Effects of a Therapeutic Exercise Protocol for Patients with Chronic Non-Specific Back Pain in Primary Health Care: A Single-Group Retrospective Cohort Study

The effectiveness of hands-off approaches alone or in combination with hands-on approaches in the treatment of chronic cervical pain within a biopsychosocial framework: A systematic review

PURPOSE

This study aimed to systematically review the current literature comparing hands-off approaches with hands-on approaches from a biopsychosocial perspective of pain processing in people suffering from chronic primary neck pain (CPNP).

METHODS

An electronic search was conducted on PubMed, Web of Science, Scopus, and Cochrane Library. Initial searches were carried out in November 2022, with electronic database searches repeated on November 25, 2024. Eligibility criteria which were randomized controlled trials comparing hands-off approaches alone or in combination with hands-on approaches and hands-on approaches alone in people with CPNP were checked by two independent authors. The risk of bias was assessed using the revised Cochrane Risk of Bias Tool (RoB). The strength of conclusion was determined using the evidence-based guideline development approach.

RESULTS

Fifteen studies with a total of 1029 participants were included in this review. The RoB was rated as low RoB for two studies, some concerns for two studies and high RoB for 11 studies. Pain processing was assessed by pain intensity(100 % of the studies), pain sensitivity(53 % of the studies), pain-related participation in social roles(46 % of the studies), pain-related emotions(26 % of the studies), and pain-related beliefs(6 % of the studies). Limited quality of evidence was found for the hands-off approaches alone being more effective on pain intensity than hands-on approaches alone in the long term. Limited- to moderate-quality of evidence was found for hands-off approaches combined with hands-on approaches, being more effective than hands-on approaches alone in improving pain intensity, pain sensitivity, pain-related participation in social roles, pain-related emotions, and pain-related beliefs in the short-, mid- or long-term.

CONCLUSIONS

The current findings suggest that hands-off approaches alone are superior to hands-on approaches in the long term, at least for pain intensity. Hands-off approaches in combination with hands-on approaches were also more effective than hands-on approaches for pain processing. However, substantial heterogeneity warrants a cautious interpretation of these results. More high-quality, randomized, controlled trials with homogenous data collection and larger sample sizes are needed.

Effects of time-dependent acupuncture on back muscle endurance in women with chronic nonspecific low back pain: A randomized crossover trial

BACKGROUNDChronic nonspecific low back pain (CNLBP) is a leading cause of disability and remains a major burden for many public health systems. Acupuncture is a nonpharmacological treatment for CNLBP that can be effective in improving low back pain; nevertheless, its effect on improving back muscle endurance in patients with CNLBP and its duration of effect have not been studied.OBJECTIVEThe goal of this study was to assess the impact of acupuncture on lower back muscle activity in CNLBP patients.METHODSThis was a single-blind, randomized, crossover experimental study. Thirty female patients were randomized into Group A (15 patients) or Group B (15 patients). Patients in Group A were assigned to receive real acupuncture (RA) in the first phase and sham acupuncture (SA) in the second phase, while those in Group B received SA first and then RA, with a 1-week washout period between phases. Two-way repeated ANOVA was used to evaluate the effect of group and time on isokinetic parameters, Surface electromyography (sEMG) data, and blood data.RESULTSSignificant interaction effects were identified between group * time on the isokinetic parameters of the lumbar extensor muscles, sEMG values of the erector spinae, blood lactate levels, and blood ammonia levels (all p < 0.05). Compared with those of the SA group, the isokinetic parameters of the lumbar extensor muscles, sEMG values of the erector spinae, blood lactate levels, and blood ammonia levels of the RA group were significantly different (all p < 0.05).CONCLUSIONRA improves lumbar extensor endurance in patients with CNLBP and lasts approximately 9 minutes. RA can improve blood circulation to reduce blood lactic acid and blood ammonia produced during exercise.

