Acupuncture for lumbar disc herniation: a systematic review and meta-analysis

Objective To evaluate evidence for the effectiveness of acupuncture in the treatment of lumbar disc herniation (LDH). Methods Electronic databases were searched to identify randomised controlled trials (RCTs) of acupuncture for LDH. A meta-analysis was conducted using RevMan 5.3 and the evidence level was assessed using GRADE methodology. Results Thirty RCTs involving 3503 participants were included in the study. Meta-analysis showed that acupuncture had a higher total effective rate than lumbar traction (RR=1.1, 95%CI 1.05 to 1.15; p<0.001), ibuprofen (RR=1.24, 95%CI 1.03 to 1.48; p=0.02), diclofenac sodium (RR=1.44, 95%CI 1.24 to 1.67; p<0.001) and meloxicam (RR=1.16, 95%CI 1.03 to 1.31; p=0.01). Acupuncture was also better than lumbar traction (SMD -1.33, 95%CI -1.82 to -0.84; p<0.001) and diclofenac sodium (SMD -1.36, 95%CI -2.59 to -0.13; p=0.03) in terms of visual analogue scale (VAS) scores, and better than lumbar traction (SMD 0.96, 95%CI 0.48 to 1.45; p=0.0001) with respect to Japanese Orthopaedic Association (JOA) scores. In addition, the total effective rate in five individual trials was greater for acupuncture than for mannitol plus dexamethasone and mecobalamin, ibuprofen plus fugui gutong capsule, loxoprofen, mannitol plus dexamethasone and huoxue zhitong decoction, respectively. Additionally, two individual trials showed a superior effect of acupuncture in VAS scores comparedwith ibuprofen or mannitol plus dexamethasone, respectively. Conclusions Acupuncture showed a more favourable effect in the treatment of LDH than lumbar traction, ibuprofen, diclofenac sodium, meloxicam, mannitol plus dexamethasone and mecobalamin, fugui gutong capsule plus ibuprofen, mannitol plus dexamethasone, loxoprofen and huoxue zhitong decoction. However, further rigorously designed, large-scale RCTs are needed to confirm these findings.