Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis

This systematic review and meta-analysis evaluated the efficacy of acupuncture in the treatment of postoperative pain after lumbar disc herniation (LDH) surgery, a condition that significantly affects patients' quality of life. Lumbar disc herniation is one of the leading causes of low back pain, affecting about 80% of the Western population at least once in their lifetime, with a higher incidence in women aged 40-69 years. Although surgical treatment is effective in relieving neural compression, many patients experience residual pain, recurrence of symptoms, and functional limitations during the postoperative period. The analysis included ten randomized clinical trials conducted in China between 2006 and 2021, involving 838 patients (423 in the acupuncture group and 415 in the control group).

The studies compared acupuncture with medications (nine studies) or rehabilitation (one study). The duration of treatment ranged from 14 to 28 days, with a predominant frequency of one session per day. Primary outcomes included cure rate, total effectiveness rate, Japanese Orthopaedic Association (JOA) scores, and visual analog scale (VAS) for pain. The results demonstrated significant superiority of acupuncture across all parameters evaluated.

The cure rate was 2.24 times higher in the acupuncture group compared with medications (OR=2.24, 95% CI=1.58-3.19, P<0.00001). The total effectiveness rate showed even more pronounced benefit, with an odds ratio of 4.85 (95% CI=2.59-9.08, P<0.00001) favoring acupuncture. Regarding pain, acupuncture provided a mean reduction of 1.26 points on the VAS compared with control (MD=-1.26, 95% CI=-1.72 to -0.79, P<0.00001). Functional improvement, measured by the JOA score, was 4.21 points higher in the acupuncture group (MD=4.21, 95% CI=1.53-6.90, P<0.00001).

Particularly relevant was the safety analysis, where acupuncture demonstrated significantly lower incidence of adverse events compared with medications (OR=0.27, 95% CI=0.11-0.62, P=0.002). Reported adverse events included worsening of pain, urinary retention, postoperative infection, and lower-limb venous thrombosis. Proposed mechanisms for the analgesic effects of acupuncture include neuroendocrine modulation, increased production of endogenous opioid peptides, reduction of inflammatory mediators (substance P, TNF-α, IL-1β), and activation of local molecular signaling pathways. Acupuncture has also been shown to improve blood flow and oxygenation of the cauda equina, nerve roots, and sciatic nerve, promoting neural recovery.

Limitations of the study include moderate methodological quality of the included trials, with only six studies describing adequate randomization methods and none using allocation concealment or placebo control. All studies were conducted in China, limiting the geographic and ethnic generalizability of the results. The relatively small sample size and the use of efficacy criteria not internationally recognized also represent limitations. Despite these limitations, the meta-analysis provides convincing evidence that acupuncture is an effective and safe intervention for postoperative pain after lumbar disc herniation surgery.

The benefits include superior pain control, better functional recovery, and a more favorable safety profile compared with conventional treatments. These findings support the incorporation of acupuncture as a therapeutic option in the multidisciplinary management of patients with postoperative LDH pain, especially considering its nonpharmacological nature and low risk of adverse effects.