Acupuncture for Pain
Introduction
Physical pain is a common occurrence for many Americans; in fact, a national survey found that more than
one-quarter of U.S. adults had recently experienced some sort of pain lasting more than a day. In addition to
conventional treatments, such as over-the-counter and prescription medications, people may try acupuncture in an
effort to relieve pain. This fact sheet provides basic information about pain and acupuncture,
summarizes scientific research on acupuncture for specific kinds of pain, and suggests
sources for additional information.
Key Points
- People use acupuncture for various types of pain. Back pain is the most commonly reported use, followed by
joint pain, neck pain, and headache.
- Acupuncture is being studied for its efficacy in alleviating many kinds of pain. There are promising
findings in some conditions, such as chronic low-back pain and osteoarthritis of the knee; but, for most other
conditions, additional research is needed. The National Center for Complementary and Alternative Medicine
(NCCAM) sponsors a wide range of acupuncture research.
- Acupuncture is generally considered safe when performed correctly.
- In traditional Chinese medicine theory, acupuncture regulates the flow of qi (vital energy) through the
body. Research to test scientific theories about how acupuncture might work to relieve pain is under way.
- Tell all your health care providers about any complementary and alternative practices you use. Give them a
full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips
about talking with your health care providers about complementary and alternative medicine (CAM), see NCCAM's
Time to Talk campaign.
About Pain
Pain is a feeling triggered in the nervous system. It may be sharp or dull, off-and-on or steady, localized
(such as back pain) or all over (such as muscle aches from the flu). Sometimes, pain alerts us to injuries and
illnesses that need attention. Although pain usually goes away once the underlying problem is addressed, it can
last for weeks, months, or even years. Chronic pain may be due to an ongoing condition (such as arthritis) or to
abnormal activity in pain-sensing regions of the brain, or the cause may not be known.
To relieve their pain, many people take over-the-counter medications—either acetaminophen or nonsteroidal
anti-inflammatory drugs (NSAIDs, including aspirin, naproxen, and ibuprofen). Stronger medications, including
NSAIDs in higher dosages and narcotics, are available by prescription only. People may also try non-drug approaches
to help relieve their pain. Examples include physical and occupational therapy, cognitive behavioral therapy,
self-care techniques, and CAM therapies such as spinal manipulation or acupuncture.
Use of Acupuncture for Pain
Acupuncture, among the oldest healing practices in the world, is part of traditional Chinese medicine. Acupuncture
practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. In
traditional Chinese medicine theory, this regulates the flow of qi (vital energy) along pathways known as
meridians.
In the 2007 National Health Interview Survey (NHIS), 1.4 percent of respondents (representing 3.1 million
Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier
NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use
acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, and
recurring pain.
What the Science Says About Acupuncture for Pain
Acupuncture has been studied for a wide range of pain conditions, such as postoperative dental pain, carpal tunnel
syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, and tennis
elbow.
Overall, it can be very difficult to compare acupuncture research results from study to study and to draw
conclusions from the cumulative body of evidence. This is because studies may use different acupuncture techniques
(e.g., electrical vs. manual), controls (comparison groups), and outcome measures.
One particularly complex factor in acupuncture research is choosing the controls for a clinical trial. The choice
depends in part on whether the researchers want to study a particular aspect of acupuncture (e.g., effects on the
brain) or to determine whether acupuncture is useful compared with other forms of care. Examples of control groups
include study participants who receive no acupuncture, simulated acupuncture (procedures that mimic acupuncture,
sometimes also referred to as "placebo" or "sham"), or other treatments (in addition to or in place of acupuncture
or simulated acupuncture).
An emerging theme in acupuncture research is the role of the placebo. For example, a 2009 systematic review of
research on the pain-relieving effects of acupuncture compared with placebo (simulated) or no acupuncture was
inconclusive. The reviewers found a small difference between acupuncture and placebo and a moderate difference
between placebo and no acupuncture; the effect of placebo acupuncture varied considerably, and the effect of
acupuncture appeared unrelated to the specific kind of placebo procedure used. All of the study participants
received standard care, typically consisting of analgesic drugs and physical therapy.