Auriculotherapy and pain intensity and functional disability in older adults with chronic low back pain: randomised single-blind clinical trial

INTRODUCTION

Considering the importance of chronic low back pain in disability in older adults, the present study aimed to investigate the effect of auriculotherapy on pain intensity and functional disability in this group.

MATERIALS AND METHODS

This single-blind clinical trial was conducted on older adults with chronic low back pain in Kashan, Iran, 2019-2020. Seventy eligible older people were allocated to the intervention and sham groups via block randomisation. In the intervention group, pressure was applied using Varcaria seeds on the Shenmen, sympathetic, nerve subcortex and low back points. The visual analogue scale was completed at the beginning (T0), weekly (T1-T4) and 1 month after intervention (T5). Functional disability was assessed using Oswestry Disability Index at T0, T4 and T5. Data were analysed in per-protocol and intention-to-treat designs using repeated measures analysis of variance and analysis of covariance.

RESULTS

There was a significant difference between the two groups regarding disease duration (p=0.012). The interaction effect of time and intervention was significant on pain intensity and functional disability (effect size (ES)=0.858 and ES=0.789, p<0.0001). The pain intensity in the intervention group was significantly lower than in the sham group at T2-T5 (p<0.0001). The functional disability score in the intervention group was significantly lower than in the sham group at T4 and T5 (p<0.0001).

CONCLUSION

Auriculotherapy can reduce pain intensity and functional disability in older adults with chronic low back pain; it can be used as a complementary medicine in care programmes for older adults with chronic low back pain.

Stepping towards relief: a scoping review on the impact of unstable footwear in chronic low back pain management

INTRODUCTION

Chronic low back pain (CLBP) is a prevalent condition causing significant disability worldwide. Traditional treatments often have limited effectiveness, prompting research into alternative, non-invasive interventions. This review examines the impact of unstable footwear on CLBP management, exploring its potential to reduce pain and disability.

EVIDENCE ACQUISITION

We analyzed randomized controlled trials focusing on adults with CLBP. Studies comparing unstable footwear to standard care or conventional footwear were included. Main outcomes measured were pain reduction, functional improvement, and biomechanical changes. Methodological quality was assessed using the PEDro scale.

EVIDENCE SYNTHESIS

Five studies met the inclusion criteria, showing a consistent trend towards pain reduction in participants using unstable footwear. Specifically, intervention groups reported significant improvements in pain levels and, in some cases, disability scores compared to control groups. However, findings on functional performance and long-term effects were mixed, with no significant differences in certain studies. Methodological quality varied, with an estimated PEDro score range of 6-7 across the reviewed studies.

CONCLUSIONS

Unstable footwear may offer a beneficial non-invasive intervention for individuals with CLBP, contributing to pain reduction and possibly improving disability. Nonetheless, the evidence is tempered by methodological limitations and the need for further research. Future studies should focus on long-term outcomes, larger sample sizes, and clarifying the mechanisms behind the observed benefits. Clinicians should consider unstable footwear as part of a personalized treatment plan for CLBP, keeping abreast of new research to inform their practice.

Dose-Weighted Network Pharmacology: Evaluating Traditional Chinese Medicine Formulations for Lumbar Disc Herniation

Background and Purpose

Lumbar disc herniation (LDH) significantly impacts individuals, particularly those aged 40-45. Traditional Chinese Medicine (TCM) formulations such as Taohong Siwu Decoction (TSD), Yaotong Jizheng Decoction (YJD), and Panlong Qi Tablet (PQT) are widely used for treatment. This study introduces dose-weighted network pharmacology, a novel approach that incorporates drug dosage as a quantitative factor into network analysis to evaluate better and compare the therapeutic potential of TCM formulations.

