Efficacy and Safety of Acupuncture and Acupuncture-Combined Therapies in the Treatment of Sciatica Caused by Lumbar Disc Herniation: A Network Meta-Analysis.

Purpose: Sciatica is a common complication of lumbar disc herniation (LDH). This network meta-analysis compared the efficacy of acupuncture monotherapies, acupuncture versus conventional rehabilitation, and acupuncture monotherapy versus combination therapies for LDH-related sciatica.

Patients and methods: We systematically searched PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, CQVIP, and CBM. Bayesian network meta-analysis was performed using RStudio and GEMTC. STATA generated network and funnel plots. Treatment rankings were assessed using the Surface Under the Cumulative Ranking curve (SUCRA). Bias risk was evaluated with the Cochrane Risk of Bias tool 2.0.

Results: According to SUCRA, in terms of total effective rate, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 92.93%); in terms of VAS, the better intervention was needle knife combined with rehabilitation therapy (NK+RT, 95.96%); in terms of ODI, the more effective intervention was electroacupuncture combined with cupping therapy (EA+Cupping, 98.03%); in terms of JOA, the best intervention was electrostimulation combined with rehabilitation therapy (ES+RT, 88.27%); in terms of IL-6 and TNF-α, the better intervention was electroacupuncture combined with electrostimulation (EA+ES, 99.99%).

Conclusion: Acupuncture combined with other therapies demonstrates superior efficacy compared to rehabilitation treatment. Specifically, NK+RT is possibly a more effective intervention for pain relief; EA+Cupping shows a better benefit in improving disability and quality of life; ES+RT is likely a more effective strategy for promoting neurological recovery; and EA+ES is possibly better in reducing inflammatory responses.