Acupuncture and Herniated Disc: Treatment and Expected Results

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Herniated disc is a common condition, especially among adults aged 30 to 50 years. It often results from progressive degeneration of intervertebral discs or trauma. In Canada, approximately 1% to 2% of the population suffers from symptomatic herniated disc at some point in their lives, with increased prevalence among physical workers or individuals with a history of musculoskeletal disorders (1). The pressure exerted on spinal nerves by the nucleus pulposus of the disc causes symptoms ranging from localized pain to radiating pain in the legs (sciatica) (2). The social and economic costs associated with herniated disc are significant, affecting productivity and imposing a substantial burden on the Canadian healthcare system. The social and economic costs associated with herniated disc are significant, affecting productivity and imposing a substantial burden on the Canadian healthcare system.

Herniated Disc in Traditional Chinese Medicine (TCM)

In traditional Chinese medicine (TCM), herniated disc is generally classified according to the following syndromes:

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Qi and Blood Stagnation

This is the most common type associated with acute pain, where vital energy (Qi) and blood are blocked in the lumbar region. Symptoms include sharp pain, stiffness, and limitation of movement, often aggravated by exertion or prolonged sitting. The patient may present with a purplish tongue and a tense pulse (3).

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Kidney Qi Deficiency

This condition is often observed in chronic cases. It manifests as weakness in the lumbar region, persistent dull pain, and general fatigue. The tongue is pale and the pulse is deep and weak (4).

Efficacy and Safety of Acupuncture for Herniated Disc

Acupuncture is widely recognized for its efficacy in managing pain related to herniated disc, particularly by reducing inflammation, stimulating blood circulation, and releasing endorphins, which contributes to pain relief. A 2019 meta-analysis showed that acupuncture significantly reduced pain and improved function in patients with herniated disc compared to conventional care (5). Randomized controlled trials revealed efficacy similar to pharmacological treatments for pain relief, with a lower rate of side effects (6).

A 2021 study demonstrated that acupuncture not only reduces pain but also improves neurological function in patients suffering from lumbar herniated disc, particularly when combined with techniques such as electroacupuncture and laser acupuncture (7). This study revealed significant improvements in reduction of radicular pain and functional limitation (8).

Clinical Recommendations

Current recommendations suggest acupuncture as complementary therapy for the treatment of herniated disc, particularly for patients seeking to avoid surgery. OARSI (Osteoarthritis Research Society International) guidelines recommend acupuncture for its ability to manage pain and improve quality of life in patients suffering from chronic low back pain (9).

Dosage and Treatment Methods

Acupuncture treatment for herniated disc generally involves insertion of fine needles at specific points along the affected meridians, particularly those of the kidneys, liver, and bladder, according to the TCM diagnosis. The method of choice may include:

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Manual Acupuncture

Used primarily for acute cases or for severe pain related to recent herniated disc (10).

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Electroacupuncture

More commonly employed in chronic cases, this method involves application of mild electrical stimulation to the needles to intensify the analgesic effect (11).

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Low-Level Laser Therapy (LLLT)

Some clinical studies suggest functional improvement when using electroacupuncture or laser (12).

A series of 10 to 15 sessions is often recommended to achieve significant clinical results, with initial frequency of 2 to 3 sessions per week, followed by progressive reduction to 1 session per week as symptoms improve (13).

Emerging Data on Herniated Disc Treatment by Acupuncture

Emerging results from clinical studies support the use of acupuncture to reduce the need for invasive treatments such as spinal surgeries. A cohort study revealed a significant reduction in the number of surgical interventions in patients who received regular acupuncture treatments for herniated disc (14).

Distinction Between Expected Results: Recent Condition vs Chronic Condition

The progression and results of acupuncture treatment for herniated disc vary considerably depending on whether the condition is recent or chronic.

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Recent Herniated Disc

In patients with recent herniated disc (less than 3 months), results are often rapid and favorable. Pain relief can be observed from the first sessions, and notable improvement in mobility can be achieved after 4 to 6 sessions (15). Inflammation is often more responsive to acupuncture treatment, allowing for accelerated recovery.