The following sections summarize research on acupuncture for a variety of pain conditions, including those reported
by NHIS respondents who had used acupuncture. In general, acupuncture appears to be a promising alternative for
some of these pain conditions; however, further research is needed.
About Scientific Evidence on CAM Therapies
Scientific evidence on CAM therapies includes results from laboratory research as well as clinical trials
(studies in people). It encompasses both "positive" findings (evidence that a therapy may work) and "negative"
findings (evidence that it probably does not work or that it may be unsafe). Scientific journals publish study
results, as well as review articles that evaluate the evidence as it accumulates; fact sheets from NCCAM—like this
one—base information about CAM research primarily on the most rigorous review articles, known as systematic reviews
and meta-analyses.
- Carpal tunnel
syndrome—Although a 1997 NIH consensus statement on acupuncture concluded that acupuncture was
promising for carpal tunnel syndrome, additional research confirming acupuncture's efficacy for this
condition is scant.
- Fibromyalgia—Evidence on acupuncture for
fibromyalgia is mixed. Some reviews of the scientific literature have found the evidence promising. However,
another review that focused on the few rigorous randomized controlled trials on acupuncture as an adjunct
therapy for fibromyalgia did not find a benefit. Additionally, a 2003 assessment by the Agency for
Healthcare Research and Quality concluded that the evidence was insufficient and the beneficial effects of
acupuncture for fibromyalgia could not be determined.
- Headache/migraine—Study results on acupuncture for headache are conflicting. Some
literature reviews found evidence to support the use of acupuncture for headache, but others noted that most of
the studies were of poor quality. A 2008 review of randomized trials on acupuncture highlighted a few
well-designed trials whose findings indicate that acupuncture reduces migraine symptoms and is as effective as
headache medications. In addition, a 2009 review found that acupuncture may help relieve tension headaches.
However, two large trials that looked at acupuncture for migraines found no difference between actual and
simulated acupuncture, both of which were equal to conventional care or superior to no treatment.
- Low-back pain—According to clinical practice guidelines
issued by the American Pain Society and the American College of Physicians in 2007, acupuncture is one of
several CAM therapies physicians should consider when patients with chronic low-back pain do not respond to
conventional treatment. In early, small studies, combining actual acupuncture with conventional treatment
was more effective than conventional treatment alone for relieving chronic low-back pain; but actual
acupuncture was not more effective than simulated acupuncture or conventional treatment. However, a large,
rigorously designed clinical trial reported in May 2009 found that actual acupuncture and simulated
acupuncture were equally effective—and both were more effective than conventional treatment—for relieving
chronic low-back pain. There is insufficient evidence to draw definite conclusions about the effectiveness
of acupuncture for acute low-back pain.
- Menstrual cramps—Two literature reviews have suggested that acupuncture may help with pain
from menstrual cramps, but the research is limited.
- Myofascial pain—The evidence for acupuncture and myofascial pain (in which pain occurs in
sensitive areas, known as trigger points, in the muscles) is mixed. Some literature reviews have found the
evidence promising, but another review indicated that "needling therapies" for myofascial trigger point pain
were not more effective than placebo.
- Neck pain—Studies of acupuncture for
chronic neck pain have found that acupuncture provided better pain relief than some simulated treatments.
However, the studies varied in terms of design and most had small sample sizes.
- Osteoarthritis/knee pain—Acupuncture appears to be effective for osteoarthritis,
particularly in the area of knee pain. Recent literature reviews have found that acupuncture provides pain
relief and improves function for people with osteoarthritis of the knee. However, authors of a 2007 systematic
literature review suggested that although some large, high-quality trials have shown that acupuncture may be
effective for osteoarthritis of the knee, differences in the design, size, and protocol of the studies make it
hard to draw any definite conclusions from the body of research. These authors concluded that it is too soon to
recommend acupuncture as a routine part of care for patients with osteoarthritis.
