Efficacy and Safety of Acupuncture versus Sham in Patients with Chronic Sciatica: A Systematic review and Meta-analysis with GRADE assessment

Background Chronic sciatica is associated with persistent pain and functional impairment. Acupuncture has emerged as a promising non-pharmacological approach for chronic sciatica. This review aimed to assess the efficacy and safety of acupuncture versus sham acupuncture in patients with chronic sciatica. Methods Following the PRISMA guidelines, we systematically searched PubMed, Scopus, Cochrane Library, and Web of Science up to March 23, 2025. Randomized controlled trials comparing acupuncture to sham in chronic sciatica were included. Primary outcomes included pain reduction measured by VAS and functional improvement assessed by ODI. Secondary outcomes included SFBI and SF-36. Risk of bias was evaluated using ROB-2, meta-analyses were performed using RevMan 5.4, and the certainty of evidence of each pooled analysis was rated according to GRADE . Results Four RCTs involving 385 participants were included. Pooled data demonstrated significant short-term benefits of acupuncture over sham in reducing both leg and back pain, particularly by week 2 and peaking at week 4. Functional improvement as measured by ODI was also significantly better in the acupuncture group at week 4. Acupuncture reduced SFBI frequency and bothersomeness scores and marginally improved SF-36 physical health outcomes. However, long-term effects at weeks 16, 28, and 52 were inconsistent. Adverse events were minimal and self-limiting, and acupuncture showed a favorable safety profile. Conclusion Acupuncture is a safe and effective complementary therapy for managing chronic sciatica, offering superior short-term pain relief and functional improvement compared to sham acupuncture. However, the durability of these effects beyond one month remains unclear. Further high-quality trials with longer follow-up periods are needed to substantiate its long-term efficacy.