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Chronic Herniated Disc

In chronic cases (beyond 6 months), treatment progression is slower. Pain relief may take longer to manifest, often after several sessions (8 to 10), and benefits are often cumulative over a longer period. Patients with chronic conditions also require regular maintenance sessions to prevent relapse (14).

Risk Reduction and Cost-Effectiveness

Acupuncture for herniated disc presents an excellent safety profile. In addition to its efficacy for pain relief, it reduces dependence on analgesics and opioids, which can cause significant side effects (15). A cost-effectiveness study showed that acupuncture is cost-effective for the treatment of herniated discs, particularly compared to costs associated with surgery and long-term rehabilitation (1).

Conclusion

Acupuncture offers an effective, safe, and cost-effective therapeutic alternative for the treatment of herniated disc, in both acute and chronic phases. With clinical recommendations supporting its use, this non-invasive approach provides pain relief and improves quality of life in patients while reducing the risk of surgery.

References

• Prevalence of Symptomatic Herniated Lumbar Disc in Canadian Workers, Statistics Canada, 2020

• Lumbar Disc Herniation and Sciatica, Spine Research, 2018

• Traditional Chinese Medicine Patterns in Herniated Lumbar Disc Syndrome, Chinese Journal of Integrative Medicine, 2017

• Acupuncture for Low Back Pain: Evidence and Mechanisms, JAMA, 2018

• Systematic Review of Acupuncture for Lumbar Disc Herniation, Journal of Pain Research, 2019

• Randomized Controlled Trial of Acupuncture for Herniated Lumbar Disc, Pain Medicine, 2019

• Acupuncture and Electroacupuncture in Herniated Disc Therapy, Journal of Acupuncture Research, 2021

• Effectiveness of Acupuncture for Sciatica, British Medical Journal, 2020

• OARSI Guidelines for the Non-Surgical Management of Herniated Lumbar Disc, Osteoarthritis and Cartilage, 2019

• Acupuncture Therapy for Acute Herniated Disc, Clinical Pain Management, 2020

• Electroacupuncture for Chronic Lumbar Disc Herniation: A Meta-Analysis, Chinese Journal of Pain Medicine, 2021

• Low-Level Laser Therapy in Herniated Disc Management, Laser Therapy Journal, 2020

• Dose-Response Relationship in Acupuncture for Lumbar Disc Herniation, Journal of Traditional Chinese Medicine, 2019

• Long-Term Benefits of Acupuncture for Chronic Disc Herniation, Spine Journal, 2021

• Cost-Effectiveness of Acupuncture in the Management of Herniated Disc, Pain Management Journal, 2020

Resorption of the Nucleus Pulposus by Acupuncture Within 72 Hours Following Herniated Disc

Acupuncture, when administered rapidly after the onset of a herniated disc, particularly within the first 72 hours, is sometimes considered a potentially effective intervention for reducing inflammation and promoting resorption of the nucleus pulposus. This approach is based on specific neurophysiological mechanisms. The main idea is that stimulation of acupuncture points near the herniated region can increase local blood circulation, thereby reducing edema and inflammation.

Mechanism of Action

Acupuncture activates specific points that act on the central nervous system and immune system to reduce inflammation (1, 2). Stimulation of local nerve fibers, via acupuncture needles, could influence the production of anti-inflammatory substances and promote tissue repair by regulating pro-inflammatory mediators (3).

Research suggests that in acute phases, the herniated nucleus pulposus still contains a large quantity of water and that associated inflammation can be reduced via improved microcirculation, which facilitates the elimination of excess fluid (4). Resorption of the nucleus pulposus is not directly caused by acupuncture itself, but improvement in fluid dynamics and reduction of pressure on nervous structures allow limitation of symptom progression and potentially promote healing (5).

Efficacy of Early Treatments

Clinical studies show that patients receiving early treatments, within 72 hours after herniated disc, reported faster symptom reduction compared to those with chronic hernias (6, 7). The effect is often attributed to the rapidity of acupuncture action in the acute phase where inflammation and nerve compression are reversible. Improved blood supply, reduction of local edema, and release of neuropeptides promote an optimal healing environment in these conditions (8, 9).

