| BackgroundSciatica is one of the most common complaints;it reduces quality of life(QOL)and decreases social and economic efficacy.In one study,Mean incidence rate of sciatica was 9.4 and mean prevalence rate was 17.2 per 1000-person years.On the other hand,other therapies such as medications and surgery have many side effects and,sometimes,don't have good efficacy.Acupuncture is a WHO approved treatment for lower back pain and sciatica and there are so many researches that show the effectiveness of acupuncture in this condition.Thread-embedding as a combination of western and Chinese medicine can be consider as a good choice for some patients.There are some limitations for doing acupuncture in these patients such as,limitation of time,inability to attend in several sessions due to severe pain and disability,financial problems and the risk of discontinue of treatment,nevertheless the studies which evaluated the clinical effectiveness of Thread-embedding in patients with sciatica are insufficient(only one study).There isn't any research or article to compare the effectiveness of acupuncture and Thread-Embedding in sciatica.So,this study has been chosen to be fulfilled and it is my honor to do this subject as the first one in this field.ObjectiveTo evaluate the efficacy of Thread-Embedding in comparison with Acupuncture in chronic discogenic sciatica patients.MethodsThis study is a randomized pilot clinical trial study in patients who referred to acupuncture clinic in Birjand,Iran since June 2017 to September 2017.In first visit all the patients who have diagnostic criteria of chronic discogenic sciatica after taking history and doing physical examination,were enrolled in this study.The diagnostic criteria of discogenic sciatica consist of:mono radicular leg pain distribution,positive straight leg raise test,unilateral motor weakness,asymmetric ankle reflex,and MRI study confirming lumbar disc herniation.History findings for diagnosis of sciatica has 88%specificity and 95%sensitivity.Then they were asked to refer after two weeks(as wash-out period)without use of medications.Two weeks later,all the enrolled patients were checked for including and excluding criteria and final candidates who met all inclusion and exclusion criteria,were defined and were divided randomly to two groups.Randomization:final candidates were listed in a paper(n=29).The even-numbers were defined as first group(n=14)and the odd-numbers were defined as second group(n=15).Then by a simple draw were determined that first group will receive Thread-Embedding therapy and second group will receive Acupuncture treatment.Intervention:For first group(thread-embedding group),at first patient lies down in prone position and is palpated carefully for detecting tender points in lower back area and along the involved meridian.The local points were inserted at first and distal points were inserted later.After sterilization by povidone iodine solution and use of sterile dressing set and surgical gloves,a piece of 2-0 monocryl absorbable surgical thread made by Ethicon Company were implanted in the points(after arrival of qi).Sterile disposable catgut needles(no:7,black,Glance medical instruments,China)were used.The depth of thread implantation was the same as Acupuncture group(the standard depth for each point).For points BL40 and GB30 the insertion of threads was shallower than standard depth of these points.(because of vessels and nerve damage risk).This group received only one session thread-embedding treatment.For second group(Acupuncture group),at first patient lies down in prone position and is palpated carefully for detecting tender points in lower back area and along the involved meridian.After disinfection by alcohol,sterile acupuncture needles(0.30 × 40-75,Dong Bang medical instrument,south Korea)were used.The local points were inserted at the first step and then distal points were inserted.The needles inserted in appropriate depth and after arrival of Qi,they remained for 20 minutes.Manipulation of needles was done two times.Manipulation technique usually in this condition is reinforcing(because of kidney deficiency in chronic cases).The treatment course was eight sessions(two times in week).All the patients in both groups were evaluated by Visualized Analogue Scale(VAS)and Maine-Seattle Back(MSB)questionnaire four times:just before treatment,two weeks after first session of treatment,four weeks after first session of treatment(at the end of acupuncture course)and eight weeks after first session of treatment.The possible side effects of thread-embedding group were recorded.Statistical analysis:SPSS version 22 statistics were used in this study and the significant statistic P value were less than 0.05.ResultsTotally 28 discogenic sciatica patients were enrolled in two groups(14 patients in each group at last),35.7%(10/28)of them were male and 64.3%(18/28)of them were female.The average age among all patients was 47.13 years(27-63).In thread-embedding group the average age was 46.42 years(33-62)and for acupuncture group was 47.85 years(27-63).The VAS and MSB scores before treatment were statistically not different.Comparison of VAS and MSB within groups in different stages shows that there is statistically significant difference between "before treatment" and "two weeks after treatment" in both groups(p<0.05).In both groups there is statistically significant difference between "two weeks after treatment" and "four weeks after treatment"(p<0.05).The evaluation of difference between "four weeks after treatment" and "eight weeks after treatment" also shows that there is statistically significant difference in both groups(p<0.05).In other words,both treatment methods are significantly effective in treatment of chronic discogenic sciatica.Comparison of VAS and MSB between two groups shows that for VAS and MSB,changes of mean differences are not statistically significant(p>0.05).In other words,there are not statistically significant difference between two groups of patients that received two treatment methods.ConclusionThe results of this study show that both methods of treatment(thread-embedding and acupuncture)cause statistically significant improvement in discogenic sciatica.Comparing these two methods,there isn't statistically significant difference between them.Thread-embedding(as a substitute of Acupuncture)can use widely for sciatica patients due to many advantages and benefits for these patients.It seems that(but not statistically significant)long-term effectiveness of Thread-embedding maybe better than Acupuncture and short-term efficacy of Acupuncture maybe better than Thread-Embedding but due to insufficient sample size and inadequate studies,it should be evaluated in future studies. |
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