Sciatica and lumbar disc herniation

Sciatica is pain that runs from the lower back or buttock down one leg along the path of the sciatic nerve, and a herniated lumbar disc pressing on a nerve root is its common cause, as the authors of a 2024 trial in JAMA Internal Medicine note. Trials of acupuncture for it measure leg pain on a visual analogue scale (VAS) of 0 to 100 mm and disability on the Oswestry Disability Index (ODI), a questionnaire about daily activities scored from 0 to 100. Many trials from China report a total effective rate instead: the share of patients whose symptoms the investigators judged to have improved totally or partly, as a 2015 review by Ji and colleagues defines it. Some trials compare acupuncture with sham acupuncture, a procedure made to resemble it, and others with drugs, traction or other kinds of acupuncture; Sham acupuncture describes the kinds in use.

No Cochrane review

Cochrane has not published a review of acupuncture for sciatica or for lumbar disc herniation. Its 2020 review of acupuncture for chronic nonspecific low back pain, by Mu and colleagues, included 33 studies with 8,270 participants and excluded trials of back pain with a specific cause, so its findings do not extend to pain from a herniated disc; Low back pain reports them. The nearest Cochrane review on the nerve side is Ju and colleagues’ 2017 review of acupuncture for neuropathic pain, which found six studies with 462 adults with chronic peripheral neuropathic pain, rated the evidence very low in quality, and concluded that it could neither support nor refute acupuncture for neuropathic pain in general or for any specific neuropathic condition. Cochrane marks that review stable, with no update expected.

Later reviews

Only the 2026 review by Qu and colleagues pooled trials against sham separately. It expressed results as a standardised mean difference (SMD), the gap between groups divided by the spread of scores, where 0.8 or more counts as large. The review found leg pain lower with acupuncture across all 11 trials (SMD −1.08) and in the 4 sham-controlled trials (SMD −1.05), and disability was lower in 7 trials that reported the ODI (SMD −0.57). Heterogeneity, the degree to which trial results disagree beyond chance, was high (I² 74%). Almost all the trials were run in China, and the authors called for cautious interpretation because of methodological limitations and differences in points, technique and frequency between trials.

The reviews against drugs pool mostly total effective rates. The 2023 review by Zhang and colleagues found a higher total effective rate with acupuncture than with drug treatment (risk ratio 1.25, moderate certainty) and lower pain scores (very low certainty), and fewer recurrences on low-certainty evidence. The 2022 review by Han and colleagues, against painkillers, reported a total effective rate risk ratio of 1.20 and lower VAS scores in 7 trials with 589 people. The 2018 review by Tang and colleagues found higher total effective rates with acupuncture than with traction, ibuprofen, diclofenac and meloxicam, and asked for rigorously designed large trials to confirm them.

The 2025 network meta-analysis by Ni and colleagues ranked acupuncture combined with cupping, a needle-knife procedure, rehabilitation or electrical stimulation highest on different outcomes. Its 94 trials came from China and South Korea; none reported concealing the allocation of patients to groups, and six reported any blinding. A 2025 overview of seven earlier reviews by Zhang and colleagues rated them with AMSTAR-2 and ROBIS, two tools for judging how a review was conducted, and found serious methodological flaws, a high risk of bias, generally poor reporting and funnel plots that suggested publication bias, the tendency for positive trials to reach print more often than negative ones.

Trials against sham

A 2019 single-centre trial by Huang and colleagues randomised 46 people with chronic sciatica from a disc to 12 sessions of acupuncture or sham over four weeks, both at the same traditional points. Weekly leg pain over the four weeks was 7.3 mm lower with acupuncture on the 100 mm scale, which the authors judged larger than the minimum clinically important difference of 5 mm. Back pain, ODI and quality of life did not differ significantly between groups over the 28 weeks of follow-up.

The largest sham-controlled trial is the 2024 JAMA Internal Medicine trial by Jian-Feng Tu and colleagues at Beijing University of Chinese Medicine, run at six hospitals in China. It randomised 220 adults and analysed 216. Its published protocol required leg pain below the knee in one leg for more than 3 months, a disc herniation confirmed on MRI or CT, and leg pain of at least 40 mm. Under the protocol, every acupuncture patient was to be needled at BL25 (Dachangshu) and BL26 (Guanyuanshu) on both sides, plus five points on the painful leg chosen by where the pain ran: down the side of the leg along the gallbladder channel, starting with GB30 (Huantiao), or down the back along the bladder channel, including BL54 (Zhibian) and BL40 (Weizhong). Sham patients were to have blunt needles pressed onto foam pads at non-acupoints without piercing the skin, except at one site needled 25 to 40 mm deep, with no attempt to provoke the needling sensation called de qi. Both groups had 10 sessions over four weeks, and patients, outcome assessors and statisticians were blinded.

• At week 4, leg pain had fallen by 30.8 mm with acupuncture and 14.9 mm with sham, a difference of 16.0 mm.
• ODI disability had fallen by 13.0 and 4.9 points, a difference of 8.1.
• At week 52, the differences were 10.8 mm for leg pain and 4.8 points on the ODI.

No serious adverse events occurred. The authors concluded that acupuncture should be considered as a potential treatment option for chronic sciatica from a herniated disc.

What guidelines say

The National Institute for Health and Care Excellence (NICE) guideline NG59, on low back pain and sciatica in people over 16, was published in November 2016 and last updated in July 2026. Recommendation 1.2.8 says not to offer acupuncture for managing low back pain with or without sciatica. It is marked 2016, the year of its last evidence review: the update record shows that the 2020 update added drug recommendations for sciatica and the July 2026 update withdrew the recommendations on psychological therapy, and neither revisited acupuncture. In the 2016 full guideline, the committee found no clinically significant improvement against sham in trials that mixed people with and without sciatica, and identified no evidence for people with sciatica as a group of their own.

The American College of Physicians’ 2017 guideline on noninvasive treatment of low back pain recommends acupuncture among the first non-drug options for chronic low back pain (moderate-quality evidence) and for acute or subacute pain (low-quality evidence), without a separate recommendation for sciatica. Its evidence review by Chou and colleagues covered radicular pain, which spreads down the leg from a nerve root, as well as back pain alone. ACP now lists the 2017 guideline among its inactive guidelines. Clinical guidelines compares other bodies’ positions.

What the reviews could not settle

The trials against sham are few, and the 2024 trial carries most of their weight. No review has rated the certainty of the sham comparison with GRADE, and the reviews that did grade their findings compared acupuncture with drugs, mostly through total effective rates, which the investigators judge themselves. Nearly every trial in these reviews was run in China; Where the trials come from discusses what the country of a trial tells a reader. The points, techniques and number of sessions differ from trial to trial, so the reviews could not say which prescription the pooled results describe. NICE’s recommendation rests on an evidence review from 2016 that found no sciatica-specific trials and predates both sham trials described above.

AcuiQ’s sciatica and lumbar disc herniation pages list the protocols individual studies prescribed, each with its citation.