Can Acupuncture Help Chronic

Sciatica From a Herniated Disc?

Sciatica can cause much more than occasional low back

discomfort.

For many patients, pain travels from the lower back or

buttock into the leg, sometimes accompanied by numbness,

tingling, weakness, or difficulty sitting, walking, working, and

sleeping.

One of the most common causes is a lumbar herniated disc,

which can irritate or compress a nerve root that contributes

to the sciatic nerve.

Acupuncture is widely used for sciatica, but an important

clinical question is:

Does acupuncture provide meaningful relief beyond a credible sham treatment?

A 2024 randomized clinical trial published in JAMA Internal Medicine directly examined this question in patients with chronic sciatica caused by a herniated lumbar disc.

The results were notable.

After four weeks, leg pain in the acupuncture group decreased by approximately 51% from baseline, while patients receiving sham acupuncture also improved — but substantially less.

The difference between the two groups was approximately 16 mm on a 100-mm pain scale, favoring acupuncture. That difference exceeded the threshold the researchers had prespecified as clinically meaningful.

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Key Takeaways

• The study was a multicenter randomized clinical trial comparing acupuncture with sham acupuncture in patients with chronic sciatica from a herniated disc.

• A total of 216 patients were included in the final analysis.

• After four weeks, leg pain decreased by 30.8 mm from a baseline of about 60 mm in the acupuncture group — approximately a 51% reduction.

• Sham acupuncture also reduced pain, by 14.9 mm.

• Acupuncture produced an additional 16.0-mm reduction in leg pain compared with sham acupuncture.

• The between-group difference exceeded the study's prespecified 15-mm threshold for clinically meaningful improvement.

• Disability also improved significantly more with acupuncture.

• Differences between acupuncture and sham treatment appeared by week 2 and remained statistically significant through 52 weeks.

• No serious adverse events were reported.

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What Is Sciatica?

Sciatica describes pain that travels along the distribution of the sciatic nerve.

Patients often describe symptoms such as:

• pain beginning in the lower back or buttock

• pain traveling down one leg

• burning or electric sensations

• tingling or numbness

• pain aggravated by sitting, bending, coughing, or certain movements

In many patients, sciatica is related to a herniated lumbar disc.

When disc material irritates or compresses a nearby nerve root, the result may be both:

Mechanical pressure on the nerve

and:

Local inflammation around the nerve root

This combination can contribute to radiating leg pain and persistent nerve sensitivity. The JAMA paper notes that lumbar disc herniation with nerve-root compression and inflammation accounts for a large proportion of sciatica cases.

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What Did the JAMA Internal Medicine Trial Study?

The researchers conducted a multicenter randomized clinical trial comparing:

Acupuncture

with:

Sham acupuncture

Participants had chronic sciatica associated with lumbar disc herniation.

A total of 216 patients were included in the analysis:

108 in the acupuncture group

and:

108 in the sham acupuncture group.

The average age was approximately 51 years, and the median duration of sciatica was about 3 years.

Treatment was provided over four weeks, and participants were followed for a full year.

The two primary outcomes were:

Leg pain

measured using a 0-to-100 mm visual analog scale, or VAS,

and:

Disability

measured using the Oswestry Disability Index, or ODI.

 

How Much Did Leg Pain Improve?

This was the most striking finding.

At the beginning of the study, average leg pain in the acupuncture group was approximately:

60 out of 100

After four weeks, the researchers reported an average decrease of:

30.8 mm

That represents approximately:

51% less leg pain from baseline

in the acupuncture group.

By comparison, the sham acupuncture group improved by:

14.9 mm

during the same four-week period.

This is important because both groups improved.

The study therefore was not simply showing that patients felt better after receiving treatment.

Instead, researchers were able to ask a more demanding question:

Did real acupuncture outperform a credible sham treatment?

The answer was yes.

 

How Much Better Was Acupuncture Than Sham Acupuncture?