Methods

This study combines drug dosage with the PPI network to propose a theoretical algorithm for comparing the therapeutic efficacy of different traditional Chinese medicine formulations. The VIKOR method was used to assess the importance of therapeutic targets, with weights assigned based on both drug and disease perspectives. TSD, YJD, and PQT were evaluated in animal experiments, and the algorithm's feasibility was validated through GO and KEGG pathway analysis, Thermal Hyperalgesia Test, H&E staining, Western blotting (WB), RT-PCR, and ELISA assays.

Results

The computational model indicated that YJD and PQT had higher predicted efficacy compared to TSD. These predictions were confirmed in animal studies, where YJD demonstrated the greatest reduction in thermal hyperalgesia and the most significant decrease in inflammatory markers, surpassing both TSD and PQT. GO and KEGG pathway analyses highlighted key pathways related to oxidative stress and inflammation, providing mechanistic insights into the effectiveness of the treatments.

Conclusion

Incorporating dosage as a reference factor into network pharmacology research proved feasible and effective, emphasizing the importance of precise dosage control in TCM formulations for treating LDH. The new algorithm provided reliable predictions, demonstrating its potential to enhance the design and evaluation of TCM formulations. Future improvements, such as establishing a target acceptance rate database, could further refine the algorithm, expanding its application in personalized medicine and targeted therapy.

Hippocampal Functional Radiomic Features for Identification of the Cognitively Impaired Patients from Low-Back-Related Pain: A Prospective Machine Learning Study

Purpose

To investigate whether functional radiomic features in bilateral hippocampi can identify the cognitively impaired patients from low-back-related leg pain (LBLP).

Patients and Methods

For this retrospective study, a total of 95 clinically definite LBLP patients (40 cognitively impaired patients and 45 cognitively preserved patients) were included, and all patients underwent functional MRI and clinical assessments. After calculating the amplitude of low-frequency fluctuations (ALFF), regional homogeneity (ReHo), voxel-mirrored homotopic connectivity (VMHC) and degree centrality (DC) imaging, the radiomic features (n = 819) of bilateral hippocampi were extracted from these images, respectively. After feature selection, machine learning models were trained. Finally, we further analyzed the relationship between the hippocampal functional radiomic features and clinical measures, to explore the clinical significance of these features.

Results

The combined radiomic features model logistic regression algorithm superior performance in distinguishing cognitively impaired patients from LBLP (AUC = 0.970, accuracy = 92.3%, sensitivity = 92.3%, specificity = 92.3%) compared to the other models. Additionally, radiomic wavelet features were correlated with Montreal Cognitive Assessment (MoCA) and Hamilton Anxiety Scale, present pain intensity scores in cognitively impaired LBLP patients (P < 0.05, with Bonferroni correction).

Conclusion

Hippocampal functional radiomic features are valuable for diagnosing cognitively impaired patients from LBLP.

The Economic Analysis of the Overlooked Recurrent Low Back Pain: Three Years Retrospective Observational Study

Purpose

Recent redefinitions of pain emphasize the importance of the previously overlooked recurrent low back pain (LBP). Understanding the direct medical cost for recurrent LBP cases based on the cost per visit is crucial economically. We aimed to compare the cost per visit for LBP and recurrent LBP, including the impact of gender and type of medical service, estimating the approximate annual cost of recurrent LBP.

Patients and Methods

Data on LBP categorized according to ICD-10 codes (G54, G55, M45, M46, M47, M48, M49, M51, M53, and M54) from the Polish National Health Fund (NHF) and Opolskie Rehabilitation Center (OCR) were analyzed based on the recurrent state as outlined in the new chronic pain definition.

Results

In OCR, a recurrent LBP was confirmed for 22.78% of patients, of which 59.72% were female (p<0.001). The mean value of a single procedure for recurrent LBP was 110.56 EUR, it was significantly higher for males (135.35 EUR) than for females (92.94 EUR) (p=0.008). Recurrent LBP generated a higher cost per visit for medical services than LBP (p<0.001), except for physiotherapy. Notably, males had a higher cost per visit in inpatient admissions, while females had a significantly higher cost per visit in physiotherapy services for both LBP and recurrent LBP. Moreover, recurrent LBP generated a statistically higher cost per visit for medical services than non-recurrent cases, except for physiotherapy. The average annual cost of LBP-related medical services in Poland was €243,861,639.

