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

Abstract

Sciatica is a condition often accompanied by neuropathic pain (NP). Acupuncture and dry needling are common treatments for pain, and the current literature supports acupuncture as an effective treatment for sciatica. However, it is unknown if the mechanisms of NP are considered in the delivery of needling interventions for sciatica. Our objective was to assess the efficacy and the effectiveness of needling therapies, to identify common needling practices and to investigate if NP mechanisms are considered in the treatment of sciatica. A scoping review of the literature on needling interventions for sciatica and a review of the literature on mechanisms related to NP and needling interventions were performed. Electronic literature searches were conducted on PubMed, MEDLINE, CINAHL and Cochrane Database of Systematic Reviews from inception to August, 2020 to identify relevant papers. Reference lists of included papers were also manually screened and a related-articles search through PubMed was performed on all included articles. Mapping of the results included description of included studies, summary of results, and identification of gaps in the existing literature. Ten articles were included. All studies used acupuncture for the treatment of sciatica, no studies on dry needling were identified. Current evidence supports the efficacy and effectiveness of acupuncture for sciatica, however, no studies considered underlying NP mechanisms in the acupuncture approach for sciatica and the rationale for using acupuncture was inconsistent among trials. This review reveals that neuropathic pain mechanisms are not routinely considered in needling approaches for patients with sciatica. Studies showed acupuncture to be an effective treatment for sciatic pain, however, further research is warranted to explore if needling interventions for sciatica and NP would be more effective if NP mechanisms are considered.

Magnetic resonance imaging assessment of the therapeutic effect of combined electroacupuncture and stem cells in acute peripheral nerve injury

“…SD rat adolescent bone marrow MSCs were collected and grown as previously described (Chen et al, 2017 ). On the second day following injury, animals in groups A and B underwent electroacupuncture by stimulating Huantiao (GB30) and Zusanli (ST36; Perreault et al, 2021 ; Yu et al, 2022 ). In addition, at the time of modeling, animals in groups A and C received subepidermal microinjections of 5 × 10 5 BMSCs suspended in phosphate-buffered saline (PBS) with a final volume of 3.0 μl.…”

Ultrasound‐guided percutaneous electrical nerve stimulation versus surgery for women with unilateral carpal tunnel syndrome: A randomized parallel‐group trial

“…A previous clinical trial found that manual therapy, when applied using current knowledge on altered pain processing, gets better short-term and similar long-term effects at 1 year (Fernández-de-las Peñas et al, 2015) and 4 years (Fernández-de-las-Peñas et al, 2020) on pain and function as compared with surgery in women with CTS. The results observed in our trial when applying PENS were like those previously observed with manual therapy at 1-year follow-up (Fernández-de-las Peñas et al, 2015).…”

“…The presence of altered nociceptive processing may explain the heterogeneity in the clinical outcomes observed in clinical trials. For example, Perreault et al (2021) found that pain mechanisms are not routinely considered in trials investigating needling approaches for neuropathic pain conditions. Accordingly, the aim of this randomized clinical trial was to investigate if the application of PENS targeting the median nerve is effective for improving pain and function in women with CTS as compared to surgery.…”

Suggesting a mechanism for acupuncture as a global percutaneous needle fasciotomy that respects tensegrity principles for treating fibromyalgia

“…Used often to treat myofascial pain and trigger/tender points, dry needling can be extremely painful for the patient (29), some might even call it abusive. In dry needling for myofascial trigger-points, a needle is often inserted forcefully and repeatedly deep into the trigger/tender point during a session (e.g., fast-in and fast-out/pistoning/sparrow pecking maneuver, possibly in a fan or cone shape), with the purpose of "destroying" the trigger point or trying to induce edema, positive inflammation, and self-healing processes; or aiming to relieve the pain through spinal cord afferent signaling or other mechanisms (42)(43)(44)(45). However, as many clinicians' experiences might indicate, these mysterious painful points recur a short while after treatment too often, if not in the same site, then in a different one.…”