Well over 1000 English-language reviews of the clinical use of acupuncture in humans have been published since the 1970s, many pointing out the challenge of designing high-quality trials with effective placebo controls. Several types of placebos have been tried: needling at nonacupuncture points, using a retractable sham needle that does not penetrate the skin, and needling at true acupuncture points that are inappropriate for the condition being treated. Data analysis is complicated by sham treatments having physiologic effects. Acupuncture has been shown to be most effective in treating pain and nausea and vomiting, with sustained benefits at 12 months in many studies. Many other diverse conditions have been studied. Below are some common conditions for which patients seek acupuncture care.
et al. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021;11:e045961.
et al. Neural substrates of acupuncture: from peripheral to central nervous system mechanisms. Front Neurosci. 2020;13:1419.
A. Postoperative Pain
Reviews comparing acupuncture with sham control have found it helpful in the management of acute postoperative pain, reducing pain intensity, opioid consumption, and opioid-associated side effects. Multiple RCTs have found that acupuncture significantly improved postoperative function and reduced pain following a wide variety of surgical procedures. Reviews and meta-analyses examining postoperative pain patients found that those treated with acupuncture had less pain and used fewer opioids. A prospective RCT of 180 women scheduled for elective cesarean delivery found that acupuncture was safe and effective in reducing pain and accelerating mobilization of patients on the first day after cesarean delivery (sitting up, standing up, removing Foley catheter, and ambulation).
et al. Effectiveness of acupuncture for pain control after cesarean delivery: a randomized clinical trial. JAMA Netw Open. 2022;5:e220517.
et al. Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice. BMC Complement Altern Med. 2019;19:192.
B. Nausea and Vomiting
Based on multiple RCTs involving more than 10,000 patients, there is strong evidence that acupuncture is effective in the treatment of pregnancy-induced, chemotherapy-induced, and postoperative nausea and vomiting. A systematic review identified 43 trials using a specific acupuncture point (P6) for treatment of nausea and vomiting. P6 is located on the anterior surface of the forearm, approximately 2 cm proximal to the wrist crease between the tendons of palmaris longus and flexor carpi radialis. Results across trials were the most consistent for postoperative nausea and vomiting. Compared with sham procedures, P6 stimulation was more effective than comparison in preventing nausea (relative risk [RR] 0.72, 95% CI 0.59–0.89) and vomiting (RR 0.71, 95% CI 0.56–0.91). In the nine trials that compared P6 stimulation with antiemetic medication, P6 stimulation was superior in preventing nausea and equivalent in preventing vomiting. Electroacupuncture was reported to be effective for first-day vomiting after chemotherapy. A Cochrane review of P6 stimulation included 59 trials and over 7600 patients and concluded that there is moderate-quality evidence showing that P6 stimulation and antiemetic medications were equally effective in preventing postoperative nausea and vomiting. A pilot study found that intraoperative laser acupuncture stimulation of P6 acupoints combined with antiemetic medication prophylaxis decreased postoperative nausea and rescue antiemetic medication need in patients who underwent a laparoscopic cholecystectomy.
et al. Effectiveness of intraoperative laser acupuncture combined with antiemetic drugs for prevention of postoperative nausea and vomiting. J Altern Complement Med. 2020;26:67.
Systematic reviews have concluded that acupuncture is a safe and effective option for preventing and treating migraine headaches and possibly for preventing tension headaches. A 2012 multicenter study of 480 adults showed benefit of acupuncture for prophylaxis of migraine, although it was only slightly better than sham acupuncture. A review concluded that acupuncture is at least as effective as conventional medication therapy and is safe and cost-effective. A Cochrane review concluded that acupuncture is as effective as migraine prophylactic medications and may have small benefit over sham acupuncture in the treatment of acute migraine attacks. Another Cochrane review concluded that acupuncture is effective for treating frequent episodic or chronic tension-type headaches. Finally, a 2020 systematic review of nine RCTs including a total of 1484 patients found that acupuncture is slightly more effective and much safer than pharmacologic prophylaxis of migraine headaches.
et al. Acupuncture vs. pharmacological prophylaxis of migraine: a systematic review of randomized controlled trials. Front Neurol. 2020;11:576272.
The efficacy of acupuncture in the treatment of OA remains uncertain. Systematic reviews and meta-analyses of RCTs suggested that acupuncture may be efficacious for pain control and function (eg, gait performance) in patients with OA of peripheral joints, particularly for knee OA. Its favorable safety profile as well as significant expectation and placebo effect may contribute to its overall benefit. It may also be a cost-effective treatment for OA. Notwithstanding the uncertainties surrounding its efficacy, the 2010 OARSI (Osteoarthritis Research Society International) recommendations reaffirmed the use of acupuncture for reducing pain from OA and for improving function. Questions remain about the duration of effect and the style of acupuncture used. In a 2020 multicenter RCT, 480 patients with knee OA were randomly assigned to receive intensive electroacupuncture, intensive manual acupuncture, or sham acupuncture, 3 times weekly for 8 weeks. This study found that intensive electroacupuncture treatment resulted in less pain and better function than sham acupuncture, with benefits persisting through 6 months. Intensive manual acupuncture treatment had no benefit for knee OA at week 8; however, by week 16 a benefit was apparent that was maintained at 6 months.
et al. Efficacy of intensive acupuncture versus sham acupuncture in knee osteoarthritis: a randomized controlled trial. Arthritis Rheumatol. 2021;73:448.