At week 4, the difference in leg pain between the groups was:

16.0 mm in favor of acupuncture

95% confidence interval:

10.6 to 21.3 mm

with:

P < .001.

This is one of the most important features of the study.

Before the trial began, the researchers had defined:

15 mm

as the minimum difference that would be considered clinically meaningful for leg pain.

The actual difference was:

16 mm

meaning the effect exceeded that prespecified threshold.

So the result was not only statistically significant.

It also crossed the study's predefined threshold for a clinically important difference.

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Why Is the Sham Comparison Important?

Sham-controlled studies are particularly useful in acupuncture research.

Patients may improve for many reasons, including:

• natural changes in symptoms over time

• expectations about treatment

• attention from a clinician

• relaxation

• participation in a structured treatment program

A well-designed sham comparison helps researchers separate these effects from the additional benefit associated with the actual acupuncture intervention.

In this trial, participants, outcome assessors, and statisticians were blinded to treatment assignment, and testing suggested that participant blinding was successful.

That makes the approximately 16-mm additional pain reduction particularly meaningful.

​

How Quickly Did Acupuncture Begin to Separate From Sham Treatment?

The difference did not appear only at the end of treatment.

By:

Week 2

leg pain was already significantly lower in the acupuncture group.

The between-group difference was approximately:

7.8 mm

with:

P = .004.

At:

Week 4

the difference increased to:

16.0 mm

favoring acupuncture.

This suggests that the treatment effect developed progressively during the four-week treatment period.

 

Did the Improvement Last?

Yes.

One of the most interesting parts of the study was the duration of follow-up.

Treatment itself occurred over only four weeks, but researchers continued to evaluate patients for:

52 weeks

At week 8, the acupuncture group still had significantly less leg pain than the sham group.

The difference was:

13.4 mm

At week 26:

11.6 mm

And at week 52:

10.8 mm

favoring acupuncture.

All of these differences remained statistically significant.

At one year, mean leg pain scores were approximately:

22.8 / 100 in the acupuncture group

versus:

33.6 / 100 in the sham group.

So although the size of the between-group difference became smaller over time, the acupuncture group continued to report significantly less leg pain one year after the study began.

​

What About Function and Disability?

Pain is only one part of sciatica.

For many patients, the bigger problem is what the pain prevents them from doing.

The study measured disability using the:

Oswestry Disability Index — ODI

At week 4, disability improved by:

13.0 points

in the acupuncture group,

compared with:

4.9 points

in the sham group.

The difference between groups was:

8.1 points

with:

P < .001.

The study had defined:

7 ODI points

as the minimum clinically important difference.

Again, the observed difference exceeded that threshold.

This means the study found evidence not only of less pain, but also of meaningful improvement in day-to-day function.

​

Did Functional Improvement Last?

Yes.

The difference in disability between acupuncture and sham treatment remained statistically significant throughout the follow-up period.

The between-group difference was approximately:

• 5.3 points at week 2

• 8.1 points at week 4

• 7.9 points at week 8

• 7.4 points at week 26

• 4.7 points at week 52

The greatest differences were seen during the earlier and middle portions of follow-up, but a statistically significant advantage remained at one year.

​

What About Low Back Pain?

Although the primary pain outcome was radiating leg pain, the researchers also measured low back pain.

At week 4, back pain scores were approximately:

27.0 in the acupuncture group

versus:

39.6 in the sham group.

At week 52:

21.9 in the acupuncture group

versus:

33.3 in the sham group.

These differences were also statistically significant.

This is clinically relevant because many people with disc-related sciatica experience both:

radiating leg pain

and:

low back pain.

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How Might Acupuncture Help Sciatic Nerve Pain?

The study tells us that acupuncture produced better clinical outcomes than sham treatment.

It does not by itself establish one single biological mechanism.

However, several mechanisms are being studied that may help explain why acupuncture can influence pain associated with sciatica.

1. Nerve Root Inflammation

A herniated disc does not cause sciatica only by mechanically pressing on a nerve.