- Postoperative dental pain—Although recent data on acupuncture for postoperative dental
pain are scant, literature reviews based on earlier evidence have identified acupuncture as a promising
treatment for dental pain—especially pain following tooth extraction. For example, a 1999 study of 39 dental
surgery patients found that acupuncture was superior to placebo (simulated acupuncture) in preventing
postoperative pain. However, a 2005 study of 200 dental surgery patients found no significant analgesic effect
for acupuncture compared to simulated acupuncture, although patients who believed they received acupuncture
reported significantly less pain than those who believed they received a placebo.
- Tennis elbow—Study results on the use of acupuncture for tennis elbow (lateral epicondyle)
pain are mixed. An early review of clinical trials reported that data on acupuncture for lateral epicondyle
pain were insufficient and of poor quality; however, recent reviews have found the evidence promising, noting
strong evidence that acupuncture provides short-term pain relief for lateral epicondyle pain.
Acupuncture has also been studied for a variety of other pain conditions, including arm and shoulder pain,
pregnancy-related pelvic and back pain, and temporomandibular joint (jaw) dysfunction. Although some studies
have produced some positive results, more evidence is needed to determine the efficacy of acupuncture for any
of these conditions.
There is evidence that people's attitudes about acupuncture can affect outcomes. In a 2007 study, researchers
analyzed data from four clinical trials of acupuncture for various types of chronic pain. Participants had been
asked whether they expected acupuncture to help their pain. In all four trials, those with positive expectations
reported significantly greater pain relief.
In addition to studying acupuncture's efficacy, researchers are looking at potential biomechanisms—that is, how
acupuncture might work to relieve pain. There are several theories about these biomechanisms (e.g., acupuncture
activates opioid systems in the brain that respond to pain); additional research is still needed to test the
theories. Researchers are using neuroimaging techniques such as functional magnetic resonance imaging (fMRI) to
look at the effects of acupuncture on various regions of the brain. In 2005, NCCAM sponsored the "Neurobiological
Correlates of Acupuncture" conference to discuss research challenges and directions in acupuncture neuroimaging
research.
Side Effects and Risks
Acupuncture is generally considered safe when performed by an experienced practitioner using sterile needles.
Relatively few complications from acupuncture have been reported. Serious adverse events related to acupuncture are
rare, but include infections and punctured organs. Additionally, there are fewer adverse effects associated with
acupuncture than with many standard drug treatments (such as anti-inflammatory medication and steroid injections)
used to manage painful musculoskeletal conditions like fibromyalgia, myofascial pain, osteoarthritis, and tennis
elbow.
NCCAM-Funded Research
NCCAM funds clinical trials to evaluate acupuncture's efficacy in alleviating various kinds of pain, as well as
research aimed at understanding the body's response to acupuncture and how acupuncture might work. The following
are examples of recent projects:
- Several studies of acupuncture for low-back pain (including integration with conventional medical care) and
osteoarthritis of the knee (including cost-effectiveness and long-term results)
- Studies of acupuncture for pain after oral surgery, and for pain associated with chronic headaches,
fibromyalgia, repetitive strain injury/carpal tunnel syndrome, and temporomandibular joint disorder
- Women's health studies, including acupuncture for pelvic pain, menstrual pain (vitamin K injections at
acupuncture points), and pain associated with advanced ovarian cancer
- Several studies using fMRI technology to study brain activity during acupuncture, including in people with
pain conditions such as fibromyalgia and osteoarthritis.
Selected References
-
Barnes PM, Bloom B, Nahin R.
Complementary and alternative medicine use among adults and
children:
United States
, 2007. CDC National Health Statistics Report #12.
2008
-
Birch S, Hesselink JK, Jonkman FA, et al.
Clinical research on acupuncture. Part 1. What have reviews
of the efficacy and safety of acupuncture told us so far? Journal of
Alternative and Complementary Medicine. 2004;10(3):468–480.
- Burke A, Upchurch DM, Dye C, et
al.
Acupuncture use in the United States: findings from the
National Health Interview Survey. Journal of Alternative and Complementary
Medicine. 2006;12(7):639–648.
- Ernst E.
Acupuncture—a critical
analysis.
Journal of Internal Medicine. 2006;259(2):125–137.
- Lao L, Hamilton GR, Fu J, et
al.