Conclusion

Recurrent LBP accounts for 5% of total direct LBP costs and has a higher cost per visit than LBP, excluding physiotherapy services. Gender significantly affected per-visit costs, with males having more inpatient admissions and females utilizing more physiotherapy services for both LBP and recurrent LBP.

Cross-cultural adaptation and validation of the Spanish version of the Prevent for Work questionnaire

Background

Musculoskeletal pain represents an increase in medical expenses due to disability and decreased quality of life among workers. Various biopsychosocial factors contribute to the development of persistent and disabling musculoskeletal pain. The Prevent for Work questionnaire (P4Wq) intended to analyze these factors. In this study, the original Italian version of the P4Wq was translated and culturally adapted to Spanish. Moreover, the psychometric properties were evaluated among Spanish workers with and without recent history of disabling spinal pain.

Methods

The first phase consisted of a forward-and-backward translation process and evaluating the face-validity of the questionnaire among 30 Spanish workers. The second phase involved 153 Spanish workers who completed the P4Wq, Oswestry Disability Index (ODI), and EQ-5D-5L questionnaires. Finally, 50 Spanish workers completed the P4Wq 2 weeks later to evaluate test-retest reliability and measurement error.

Results

Minor changes were made after the forward-and-backward translation process, which ensured that the Spanish versions was face-valid. The P4Wq demonstrated acceptable internal consistency for Spanish version (Cronbach's alpha: 0.91), a moderate negative association with the indicator of quality of life (ρ < -0.39; p = 0.001) and moderate positive association with the disability index (ρ > 0.46; p = 0.001). Furthermore, the P4Wq showed good to excellent item response stability (weighted kappa = 0.75-0.96) and good for the total score (ICC = 0.98).

Conclusion

The Spanish version of the P4Wq was face-valid and exhibited a similar structure as the original version. Additionally, good internal consistency and construct validity were found. This translated version of the questionnaire can therefore be considered acceptable for use by workers with and without history of disabling musculoskeletal pain.

Migu Capsules in the Treatment of Osteoporotic Low Back Pain in Postmenopausal Women: A Single-Center Randomized Controlled Trial

Purpose

This trial aimed to investigate the efficacy of Migu capsules in treating osteoporotic low back pain.

Patients and Methods

In this single-center trial, we randomly assigned patients with osteoporotic low back pain that had lasted for 3 months in a 1:1 ratio to receive Migu capsules alongside Caltrate D in treatment group or to receive Caltrate D only in control group, both for 48 weeks. The primary outcome measure was the intensity of low back pain on a visual analog scale at 24 weeks after enrollment. Secondary outcome measures included the Roland-Morris Disability Questionnaire (RMDQ), bone turnover markers, and bone mineral density.

Results

A total of 100 patients were enrolled, with 50 in each group. At baseline, the mean score for low back pain intensity was 6.2 in the treatment group and 6.1 in the control group. The primary outcome of the low back pain intensity score at 24 weeks was 2.9 in the treatment group and 4.7 in the control group (adjusted mean difference, -1.8; 95% confidence interval, -2.3 to -1.4; P<0.001). Secondary outcomes including the score on RMDQ and pain at 48 weeks were in the same direction as the primary outcome. Compared to the control group, the treatment group only showed a difference in bone density after continuous intervention for 48 weeks (P<0.05). Three patients experienced a mild adverse event associated with the intake of Migu capsules.

Conclusion

Migu capsules can alleviate bone pain and reduce functional disabilities caused by osteoporotic lower back pain.