Inflammation around the affected nerve root can also contribute to:

• irritation

• hypersensitivity

• radiating pain

• prolonged nerve symptoms

Modern pain research increasingly recognizes that sciatica involves both mechanical and inflammatory components.

Acupuncture is being studied for its potential influence on inflammatory signaling and local pain-related biological processes.

This may be one reason researchers are interested in acupuncture for nerve-root-related pain.

2. Pain Signaling in the Nervous System

Pain is not simply a signal traveling from the leg to the brain.

Pain intensity is also influenced by how the spinal cord and brain process those signals.

Acupuncture has been studied for its effects on:

pain-modulating pathways

including neural systems involved in reducing or amplifying pain signals.

One proposed explanation is that acupuncture may help activate the body's own pain-regulating systems.

This could potentially reduce how strongly persistent nerve irritation is experienced as pain.

3. Endogenous Pain-Relief Mechanisms

The human nervous system produces its own pain-modulating substances.

Researchers have investigated acupuncture's relationship with neurotransmitters and endogenous opioid systems involved in pain control.

In simple terms, acupuncture may interact with some of the same internal systems the body naturally uses to regulate pain.

This does not mean acupuncture acts like a conventional pain medication.

Rather, it is one of several biological pathways researchers are exploring.

4. Muscle Guarding and Movement

Chronic sciatica can change the way a person moves.

Pain may lead to:

• muscle guarding

• stiffness

• reduced activity

• altered movement patterns

• fear of certain movements

These changes can sometimes contribute to an ongoing cycle of pain and disability.

By reducing pain and sensitivity, acupuncture may make it easier for some patients to move more comfortably and resume normal activity.

This may help explain why improvements in this trial were seen not only in pain scores but also in disability scores.

​

A Simple Way to Think About Sciatica and Acupuncture

A herniated disc may contribute to:

Nerve-root irritation or compression

↓

Inflammation and increased nerve sensitivity

↓

Radiating leg pain

↓

Muscle guarding and reduced movement

↓

Functional limitation

Acupuncture may potentially influence several parts of this process:

Pain signaling

Neural pain modulation

Inflammatory signaling

Muscle tension and movement tolerance

The JAMA study does not prove exactly which of these mechanisms produced the observed benefit.

But the clinical findings show that patients receiving acupuncture experienced greater improvements in both pain and function than those receiving sham acupuncture.

​

How Meaningful Is a 51% Reduction in Pain?

The approximately 51% reduction refers to the improvement within the acupuncture group from baseline to week 4.

Patients began with average leg pain of approximately 60 mm on a 100-mm scale.

The reported mean decrease was:

30.8 mm

which is approximately:

51% of the baseline pain level.

This is a useful way to understand the magnitude of improvement experienced by the acupuncture group.

But it is important to distinguish this from the comparison with sham acupuncture.

The sham group also improved.

Therefore, the more rigorous comparison is:

Acupuncture improved leg pain by approximately 16 mm more than sham acupuncture.

Both numbers are useful.

They answer two different questions:

How much did the acupuncture group improve?

Approximately 51% from baseline.

And:

How much additional improvement occurred compared with sham treatment?

Approximately 16 mm on a 100-mm pain scale.

​

What Did the Researchers Conclude?

The authors concluded that acupuncture resulted in:

less pain

and:

better function

than sham acupuncture in patients with chronic sciatica associated with a herniated disc.

They also noted that these benefits remained evident through the 52-week follow-up period.

The authors stated that acupuncture should be considered a potential treatment option for chronic sciatica from a herniated disc.

​

Was Acupuncture Safe in This Study?

No serious adverse events were reported.

Minor acupuncture-related effects did occur more often with acupuncture than with sham treatment.

These were generally mild and self-limited, including issues such as:

• minor bleeding

• bruising

The study did not identify a serious safety signal associated with acupuncture treatment.

