<p>Acupotomy versus Manual Acupuncture for the Treatment of Back and/or Leg Pain in Patients with Lumbar Disc Herniation: A Multicenter, Randomized, Controlled, Assessor-Blinded Clinical Trial</p>

Abstract

Background: Acupotomy, which involves the addition of a scalpel function to the conventional acupuncture treatment, has recently been applied as a conservative treatment method for lumbar disc herniation (LDH). This study investigated the effectiveness and safety of acupotomy, compared to manual acupuncture, for the treatment of patients with LDH. Methods: A total of 146 patients diagnosed with LDH were randomly assigned to either the acupotomy group or the manual acupuncture group at a 1:1 ratio. Participants in both groups received four sessions of each intervention over 2 weeks. Outcome assessments based on the visual analog scale (VAS), Roland Morris Disability Questionnaire (RMDQ), Modified-Modified Schober Test (MMST), EuroQol Five Dimensions (EQ-5D), clinically important difference (CID), and patient global impression of change (PGIC) were conducted at baseline and at 2, 4, and 6 weeks post-randomization. Results: The acupotomy group showed significant improvement in VAS and MMST at 2, 4, and 6 weeks than did the manual acupuncture group. RMDQ was significantly different between the two groups at 2 and 6 weeks. In EQ-5D, there was no significant difference between the two groups. The proportion of patients with ≥15 mm decrease on the VAS (minimal CID) was significantly higher in the acupotomy group at weeks 2 and 4. Better improvement in the PGIC at week 4 was also observed in the acupotomy group. Postintervention muscle pain was reported, but there was no serious adverse event related to interventions. Conclusion: In this study, four sessions of acupotomy treatment were found to be effective in improving the pain intensity and range of motion of the lumbar region in patients with LDH. Despite post-treatment muscle pain, acupotomy treatment can be considered a preferred treatment method over manual acupuncture. Trial Registration: This trial has been registered 24 April 2018 in Clinical Research Information Service of South Korea (CRIS-KCT0002824).

Needling Interventions for Sciatica: Choosing Methods Based on Neuropathic Pain Mechanisms—A Scoping Review

“…Using our inclusion criteria, no studies on dry needling were identified cluded studies (n = 10) used acupuncture for treatment of sciatica and are out bles 3 and 4. The inclusion criteria for patients with sciatica varied across the s studies included participants with sciatica symptoms and clinical findings tha with MRI or CT confirmation of lumbar disc herniation [22,[38][39][40][41]. Three stud patients with a clinical diagnosis of sciatica based on nerve root pain and re [24,42,43].…”

“…Importantly, at week 28 follow-up only the EA group showed significantly decreased leg pain compared to the baseline, implying that the effect of EA but not electrotherapy lasted for 28 weeks. Jeong et al reported that acupuncture led to reductions in pain of 8.13 and 12.28 mm on the VAS at 4 and 6 weeks from baseline, respectively, in 70 patients with radicular symptoms consistent with lumbar disc herniation [ 39 ].…”

“…Two systematic reviews reported that all included trials used Traditional Chinese Medicine (TCM) theory [ 44 , 45 ], two selected points based on expert consensus and a previous study protocol [ 38 , 41 ], and one study used acupuncturist experience in addition to TCM theory [ 22 ]. In four studies the treatment rationale for use of acupuncture was either not explicitly stated [ 39 , 49 ] or could not be determined due to language barriers [ 24 , 42 , 43 ]. Interestingly, one recent trial applied a Western medicine approach by choosing acupuncture points for sciatica that were distributed along the L4, L5 and S1 dermatomes in addition to rationale based on TCM theory [ 22 ].…”

“…Regarding type of needle stimulation, EA was most frequently used in the included trials in the systematic reviews and meta-analysis studies followed by acupuncture. Within the selected randomized controlled trials, three used acupuncture exclusively [ 22 , 39 , 41 ] while one reported manual manipulation followed by electric needle stimulation [ 38 ]. Most reported the elicitation of de qi (needle sensation) and needle manipulations varied across studies between lift-thrust, twirling or a combination of both [ 22 , 39 , 40 ].…”

Acupuncture for gouty arthritis

“…[ 19 , 20 ] Acupotomy is a special technique of acupuncture conducting minimally invasive surgery using a needle with a flat blade shape and causes natural opioid-mediated pain suppression by stimulating local alpha–delta nerve fibers. [ 21 , 22 ] Fire-needling acupuncture is an acupuncture technique that inserts a heated acupuncture needle on the body to add cauterization effect, and it promotes microcirculation in the treated area through the regulation of cutaneous nerves, which is beneficial for the absorption of inflammatory metabolites. [ 23 ] Because various types of acupuncture are used for the treatment of gouty arthritis based on these mechanisms, additional analyses of each technique are required along with analysis of the entire acupuncture treatment.…”