Nonspecific cervical spine pain/neck pain/in medical personnel of north-eastern Poland-A cross-sectional study

Both mechanical and psychological overload are inherent to the work of nurses and paramedics, resulting spondylogenic pain.

Aim of the study

To identify potential risk factors influencing the prevalence of non-specific cervical spine pain in professionally active nurses and paramedics.

Material and methods

324 nurses (53.2% of the total) and 285 paramedics (46.8%) were included in the study-609 people in total. The study was carried out using an auditorium survey technique supervised by the researchers. The methods used were: Nordic Musculoskeletal Questionnaire, a spinal pain questionnaire validated according to IEA guidelines, a short version of the IPAQ and the author's survey questionnaire, concerning sociodemographic data, chronic diseases including metabolic syndrome (MetS). A univariate logistic regression model was used in the statistical analysis. The level of statistical significance was taken as p < 0.05.

Results

Recurrent NP was significantly more common in paramedics compared to nurses (29.5 % vs. 9.3 %; p < 0.0001). In a univariate logistic regression model, the risk of NP was significantly increased by: length of service > 15 years (p < 0.024), presence of: low back pain (p < 0.0001), type 2 diabetes (p = 0.013), hypertension (p < 0.001), depression (p < 0.01). Of the modifiable factors, the risk of NP was significantly increased by high physical activity and short sleep <7 h (p < 0.001).

Sleeping <6.55 h per day was associated with a higher risk of low back pain in adults aged over 50 years: a Korean nationwide cross-sectional study

Background

Patients with low back pain (LBP) often suffer from sleep disorder, and insufficient sleep duration was recognized as a potential risk factor for LBP. Our aim was to explore the exact effect of sleep duration on LBP and the optimal sleep duration to reduce the risk of LBP.

Methods

Analyzing data from the Korean National Health and Nutrition Examination Survey (KNHANES), we investigated the association between sleep duration and LBP in individuals aged 50 years and older. We used logistic regression models, interaction stratification analysis, and threshold effect assessment to analyze the relationship between sleep duration and LBP.

Results

A total of 6,285 participants, comprising 3,056 males and 3,229 females with a median age of 63.1 years, were enrolled in the study. The association between sleep duration and LBP risk exhibited an L-shaped curve (p < 0.015) in RCS analysis. In the threshold analysis, the OR of developing risk of LBP was 0.864 (95% CI:0.78-0.957, p = 0.005) in participants with sleep duration <6.55 h. Each additional hour of sleep was associated with a 13.6% decrease in the risk of LBP. No significant association was observed between sleep duration ≥6.55 h and the risk of LBP. The risk of LBP did not decrease further with increasing sleep duration. Results remain robust across subgroups.

Conclusion

Our findings indicate that shorter sleep duration is a risk factor for LBP in adults aged over 50 years. We revealed an L-shaped association between sleep duration and LBP, with an inflection point at approximately 6.55 h per day. These results underscore the significance of sleep duration as a factor in the risk assessment for LBP.

Disrupted Resting-State Functional Connectivity and Effective Connectivity of the Nucleus Accumbens in Chronic Low Back Pain: A Cross-Sectional Study

Purpose

Chronic low back pain (cLBP) is a recurring and intractable disease that is often accompanied by emotional and cognitive disorders such as depression and anxiety. The nucleus accumbens (NAc) plays an important role in mediating emotional and cognitive processes and analgesia. This study investigated the resting-state functional connectivity (rsFC) and effective connectivity (EC) of NAc and its subregions in cLBP.

Methods

Thirty-four cLBP patients and 34 age- and sex-matched healthy controls (HC) underwent resting-state functional magnetic resonance imaging (rs-fMRI). Seed-based rsFC and Dynamic Causal Modelling (DCM) were used to examine the alteration of the rsFC and EC of the NAc.

