Intravascular Laser and Electroacupuncture for Sciatica With Insomnia: A Pilot Trial

Sciatica, characterized by radiating pain along the sciatic nerve, is one of the most common causes of chronic low back pain. The condition affects approximately 13%-40% of adults globally and remains a major contributor to disability, reduced productivity, and impaired quality of life. In Vietnam, hospital-based surveys have reported that sciatica accounts for 12%-26% of inpatient admissions in traditional medicine and rehabilitation facilities.

Chronic musculoskeletal pain such as sciatica is frequently associated with sleep disorders. Studies indicate that up to 70% of patients with chronic pain experience poor sleep quality, and the relationship between pain and sleep is bidirectional: persistent pain interferes with sleep continuity, while sleep deprivation increases pain sensitivity and emotional distress. Conventional pharmacologic treatments for insomnia (such as benzodiazepines or non-benzodiazepine hypnotics) often provide temporary relief but may cause tolerance, dependence, or adverse cognitive effects. Consequently, non-pharmacologic and integrative approaches are increasingly emphasized in chronic pain management.

Intravascular photobiomodulation (ILIB), also referred to as intravascular laser irradiation of blood, is a minimally invasive technique that introduces low-level laser light (typically 630-650 nm) into the venous circulation. The photobiological effects of ILIB include enhanced oxygen transport, improved microcirculation, modulation of oxidative stress, and anti-inflammatory action. Clinical studies have demonstrated ILIB's potential in various chronic diseases, including musculoskeletal pain, vascular disorders, and metabolic dysfunctions. Preliminary evidence also suggests that ILIB may enhance sleep quality through regulation of circadian and autonomic function.

This randomized controlled pilot study was designed to evaluate the short-term efficacy of ILIB combined with electroacupuncture in improving pain and sleep quality in patients with chronic sciatica. The trial was conducted at the Binh Dinh Hospital of Traditional Medicine and Rehabilitation, Vietnam, from January to December 2025.

A total of 66 patients aged 18 years or older, diagnosed with chronic sciatica (pain duration ≥ 3 months) and sleep disturbance (Pittsburgh Sleep Quality Index > 5), were recruited and randomly assigned to one of two groups:

• Control Group (n = 33): Received standardized electroacupuncture at a continuous frequency of 60 Hz for 20 minutes per session, once daily for 10 sessions over 2 weeks. Acupuncture points targeted specific dermatomal roots matching the sciatic path: Jiaji (L3-S1), Dachangshu (BL25), Huantiao (GB30), Yinmen (BL37), Yanglingquan (GB34), Chengfu (BL36), Chengshan (BL57), and Kunlun (BL60).
• Intervention Group (n = 33): Received the identical electroacupuncture regimen plus adjunctive low-level intravascular laser irradiation (wavelength: 630 nm; output power: 2.5 mW) administered continuously for 30 minutes per session, totaling 10 sessions.

To control for pharmacological confounding factors, participants were restricted from modifying baseline drug therapies or initiating non-protocol physical modalities. Permitted rescue analgesic medication was restricted to paracetamol (maximum 2 g/day), tracked quantitatively via daily patient compliance diaries. Outcome measures were logged across four temporal milestones: baseline (Day 0), Day 7, Day 15, and an exploratory post-treatment follow-up on Day 22 to examine short-term carry-over retention after treatment withdrawal. Longitudinal data analysis was performed using linear mixed-effects regression models to handle repeated measurements while protecting statistical transparency.

Inclusion criteria

• Adults aged ≥ 18 years.
• Diagnosis of chronic sciatica pain lasting ≥ 3 months.
• Sleep disturbance defined by a Pittsburgh Sleep Quality Index (PSQI) score > 5.
• Pain intensity score ≥ 50 mm on a 100-mm Visual Analog Scale (VAS).
• Able to walk independently (with or without walking aids).
• Provided written informed consent to participate in the study.

Exclusion criteria

• Malignant diseases, autoimmune diseases, or systemic inflammatory disorders.
• History of prior spinal surgery.
• Acute low back pain of < 4 weeks' duration.
• Primary sleep disorders (e.g., narcolepsy, sleep apnea, circadian rhythm disorders).
• Diagnosed psychiatric conditions such as depression, anxiety, or delirium.
• Current use of psychotropic, antidepressant, hypnotic, corticosteroid, or antihistamine medications.
• Contraindications to low-level intravascular laser irradiation (e.g., hemophilia, acute myocardial infarction, acute stroke within 72 hours, active infection, pregnancy).
• Signs or suspicion of severe spinal conditions (e.g., cancer, vertebral fracture, spinal infection, or cauda equina syndrome).
• Concurrent involvement of lumbosacral nerve roots, plexus, or peripheral neuropathy confirmed by electrodiagnostic testing.