Sciatica is a common neuralgia characterized by pain radiating into the leg; it is usually caused by nerve root compression and irritation or inflammation of the sciatic nerve, and is often accompanied by lower back pain and neurological deficits in the lower limb. The pain is often associated with tingling, numbness and weakness of the leg; it may be sudden in onset and then persist for days or weeks. It is believed that 30% of patients live with sciatica for more than 1 year, which results in an obvious decrease in the quality of life.

Neuropathic pain results from damage to, or dysfunction of, the system that normally signals pain.

Neuropathic pain is often chronic, and can be severe and difficult to treat. The origin of neuropathic pain can be metabolic, inflammatory, infective or neoplastic, or can be due to an injury, compression or infiltration (e.g. by tumour) of peripheral nerves. Various conditions can cause neuropathic pain include diabetic neuropathy, postherpetic neuralgia and trigeminal neuralgia, pain following chemotherapy and HIV infection.

Neuropathic pain is commonly described as burning, stabbing, stinging, shooting, aching or electric shock-like in quality. The pain may superficial or deep, intermittent or constant, and can be spontaneous or be triggered by various stimuli.

Neuropathic pain, as the significant sample of sciatica, causes significant suffering for the individual, yet most of the currently available treatment options are not adequate to control pain. Pharmacological methods have associated adverse effects, while surgery is expensive and is not appropriate for every patient.

Acupuncture has been used for 3000 years in China and is generally regarded as a safe and effective measure to alleviate pain.

There is substantial research to show that acupuncture is significantly better than no treatment and also at least as good. Acupuncture can help relieve neuropathy pain and sciatica by stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord; reducing inflammation, by promoting release of vascular and immunomodulatory factors; improving muscle stiffness and joint mobility by increasing local microcirculation, which aids dispersal of swelling; influencing the neurotrophic factor signalling system, which is important in neuropathic pain; increasing levels of serotonin and noradrenaline, which can help reduce pain and speed nerve repair; etc.

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References:

Qin, ZS., et al. (2015). Acupuncture for treating sciatica: a systematic review protocol.  BMJ Open 5: e007498 doi:10.1136/bmjopen-2014-007498.

Koes, BW. et al (2007). Diagnosis and treatment of sciatica. BMJ 334: 1313-17.

Younes, M. et al. (2006) Prevalence and risk factors of disc-related sciatica in an urban population in Tunisia. Joint Bone Spine. 73: 538-42.

Galer,BS.(1995) Neuropathic pain of peripheral origin: advances in pharmacologic treatment. Neurology 45 (suppl 9): S17-25.

International Association for the Study of Pain (2007). IASP Pain terminology [online]. Available: www.iasp-pain.org/AM/Template.cfm?Section=Home&Template=/CM/HTMLDisplay.cfm&ContentID=3058#Neuropathic (last access 11/11/2015)

National Institute for Health and Clinical Excellence, 2010. CG96 Neuropathic pain – pharmacological management: full guideline [online]. Available: http://guidance.nice.org.uk/CG96/Guidance (last access 11/11/2015)

Smith, BH. and Torrance, N. (2010). Neuropathic pain. In: Croft PR, editor. Chronic pain epidemiology: from aetiology to public health. Oxford: Oxford University Press, in press (ISBN 9780199235766)

Sykes, J. et al. (1997). Difficult pain problems. BMJ; 315: 867-69.