Effect of prior acupuncture experience on the efficacy of acupuncture treatment for discogenic sciatica： a secondary analysis of a multicenter randomized controlled trial

目的: 探讨既往针刺经历对针刺治疗椎间盘源性坐骨神经痛临床疗效的影响。方法: 对一项多中心、随机对照试验进行二次分析，将216例椎间盘源性坐骨神经痛患者随机分为针刺组和假针组，每组各108例。其中针刺组采用基于循经辨证取穴的半标准化治疗方案，施以手法以达得气感;假针组选择非穴点针刺，不施手法、不求得气。两组均每次针刺30 min，治疗持续4周，前2周每周3次，后2周每周2次。于基线和针刺治疗4周后记录腿痛视觉模拟量尺（VAS）评分、腰椎功能Oswestry 残疾指数（ODI）评分，以第4周VAS和ODI评分较基线的评分差值作为评估疗效的主要结局指标。根据既往有无针刺经历对针刺组、假针组患者的疗效进行亚组分析。结果: 在纳入的216例患者中，既往有针刺经历的患者81例，无针刺经历的患者135例。在既往有针刺经历或无针刺经历的亚组中，针刺干预4周后患者腿痛VAS评分和腰椎功能ODI评分变化值相较于假针组均增加（P<0.001， P<0.01）。交互作用分析显示既往有无针刺经历和干预因素对VAS评分和ODI评分变化值的影响不存在交互作用。结论: 不论既往有无针刺经历，针刺在改善椎间盘源性坐骨神经痛患者的腿痛和腰椎功能障碍方面均具有较好的疗效。.; OBJECTIVES: To investigate the effect of prior acupuncture experience on the clinical efficacy of acupuncture for discogenic sciatica. METHODS: A secondary analysis was conducted on a multicenter, randomized controlled trial. A total of 216 patients with discogenic sciatica were randomly divided into an acupuncture group and a sham acupuncture group, with 108 patients in each group. The acupuncture group received a semi-standardized treatment protocol based on meridian pattern differentiation for acupoint selection, and manual manipulation was applied to achieve the deqi sensation. The sham acupuncture group received needling at non-acupoints without manipulation or the pursuit of deqi. Each session lasted for 30 min. The treatment continued for 4 weeks, with 3 sessions per week for the first 2 weeks and 2 sessions per week for the subsequent 2 weeks. The visual analog scale (VAS) score for leg pain and the Oswestry disability index (ODI) score for lumbar function were recorded at baseline and after 4 weeks of treatment. The differences in VAS and ODI scores from baseline to week 4 were used as the primary outcome measures to evaluate the efficacy. Subgroup analysis were performed to compare the efficacy between the acupuncture and sham acupuncture groups based on the presence or absence of previous acupuncture experience. RESULTS: Among the 216 patients, 81 had prior acupuncture experience and 135 had no prior acupuncture experience. In the subgroup with prior acupuncture experience or without previous acupuncture experience, the changes of VAS score for leg pain and the ODI score for lumbar function in the acupuncture group were significantly higher than those in the sham acupuncture group after 4 weeks of intervention (P<0.001, P<0.01). Interaction analysis showed that there was no interaction effect between prior acupuncture experience and intervention factors on the changes in VAS and ODI scores. CONCLUSIONS: Acupuncture has a favorable effect on improving leg pain and lumbar dysfunction in patients with discogenic sciatica, regardless of prior acupuncture experience.