Sciatica, a common clinical neuropathic pain, can be primary or secondary, radicular or trunkal, and acute or chronic. Acupuncture generally yields good results for sciatica, provided the technique is correctly applied. However, in secondary cases where the pain's cause cannot be eliminated by acupuncture, the treatment may not be effective.
When sciatica is caused by lumbar-sacral spine issues, it often coexists with lower back pain. Primary sciatica, also known as sciatic neuritis, is rare in clinical practice, whereas secondary sciatica is usually due to nearby tissue pathology affecting the sciatic nerve along its path. Depending on the location of the pathology, it can be classified into radicular and trunkal sciatica.
Radicular sciatica, often caused by lumbar disc herniation, is the most common clinical form. It can also be due to spinal osteoarthritis, such as degenerative changes in the lumbar spine. This condition typically worsens with coughing, sneezing, and straining, and presents as radiating pain. Tenderness is most noticeable over the affected lumbar vertebrae and transverse processes, while along the sciatic nerve path, tenderness is less pronounced or absent.
Trunkal sciatica mainly occurs outside the spinal canal, common causes include lumbosacral plexus and sciatic nerve trunk pathologies like sacroiliac joint arthritis, Piriformis syndrome, endometriosis, or tumor compression. In these cases, significant tenderness can usually be detected at specific nerve points: the "sciatic foramen point" near the upper margin of the sciatic foramen, corresponding to the Zhibian acupoint; the "trochanter point" between the ischial tuberosity and trochanter, corresponding to the Huantiao acupoint; the "popliteal point" in the popliteal fossa, corresponding to the Weizhong acupoint; the "fibular point" below the head of the fibula; the "ankle point" behind the medial malleolus at the lateral plantar nerve of the tibial nerve; and the "central metatarsal point" in the center of the foot sole. Tenderness in muscles is most apparent in the gastrocnemius and soleus muscles. Sensory abnormalities like paresthesia, burning, and numbness may also occur along the lateral calf and dorsal foot. In acupuncture treatment for all types of sciatica, patients with numbness as the main symptom are generally harder to treat than those with pain. Direct stimulation of the aforementioned nerve points to achieve a tingling electric sensation, employing nerve trunk (point) acupuncture, is often an effective strategy.
The effectiveness of acupuncture in treating sciatica can be evaluated both objectively and subjectively. Objectively, the straight leg raise test or Lasegue sign, which is often positive during sciatic attacks, is used. Subjectively, the patient's pain perception improvement while lying down and standing for 10 minutes, as well as the reduction in painkiller dosage, are considered.
For patients with chronic, intractable sciatica, like other chronic pain sufferers, concurrent neurasthenia should be considered. Treating neurasthenia can expedite sciatica recovery. These patients often have tenderness at the back of the head or crown, and can be treated with acupoints like Baihui, Shenmen, and Sanyinjiao, along with psychotherapy. Additionally, for women with irregular menstruation, menstrual regulation is essential; for those with constipation, addressing the bowel issues is important.
It's important to note that many patients diagnosed with lumbar disc herniation or lumbar degenerative changes can experience pain relief through acupuncture without surgery. This suggests that their pain is primarily due to nerve root compression caused by local soft tissue inflammation. Even after pain relief, the initial disc herniation or degenerative changes usually remain unchanged. Acupuncture's analgesic effect is likely through promoting hormone secretion and local blood circulation, thereby eliminating inflammation around the nerve root, nerve trunk, or its branches. Therefore, for acute sciatica caused by lumbar disc herniation, acupuncture should be the first treatment choice, with surgery considered only if acupuncture proves ineffective.