Is acupuncture safe? A systematic review of case
reports.
Alternative Therapies in Health and
Medicine. 2003;9(1):72–83.
- Linde K, Witt CM, Streng A, et
al.
The impact of patient expectations on outcomes in four
randomized controlled trials of acupuncture in patients with chronic pain. Pain. 2007;128(3):264–271.
- Madsen MV, Gøtzsche PC, Hróbjartsson
A.
Acupuncture treatment for pain: systematic review of
randomized clinical trials with acupuncture, placebo acupuncture, and no acupuncture
groups.
BMJ. 2009;338:a3115.
- MacPherson H, Nahin R, Paterson C, et al.
Developments in acupuncture research: big-picture
perspectives from the leading edge. Journal of Alternative and Complementary
Medicine. 2008:14(7):883–887.
- Napadow V, Ahn A, Longhurst J, et
al.
The status and future of acupuncture clinical
research.
Journal of Alternative and Complementary
Medicine. 2008:14(7):861–869.
- Napadow V, Webb JM, Pearson N, et
al.
Neurobiological correlates of acupuncture: November 17–18,
2005. Journal of Alternative and Complementary Medicine. 2006;12(9):931–935.
- National Center for Health Statistics. Health, United
States, 2006, With Chartbook on Trends in the Health of
Americans. Special feature:
pain. Hyattsville , MD: National Center for Health Statistics; 2006:68–87.
- National Institutes of Health
Consensus Panel.
Acupuncture: NIH Consensus Development Conference
Statement, Nov. 3–5, 1997. 15(5):1–34.
- Park J, Linde K, Manheimer E, et al.
The status and future of acupuncture clinical
research.
Journal of Alternative and Complementary
Medicine. 2008;14(7):871–881.
Carpal Tunnel
Syndrome
Fibromyalgia
- Agency for Healthcare Research and
Quality. Technology Assessment: Acupuncture for
Fibromyalgia. Rockville, MD:
Agency for Healthcare Research and Quality; 2003.
- Assefi NP, Sherman KJ, Jacobsen
C, et al.
A randomized clinical trial of acupuncture compared
with sham acupuncture in fibromyalgia. Annals of Internal
Medicine. 2005;143(1):10–21.
- Harris RE, Gracely RH, McLean
SA, et al.
Comparison of clinical and evoked pain measures in
fibromyalgia. The Journal of Pain: Official Journal of
the American Pain Society. 2006;7(7):521–527.
- Harris RE, Tian X, Williams DA,
et al.
Treatment of fibromyalgia with formula acupuncture:
investigation of needle placement, needle stimulation, and treatment
frequency. Journal of Alternative and Complementary
Medicine. 2005;11(4):663–671.
- Mayhew E, Ernst
E.
Acupuncture for fibromyalgia—a systematic review of
randomized clinical trials. Rheumatology
(Oxford). 2007;46(5):801–804.
Headache/Migraine
- Coeytaux
RR, Kaufman JS, Kaptchuk TJ, et al.
A randomized, controlled trial
of acupuncture for chronic daily headache. Headache. 2005;45(9):1113–1123.
- Diener HC, Kronfeld K, Boewing G, et
al.
Efficacy of acupuncture for
the prophylaxis of migraine: a multicentre randomized controlled clinical
trial. Lancet
Neurology. 2006;5(4):310–316.
- Endres HG, Diener HC, Molsberger, et
al.
Role of acupuncture in the
treatment of migraine. Expert Review of
Neurotherapeutics. 2007;7(9):1121–1134.
- Griggs
C, Jensen J.
Effectiveness of acupuncture
for migraine: critical literature review. Journal of Advanced
Nursing. 2006 May;54(4):491–501.
- Linde K, Allais G, Brinkhaus B, et al. Acupuncture
for tension-type headache. Cochrane Database of
Systematic Reviews. 2009;(1):CD007587.
- Linde K,
Streng A, Jürgens S, et al.
Acupuncture for patients with
migraine: a randomized controlled trial. Journal of the American Medical
Association. 2005;293(17):2118–2125.
- Melchart
D, Streng A, Hoppe A, et al.
