. Ann Intern Med. 2005;143:849-856.

64. Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain. Cochrane Database Syst Rev. 2005;CD000335.

65. van Tulder MW, Koes B, Malmivaara A, et al. Outcome of non-invasive treatment modalities on back pain: an evidence-based review. Eur Spine J. 2005 Dec 1. [Epub ahead of print]

66. Pittler MH, Karagulle MZ, Karagulle M, et al. Spa therapy and balneotherapy for treating low back pain: meta-analysis of randomized trials. Rheumatology (Oxford). 2006;45:880-884.

67. Balogh Z, Ordogh J, Gasz A, et al. Effectiveness of balneotherapy in chronic low back pain—a randomized single-blind controlled follow-up study. Forsch Komplementarmed Klass Naturheilkd. 2005;12:196-201.

68. Eisenberg DM, Post DE, Davis RB, et al. Addition of choice of complementary therapies to usual care for acute low back pain: a randomized controlled trial. Spine. 2007;32:151-158.

69. Morone NE, Greco CM, Weiner DK. Mindfulness meditation for the treatment of chronic low back pain in older adults: A randomized controlled pilot study. Pain. 2007 May 31. [Epub ahead of print]

70. Khoromi S, Blackman MR, Kingman A, et al. Low intensity permanent magnets in the treatment of chronic lumbar radicular pain. J Pain Symptom Manage. 2007 Jul 6. [Epub ahead of print]

71. Collacot EA, Zimmerman JT, White DW, et al. Bipolar permanent magnets for the treatment of chronic low back pain: a pilot study. JAMA. 2000;283:1322-1325.

72. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007;167:1892-1898.

73. Yousefi-Nooraie R, Schonstein E, Heidari K, et al. Low level laser therapy for nonspecific low-back pain. Cochrane Database of Systematic Reviews. 2008;(2):CD005107.

74. Wilkey A, Gregory M, Byfield D, et al. A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. J Altern Complement Med. 2008;14:465-473.

75. Tekur P, Singphow C, Nagendra HR, et al. Effect of short-term intensive yoga program on pain, functional disability and spinal flexibility in chronic low back pain: a randomized control study. J Altern Complement Med. 2008;14:637-644.

76. Juni P, Battaglia M, Nuesch E, et al. A randomised controlled trial of spinal manipulative therapy in acute low back pain. Ann Rheum Dis. 2008 Sep 5.

77. Furlan AD, Imamura M, Dryden T, Irvin E. Massage for low-back pain. Cochrane Database Syst Rev. 2008;CD001929.

78. Little P, Lewith G, Webley F, et al. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ. 2008;337:a884.

79. Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2008;33:E887-900.

80. Cherkin DC, Sherman KJ, AVins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med. 2009;169:858-866.

81. Dagenais S, Yelland M, Del Mar C, Schoene M. Prolotherapy injections for chronic low back pain. Cochrane Database of Systematic Reviews. 2007;2.

82. Dagenais S, Mayer J, Haldeman S, Borg-Stein J. Evidence-informed management of chronic low back pain with prolotherapy. Spine J 2008 Jan-Feb;8(1):203-12.