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When Does Sciatica Need Medical Evaluation?

Sciatica often improves with conservative care, but some symptoms require prompt medical evaluation.

Patients should seek medical attention when sciatica is associated with symptoms such as:

• significant or progressive leg weakness

• difficulty controlling the bladder or bowel

• numbness in the saddle or groin area

• major trauma

• severe or rapidly worsening neurological symptoms

These symptoms may indicate a more serious neurological problem requiring urgent medical assessment.

For persistent sciatica, appropriate evaluation can also help determine whether symptoms are related to a herniated disc or another cause.

​

What Does This Study Mean for Patients With Chronic Sciatica?

This trial provides strong clinical evidence that acupuncture can offer meaningful symptom improvement for patients with chronic sciatica associated with lumbar disc herniation.

The findings are notable for several reasons:

Pain improved substantially.

The acupuncture group experienced approximately a 51% reduction in leg pain over four weeks.

Acupuncture outperformed sham treatment.

The additional improvement was approximately 16 mm on a 100-mm pain scale, exceeding the trial's prespecified threshold for clinical importance.

Function also improved.

Disability improved significantly more with acupuncture than with sham treatment.

Benefits were not limited to the treatment period.

Differences remained statistically significant through the study's 52-week follow-up.

Taken together, these findings support acupuncture as a potential non-surgical treatment option for chronic sciatica associated with a herniated disc.

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The Bigger Picture: Acupuncture and Chronic Pain Research

Modern acupuncture research is increasingly moving beyond the question:

“Does acupuncture help pain?”

Better clinical trials are asking more specific questions:

Which type of pain?

Which patients?

Compared with what control treatment?

Does the improvement reach a clinically meaningful threshold?

Does function improve as well as pain?

And does the effect persist after treatment ends?

This JAMA Internal Medicine study is particularly useful because it addressed several of these questions simultaneously.

It compared acupuncture with a credible sham intervention, evaluated both pain and disability, established clinically meaningful thresholds in advance, and followed patients for one year.

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Our Perspective

Chronic sciatica can significantly affect mobility, work, sleep, exercise, and quality of life.

The findings of this randomized clinical trial are encouraging.

After four weeks, patients receiving acupuncture experienced approximately a 51% reduction in leg pain from baseline, while the direct comparison with sham acupuncture showed an additional 16-mm improvement favoring acupuncture.

The trial also found meaningful improvements in physical function, with benefits continuing to be measurable through one year.

At Balance Art Acupuncture, we believe research like this is important because it moves the conversation beyond whether acupuncture simply “feels helpful.”

It asks whether acupuncture can produce measurable, clinically meaningful improvements when compared with a credible control treatment.

For patients with persistent sciatica related to a herniated disc, these findings provide evidence that acupuncture may be a valuable component of a conservative pain-management approach.

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Original Research

Tu J, Shi G, Yan S, et al.

Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk: A Randomized Clinical Trial.

JAMA Internal Medicine. 2024;184(12):1417–1424.

DOI:

10.1001/jamainternmed.2024.5463

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About the Author

Run Guo, L.Ac., DAOM
Licensed Acupuncturist | Clinician & Educator
Balance Art Acupuncture | Vienna, Virginia

Run Guo, L.Ac., DAOM, is a licensed acupuncturist with more than 15 years of clinical practice and university-level teaching experience in acupuncture and related integrative health approaches. His clinical practice provides more than 10,000 patient visits annually, giving him extensive experience in the real-world application of acupuncture across a broad range of patient needs.

Alongside his clinical work, Run Guo has been involved in university-level education in acupuncture for more than a decade, combining hands-on clinical experience with an academic perspective on the field.

Through Balance Art Acupuncture's Research & Insights series, he reviews emerging peer-reviewed research in acupuncture, electroacupuncture, neuroscience, pain medicine, reproductive health, immunology, and modern biomedical science, translating complex scientific findings into clear, evidence-informed, and balanced information for patients and the general public.

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