Acupuncture in patients with
tension-type headache: randomized controlled trial. BMJ. 2005;331:376–382.
Low-Back Pain
- Chou R,
Qaseem A, Snow V, et al.
Diagnosis and treatment of low
back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain
Society. Annals of Internal
Medicine. 2007;147(7):478–491.
- Eisenberg DM, Post DE, Davis RB, et
al.
Addition of choice of
complementary therapies to usual care for acute low back pain: a randomized controlled
trial. Spine. 2007;32(2):151–158.
- Furlan
AD, van Tulder M, Cherkin D, et al.
Acupuncture and dry-needling
for low back pain: an updated systematic review within the framework of the Cochrane
collaboration. Spine. 2005;30(8):944–963.
- Manheimer E, White A, Berman B, et
al.
Meta-analysis: acupuncture for
low back pain. Annals of Internal
Medicine. 2005;142(8):651–663.
Menstrual
Cramps
Myofascial
Pain
Neck
Pain
-
Trinh KV, Graham N, Gross AR, et al. Cervical
Overview Group. Acupuncture for neck disorders. Cochrane
Database Systematic Reviews. 2006;3:CD004870
.
Osteoarthritis/Knee
Pain
- Agency for Healthcare Research and
Quality. Technology Assessment: Acupuncture for
Osteoarthritis. Rockville, MD:
Agency for Healthcare Research and Quality; 2003.
- Berman BM, Lao L, Langenberg P, et al.
Effectiveness of acupuncture as adjunctive therapy in
osteoarthritis of the knee: a randomized, controlled trial. Annals of Internal
Medicine. 2004;141(12):901–910.
- Bjordal JM, Johnson MI,
Lopes-Martins RA, et al.
Short-term efficacy of physical interventions in
osteoarthritic knee pain. A systematic review and meta-analysis of randomised placebo-controlled
trials. BMC Musculoskeletal Disorders [online
journal]. 2007; 8:51. Accessed at
http://www.biomedcentral.com/1471–2474/8/51 on July 30,
2008.
- Foster NE, Thomas E, Barlas P, et al.
Acupuncture as an adjunct to exercise based
physiotherapy for osteoarthritis of the knee: randomised controlled
trial. BMJ. [online
journal]. 2007;335(7617):436. Accessed at
http://www.bmj.com/cgi/content/full/335/7617/436 on July 30,
2008.
- Kwon YD, Pittler MH, Ernst E.
Acupuncture for peripheral joint osteoarthritis: a
systematic review and meta-analysis. Rheumatology
(Oxford). 2006;45(11):1331–1337.
- Manheimer E, Linde K, Lao L, et al.
Meta-analysis: acupuncture for osteoarthritis of the
knee. Annals of Internal
Medicine. 2007;146(12):868–877.
- Scharf H-P, Mansmann U, Streitberger K, et
al.
Acupuncture and knee osteoarthritis: a three-armed
randomized trial. Annuals of Internal
Medicine. 2006;145(1):12–20.
- White A, Foster NE,
Cummings M, et al.
Acupuncture treatment for chronic knee pain: a
systematic review. Rheumatology
(Oxford). 2007;46(3):384–390.
Postoperative Dental
Pain
Tennis
Elbow
- Bisset L, Paungmali A, Vicenzino B, et
al.
A systematic review and meta-analysis of clinical trials on
physical interventions for lateral epicondylalgia. British Journal of Sports
Medicine. 2005;39(7):411–422.
- Green S, Buchbinder R, Barnsley L, et
al. Acupuncture for lateral elbow pain. Cochrane Database
of Systematic Reviews. 2002;(1):CD003527.
- Trinh KV, Phillips SD, Ho E, et al.
Acupuncture for the alleviation of lateral epicondyle pain:
a systematic review.
Rheumatology (Oxford). 2004;43(9):1085–1090.
- Trudel D, Duley J, Zastrow I, et
al.
Rehabilitation for patients with lateral epicondylitis: a
systematic review.
Journal of Hand Therapy: Official Journal of the American Society of Hand
Therapists. 2004;17(2):243–266.
Other Pain
Conditions
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