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Acupuncture for chronic pain

Acupuncture comes from traditional Chinese medicine, which explains it as restoring the flow of qi along meridians. In individual patient data meta-analyses of adults with chronic back, neck, osteoarthritis, headache and shoulder pain, acupuncture lowered pain scores clearly against no acupuncture and modestly against sham, with most of the effect still present at one year, so it may help people living well with chronic pain. Serious adverse events are rare but are linked to non-sterile needles and improper technique.

  • Recovery

Evidence retrieved up to

What the research shows

In trial follow-up of adults with chronic pain, most of the difference in pain scores between acupuncture and control groups was still present one year after treatment.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteBenefit

Who this is about

adults with chronic musculoskeletal pain, osteoarthritis pain or chronic headache

Practical note

Graded low: long-term data came from a subset of trials (20 studies, 6,376 participants), loss to follow-up grows over a year, and the persistence was not seen for neck pain.

Safety note

Serious adverse events are rare but reported when acupuncture is delivered improperly, including infections (mainly from non-sterile technique or skin contact at needle sites), punctured organs such as a collapsed lung (pneumothorax), and nervous-system injury. Trials used single-use sterile needles; licensing and registration of practitioners vary by place, so choosing a registered, trained practitioner matters. People living with chronic pain may wish to discuss acupuncture with their health care provider.

Sources

In randomised trials of adults with chronic back, neck, osteoarthritis, headache or shoulder pain, those given a course of acupuncture reported lower pain scores than those given no acupuncture, by about half a standard deviation; acupuncture may help people living well with chronic pain.

Moderate certaintyFurther research may change the size of the effect.
Take care: see the safety noteBenefit

Who this is about

adults with chronic musculoskeletal pain, osteoarthritis pain or chronic headache

Practical note

Individual patient data meta-analyses pooled raw data from up to 39 trials and 20,827 patients; certainty is moderate rather than high because neither patients nor acupuncturists can be blinded in a no-acupuncture comparison, so expectation effects are mixed into the difference.

Safety note

Serious adverse events are rare but reported when acupuncture is delivered improperly, including infections (mainly from non-sterile technique or skin contact at needle sites), punctured organs such as a collapsed lung (pneumothorax), and nervous-system injury. Trials used single-use sterile needles; licensing and registration of practitioners vary by place, so choosing a registered, trained practitioner matters. People living with chronic pain may wish to discuss acupuncture with their health care provider.

Sources

Serious adverse events after acupuncture are rare, but infections, punctured organs including collapsed lung, and nervous-system injury have been reported, mostly with non-sterile needles or improper technique.

Low certaintyFurther research is likely to change this.
Take care: see the safety noteRisk

Who this is about

adults receiving acupuncture

Practical note

Evidence on rare serious harms comes mainly from case reports and agency summaries, which show what can happen but not how often, so certainty about frequency is low. Commonly reported minor events in trials were pain at the insertion point, bruising and bleeding.

Safety note

Serious adverse events are rare but reported when acupuncture is delivered improperly, including infections (mainly from non-sterile technique or skin contact at needle sites), punctured organs such as a collapsed lung (pneumothorax), and nervous-system injury. Trials used single-use sterile needles; licensing and registration of practitioners vary by place, so choosing a registered, trained practitioner matters. People living with chronic pain may wish to discuss acupuncture with their health care provider.

Sources

Compared with sham acupuncture, real acupuncture lowered chronic pain scores by only a small amount, about one fifth of a standard deviation, so much of the improvement seen in trials comes from factors other than the needling itself.

Moderate certaintyFurther research may change the size of the effect.
Take care: see the safety noteBenefit

Who this is about

adults with chronic musculoskeletal pain, osteoarthritis pain or chronic headache

Practical note

The Cochrane review of chronic nonspecific low back pain found the difference from sham did not reach a clinically important threshold; effect sizes were smaller in trials whose sham used a penetrating needle.

Safety note

Serious adverse events are rare but reported when acupuncture is delivered improperly, including infections (mainly from non-sterile technique or skin contact at needle sites), punctured organs such as a collapsed lung (pneumothorax), and nervous-system injury. Trials used single-use sterile needles; licensing and registration of practitioners vary by place, so choosing a registered, trained practitioner matters. People living with chronic pain may wish to discuss acupuncture with their health care provider.

Sources

What the tradition holds

Traditional Chinese medicine holds that needling specific points along the meridians restores the flow of qi and thereby relieves pain, so the choice of points is held to matter for how much pain is relieved.

Take care: see the safety noteUnclear

Who this is about

adults with chronic pain

The tradition's frame

TCM

Traditional Chinese medicine explains pain as disturbed flow of qi, and acupuncture restores that flow by needling specific points along the meridians.

Practical note

Across trials, the characteristics of the acupuncture given showed no clear link with outcome, and sham needling also reduced pain, which does not support point specificity.

Safety note

Serious adverse events are rare but reported when acupuncture is delivered improperly, including infections (mainly from non-sterile technique or skin contact at needle sites), punctured organs such as a collapsed lung (pneumothorax), and nervous-system injury. Trials used single-use sterile needles; licensing and registration of practitioners vary by place, so choosing a registered, trained practitioner matters. People living with chronic pain may wish to discuss acupuncture with their health care provider.

Sources