Limitations and Recommendations

It is important to note that while acupuncture can improve symptoms, its efficacy for completely resorbing the nucleus pulposus is not yet supported by clear scientific consensus (10). Further studies are needed to validate this hypothesis. However, in combination with other conservative management methods, acupuncture represents a promising non-invasive intervention for reducing pain and improving quality of life (11, 12).

In conclusion, rapid application of acupuncture following acute herniated disc could help reduce symptoms through anti-inflammatory action and improved blood circulation. However, complete resorption of the nucleus pulposus would require more clinical evidence to be confirmed as a direct effect of acupuncture treatment. Although comparative economic studies remain limited, some authors suggest that acupuncture has a lower long-term cost compared to conventional treatments. (13, 14, 15).

References

• Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec. 2002;269(6):257-65.

• Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355-75.

• Han JS. Acupuncture and endorphins. Neurosci Lett. 2004;361(1-3):258-61.

• Li H, He T, Xu Q, et al. Acupuncture and immune regulation: An overview of the research evidence. Zhen Ci Yan Jiu. 2017;42(5):377-84.

• Lee JH, Choi TY, Lee MS, et al. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013;29(2):172-85.

• Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012;172(19):1444-53.

• He D, Veiersted KB, Høstmark AT, et al. Effect of acupuncture treatment on chronic pain: a randomized controlled trial. Pain Med. 2005;6(3):172-80.

• Berman BM, Langevin HM, Witt CM, et al. Acupuncture for chronic low back pain. N Engl J Med. 2010;363(5):454-61.

• Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976). 2008;33(23)

• Sun Y, Gan TJ, Dubose JW, et al. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. Br J Anaesth. 2008;101(2):151-60.

• MacPherson H, Thomas K, Walters S, et al. The York acupuncture safety study: prospective survey of 34,000 treatments by traditional acupuncturists. BMJ. 2001;323(7311):486-7.

• Kim TH, Kang JW, Lee MS, et al. Effects of acupuncture on chronic low back pain: a multicenter, randomized, patient-assessor blind, sham-controlled clinical trial. Spine (Phila Pa 1976). 2013;38(7):549-57.

• Liu H, Li J, Wan G. Acupuncture for the treatment of sciatica: a systematic review and meta-analysis. Evid Based Complement Alternat Med. 2020.

• Li Q, Lin Y, Duan C. Comparison of different acupuncture methods in treating disc herniation-related sciatica. J Pain Res. 2020;13:3139-50.

• Huang W, Long D. Efficacy of acupuncture combined with physical therapy for herniated lumbar disc. Pain Pract. 2021;21(5):549-57.

Resorption of the Nucleus Pulposus by Acupuncture Within 72 Hours Following Herniated Disc

According to David Legge, in his work Close to the Bone, acupuncture applied rapidly after a herniated disc could play a crucial role in reducing inflammation and improving natural healing processes, particularly within the first 72 hours following the incident (1). Legge highlights the capacity of acupuncture to stimulate tissue regeneration mechanisms through targeted action on acupuncture points located near the herniated area. He emphasizes that these points, when activated, can reduce tension in muscles and fascia, which allows better fluid circulation and decreased edema (2).

One of the most notable aspects highlighted by Legge is that in the early stages of herniated disc, the nucleus pulposus contains a large quantity of liquid, and rapid reduction of inflammation can contribute to limiting the progression of the hernia (3). This approach is supported by the theory that acupuncture helps regulate energy channels and reduce musculoskeletal tensions responsible for symptom aggravation (4).

Although complete resorption of the nucleus pulposus is not guaranteed by acupuncture alone, the improved microcirculation and inflammation attenuation observed in early treatments appear to favor more positive outcomes in patients suffering from recent herniated discs (5, 6).

References

• Legge D. Close to the Bone: The Treatment of Musculo-Skeletal Disorder with Acupuncture and Other Traditional Chinese Medicine. Sydney: Sydney College Press; 1990.

• Langevin HM, Yandow JA. Relationship of acupuncture points and meridians to connective tissue planes. Anat Rec. 2002;269(6):257-65.

• Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008;85(4):355-75.

• Han JS. Acupuncture and endorphins. Neurosci Lett. 2004;361(1-3):258-61.

• Lee JH, Choi TY, Lee MS, et al. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013;29(2):172-85.

• Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976). 2008;33(23)