Results

Our results showed that the cLBP group had increased rsFC of the bilateral NAc-left superior frontal cortex (SFC), orbital frontal cortex (OFC), left angular gyrus, the left NAc-bilateral middle temporal gyrus, as well as decreased rsFC of left NAc-left supramarginal gyrus, right precentral gyrus, left cerebellum, brainstem (medulla oblongata), and right insula pathways compared with the HC; the results of the subregions were largely consistent with the whole NAc. In addition, the rsFC of the left NAc-left SFC was negatively correlated with Hamilton's Depression Scale (HAMD) scores (r = -0.402, p = 0.018), and the rsFC of left NAc-OFC was positively correlated with present pain intensity scores (r = 0.406, p = 0.017) in the cLBP group. DCM showed that the cLBP group showed significantly increased EC from the left cerebellum to the right NAc (p = 0.012) as compared with HC.

Conclusion

Overall, our findings demonstrate aberrant rsFC and EC between NAc and regions that are associated with emotional regulation and cognitive processing in individuals with cLBP, underscoring the pivotal roles of emotion and cognition in cLBP.

Immediate Efficacy of Contralateral Acupuncture on SI3 Combined with Active Exercise for Acute Lumbar Sprains: Protocol for a Randomized Controlled Trial

PURPOSE

Acute lumbar sprain (ALS) is a common clinical disease characterized by persistent intolerable low back pain and limitation of movement, and quick pain relief and restoration of mobility in a short time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of contralateral acupuncture (CAT) on SI3 combined with active exercise in treating ALS.

METHODS AND ANALYSIS

This study is a randomized controlled trial which will recruit 118 eligible participants aged 18 to 55 years with ALS at the Second Affiliated Hospital of Yunnan University of Chinese Medicine between March 2024 and December 2026. Participants will be randomly assigned to the acupuncture group or the sham-acupuncture group in a 1:1 ratio. The acupuncture group will receive a 10-minute acupuncture treatment combined with active exercise, while the sham-acupuncture group will receive a 10-minute sham acupuncture treatment combined with active exercise. Randomization will use a computer-generated sequence with allocation concealed in opaque envelopes. The primary outcome will be the pain visual analogue scale (VAS) scores after 10 minutes of treatment. Secondary outcomes will include the pain VAS scores at other time points (2, 4, 6, and 8 minutes post-treatment), the lumbar range of motion (ROM) scores at various time points, blinded assessment, the treatment effect expectancy scale, and the rescue analgesia rate. The analysis will follow the intention-to-treat principle. The primary outcome will be analyzed using ANCOVA, and secondary outcomes with repeated measures ANOVA. The rescue analgesia rate will be assessed using either the χ2 test or Fisher's exact test.

DISCUSSION

This study is the first randomized controlled trial to assess the immediate efficacy of CAT in combination with active exercise for ALS. This study will provide a simple, rapid, and effective treatment for the clinical management of ALS.

Clinical Efficacy and Safety of a Modified Moxibustion Therapy for Low Back Pain in Lumbar Disc Herniation: A Two-Center, Randomized, Controlled, Non-Inferiority Trial

Objective

Our pilot study shows that a modified moxibustion therapy called Ma's bamboo-based medicinal moxibustion can alleviate the symptoms of low back pain in lumbar disc herniation (LDH), and has the potential to treat LDH. The aim of this study is to evaluate the efficacy and safety of Ma's bamboo-based medicinal moxibustion for low back pain in LDH.

Methods

A total of 312 LDH patients with low back pain were randomized to receive Ma's bamboo-based medicinal moxibustion (MBMM) or acupuncture (AT). The primary efficacy measure was the change of Visual Analogue Scale (VAS) on the 14th day compared with that at baseline. The secondary efficacy measures included VAS score, Oswestry disability index (ODI), modified Japanese Orthopaedic Association (M-JOA) score, and the content of β-endorphin (β-EP) and substance-P (SP). The safety measures included the occurrence of adverse events and the changes in laboratory indicators.