The updated clinical practice guidelines from the American College of Physicians on noninvasive treatments for acute and chronic low back pain recommended acupuncture as an option for acute, subacute, and chronic low back pain. Similarly, the 2017 Canadian clinical practice guideline also endorsed use of acupuncture for chronic low back pain. Furthermore, a systematic review of therapies for low back pain concluded that acupuncture is a cost-effective option. In contrast, a 2020 Cochrane review found that acupuncture may not better than sham acupuncture in the relief of chronic low back pain, although it is more effective than no treatment in improving pain and function. In 2020, the Centers for Medicare & Medicaid Services approved coverage of acupuncture for Medicare patients with chronic low back pain. Many other insurance providers also offer coverage for acupuncture.
et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12:CD013814.
F. Other Pain Conditions
Acupuncture appears effective for temporomandibular joint (TMJ) pain, other orofacial pain, chronic neck pain, chronic shoulder pain, peripheral neuropathy, acute zoster pain, plantar heel pain, and arthralgias from aromatase inhibitors in women with breast cancer. A systematic review of acupuncture in the treatment of TMJ suggested it is beneficial compared with placebo and has equivalent efficacy to occlusal splints; however, studies were few, and larger sample sizes are needed. A 2019 meta-analysis found that the placebo response may play a large role in TMJ pain management.
A 2021 meta-analysis of aromatase inhibitor-induced arthralgia in patients with breast cancer examined seven trials involving 603 patients. This study found significant differences between the acupuncture and control groups. No adverse events were noted, suggesting that acupuncture is a safe treatment option for these patients. A 2020 systematic review and meta-analysis of 17 RCTs involving 1111 patients found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics. Due to significant heterogeneity among studies, the evidence was graded moderate. More rigorous trials are needed in this patient population.
et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol. 2020;6:271.
et al. Acupuncture for arthralgia induced by aromatase inhibitors in patients with breast cancer: a systematic review and meta-analysis. Integr Cancer Ther. 2021;20:1534735420980811.
et al. Placebo and nocebo response magnitude on temporomandibular disorder-related pain: a systematic review and meta-analysis. J Oral Rehabil. 2019;46:862.
G. Tobacco, Alcohol, and Substance Use Disorders
Reviews have yielded conflicting results on the benefit of acupuncture promoting smoking cessation in patients with nicotine addiction. The most recent Cochrane systematic review of 38 trials concluded that there is no consistent, bias-free evidence that acupuncture has a sustained benefit on smoking cessation for 6 months or more. Because of methodological problems, no firm conclusions can be drawn.
A systematic review and meta-analysis of nine studies, comprising more than 1000 patients, found that acupuncture could be effective in treatment of opioid use disorders. A 2021 retrospective study of 52,346 patients with chronic pain found a clinically significant reduction in all-cause and pain-related emergency department use in the 12-month follow-up period. More studies are needed to be done to better understand which modality of acupuncture is best, what symptoms are being treated, and length of treatment.
et al. Do acupuncture services reduce subsequent utilization of opioids and surgical interventions compared to noninvasive therapies among patients with pain conditions? Pain Med. 2021;22:2754.
Acupuncture has been studied in a variety of other conditions with interesting results. A 2019 systematic review and meta-analysis of 12 studies with 798 patients with COPD found that acupuncture improved health-related quality of life. Notably, the authors did not find improvements in lung function above and beyond standard of care (medication and pulmonary rehabilitation).
Acupuncture has also shown benefit in patients with mental health conditions. A 2021 network meta-analysis of 71 studies involving 5856 patients with major depression disorder found that combined interventions of electroacupuncture with SSRIs and manual acupuncture with SSRIs were more effective in improving depression symptoms compared with acupuncture alone, pharmacological interventions alone, or other inactive groups. This study indicates that acupuncture in combination with pharmacotherapy could be a safe and effective interventions for patients with major depressive disorder. Larger, well-designed studies are needed.
Increasing research with acupuncture in cancer patients has shown benefits in symptom management. A meta-analysis of 10 RCTs, representing over 1300 patients, found that acupuncture had a beneficial effect on cancer-related fatigue, compared with sham acupuncture and usual care.
Acupuncture has long been used to assist with labor and delivery. A 2015 study comparing two different acupuncture point treatments and a control group found that the use of electroacupuncture significantly decreased labor pain and shortened the duration of the active phase of labor. A 2017 Cochrane review examined 22 trials that included over 3000 women and found that there was no clear benefit of acupuncture or acupressure in reducing rates of cesarean delivery.
A 2021 meta-analysis of 17 studies of acupuncture for menopausal hot flashes included 1123 women with seven or more hot flashes per day. The efficacy of acupuncture was significantly related to treatment duration, reaching 50% of maximum effect at 2 weeks and 80% at 8 weeks. In addition, the higher the baseline level of hot flashes, the better the efficacy of acupuncture. The effects were comparable to pharmacotherapy such as SSRIs and SNRIs.
A 2021 systematic review of acupuncture for urinary incontinence found that it was clinically effective at reducing urine leakage in middle-aged and older women.
et al. Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019;35:208.
et al. Quantitative study on the efficacy of acupuncture in the treatment of menopausal hot flashes and its comparison with nonhormonal drugs. Menopause. 2021;28:564.
et al. Efficacy of acupuncture for urinary incontinence in middle-aged and elderly women: a systematic review and meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol. 2021;257:138.
et al. A network meta-analysis on the effectiveness and safety of acupuncture in treating patients with major depressive disorder. Sci Rep. 2021;11:10384.