Results

In total, 304 patients were incorporated for the analysis of efficacy, including 96 males and 208 females, aged 21-65 years. There was no statistically significant difference in the change of VAS score between the two groups on the 14th day [mean difference (95% CI) = -2.31 (-2.48, -2.13) and -2.28 (-2.45, -2.11), respectively; p = 0.819]. The VAS, ODI, and M-JOA scores changed after the intervention in both groups (p <0.001), with increased β-EP content (p = 0.014, p = 0.032) and decreased SP content (p <0.001, p = 0.048). The ODI score (p = 0.039) and M-JOA score (p = 0.032) of the MBMM group on the 28th day were lower than those of the AT group.

Conclusion

The efficacy of Ma's bamboo-based medicinal moxibustion therapy in relieving low back pain of LDH patients is comparable to that of acupuncture, and it has post-effect advantages in improving lumbar dysfunction and daily living ability, which can be used as a safe and effective alternative method for LDH treatment.

Effect of transcutaneous neuromodulation on normalization of dermal body temperature and pain in a tender scar in the presence of low back pain: An update and case report

Low back pain affects over 20% of individuals during their lifetime, and in some patients, it may be associated with scar tissue formation after surgery. Small-fiber neuropathy and scar tissue dysfunction can lead to localized pain by affecting signals to the thalamus. Transcutaneous neuromodulation using Tape with Magnetic Particles shows promise in relieving perceived pain, modulating vascularization and the autonomic nervous system, and reducing dermal temperature. In the present case, a 24-year-old woman with L5-S1 disk herniation experienced low back pain and leg pressure. The surgical intervention provided temporary relief, but scar restrictions caused pain recurrence. Tape with Magnetic Particles application initially induced scar hypothermia and pressure tolerance during posteroanterior tests on lumbar spinous processes increased, reducing pain perception for at least 12 h. Transcutaneous neuromodulation with Tape with Magnetic Particles modulated dermal temperature immediately and for 12 h, reducing perceived pain and sustaining improvement thereafter. This highlights the potential of Tape with Magnetic Particles in managing chronic low back pain associated with scar tissue.

Efficacy of Electroacupuncture Combined with Chinese Herbal Medicine on Pain Intensity for Chronic Sciatica Secondary to Lumbar Disc Herniation: Study Protocol for a Randomised Controlled Trial

Purpose

Chinese herbal medicine and electroacupuncture (EA) have been used to control pain for many decades in China. We aim to explore the efficacy of intervening patients whose discogenic sciatica symptoms lasting longer than 3 months with these conservative treatments.

Patients and Methods

This is a single-center, parallel-group, patient-unblinded Randomized Controlled Trial (RCT) with blinded outcome assessment and statistician. One hundred and twenty-four patients will be assigned randomly into 2 groups including conservative treatment group (Shenxie Zhitong capsule combined with EA treatment) and Nonsteroidal Anti-inflammatory Drugs (Nonsteroidal Anti-inflammatory Drugs, NSAIDs) control group (Celecoxib) in a 1:1 ratio. The trial involves a 4-week treatment along with follow-up for 6 months. The primary outcome is the leg pain intensity measured by the visual analogue scale (VAS) at 6 months after randomization. Secondary outcomes include leg pain intensity at other time points, back pain intensity, leg pain and back pain frequency, functional status, quality of life, return to work status and satisfaction of patients. Adverse events will also be recorded.

Strengths and Limitations of This Study

Through this study, we want to observe the efficacy of electroacupuncture combined with Chinese herbal medicine on pain intensity for chronic sciatica secondary to Lumbar Disc Herniation. If the final results are favorable, it is expected to be a safe, economical, and effective treatment for patients. The study design has the following limitations: the setup of control group was less than perfect; patients and doctors could not be blinded in this trial; we skipped the feasibility study. We have tried our best to minimize adverse impacts.

Trial Registration

ChiCTR2300070884 (Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 25th April 2023).