Acupuncture

Evidence

Acupuncture is a treatment derived from ancient Chinese medicine. Fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.

It is used in many NHS general practices, as well as the majority of pain clinics and hospices in the UK.

Acupuncture is often seen as a form of complementary or alternative medicine (CAM).

How acupuncture works

Western medical acupuncture is the use of acupuncture following a medical diagnosis. It involves stimulating sensory nerves under the skin and in the muscles of the body.

This results in the body producing natural substances, such as pain-relieving endorphins. It's likely that these naturally released substances are responsible for the beneficial effects experienced with acupuncture.

A course of acupuncture usually creates longer lasting pain relief than when a single treatment is used.

Traditional acupuncture is based on the belief that an energy, or "life force", flows through the body in channels called meridians. This life force is known as Qi (pronounced "chee").

Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi doesn't flow freely through the body, this can cause illness. They also believe acupuncture can restore the flow of Qi, and so restore health.

Uses of acupuncture

Acupuncture practitioners – sometimes called acupuncturists – use acupuncture to treat a wide range of health conditions. However, the use of acupuncture isn't always based on rigorous scientific evidence.

The National Institute for Health and Care Excellence (NICE) provides guidelines for the NHS on the use of treatments and care of patients.

Currently, NICE only recommends considering acupuncture as a treatment option for:

chronic tension-type headaches
migraines

Acupuncture is also often used to treat other musculoskeletal conditions (of the bones and muscles) and pain conditions, including:

chronic pain, such as neck pain
joint pain
dental pain
postoperative pain

However, in many conditions where acupuncture is used, there's less good quality evidence to draw any clear conclusions over its effectiveness compared with other treatments.

Acupuncture on the NHS

Acupuncture is sometimes available on the NHS, most often from GPs or physiotherapists, although access is limited.

Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners. Initial sessions usually cost £40-70, and further sessions £25-60.

If you're being treated by an acupuncture practitioner for a health condition or are considering having acupuncture, it's advisable to discuss this with your GP.

How acupuncture is performed

An initial acupuncture session usually lasts 20-40 minutes and involves an assessment of your general health, medical history and a physical examination, followed by insertion of the acupuncture needles.

Courses of treatment often involve up to 10 separate sessions, but this can vary.

Insertion of the needles

The needles are inserted into specific places on the body, which practitioners call acupuncture points.

During the session, you'll usually be asked to sit or lie down. You may also be asked to remove some clothes so the practitioner can access certain parts of your body.

The needles used are fine and are usually a few centimetres long. They should be single-use, pre-sterilised needles that are disposed of immediately after use.

Acupuncture practitioners choose specific points to place the needles based on your condition. Up to 12 points may be used during a typical session, sometimes more depending on the number of symptoms you have.

The needles may be inserted just under the skin, or deeper so they reach muscle tissue. Once the needles are in place, they may be left in position for a length of time lasting from a few minutes up to around 30 minutes.

You may feel a tingling or a dull ache when the needles are inserted but shouldn't experience any significant pain. If you do, let your practitioner know straight away.

In some cases, your practitioner may rotate the needles or stimulate them with a mild electric current (known as electroacupuncture).

Acupuncture safety and regulation

There's no statutory regulation of acupuncture in England, but many non-medical acupuncture practitioners are required to register with their local authority.

If you choose to have acupuncture, make sure your acupuncture practitioner is either a regulated healthcare professional such as a doctor, nurse of physiotherapist or a member of a recognised national acupuncture organisation.

The British Acupuncture Council holds a register of practitioners that has been vetted and approved by the Professional Standards Authority. If you decide to have traditional Chinese medicine acupuncture, you can visit this website to find a qualified acupuncturist near you.

When it's carried out by a qualified practitioner, acupuncture is generally very safe. Some people experience mild, short-lived side effects such as:

pain where the needles puncture the skin
bleeding or bruising where the needles puncture the skin
drowsiness
feeling sick
feeling dizzy or faint
worsening of pre-existing symptoms

If you have a bleeding disorder, such as haemophilia, or are taking anticoagulants, talk to your GP before you have acupuncture.

Acupuncture is also not usually advised if you have a metal allergy or an infection in the area where needles may be inserted.

It's generally safe to have acupuncture when you're pregnant. However, let your acupuncture practitioner know if you're pregnant because certain acupuncture points can't be used safely during pregnancy.

Read about:

Are complementary therapies safe in pregnancy?

Evidence for and against Acupuncutre

There is some scientific evidence acupuncture has a beneficial effect for a number of health conditions.

However, there is less clear scientific evidence about the benefits of acupuncture in the majority of conditions it is often used for.

The National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraine.

Assessing the evidence

One of the best ways researchers can assess the evidence behind a particular treatment is by carrying out a systematic review. This is a "study of studies" that combines findings from separate but similar studies to come up with an overall conclusion.

Systematic reviews are an important part of health research because they can identify findings that might otherwise be missed in individual studies. They can also help distinguish the effects of treatment from the effects of chance.

It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect and not because of the treatment itself. Systematic reviews can help reduce the potential influence of the placebo effect.

While systematic reviews cannot always determine conclusively whether a treatment does or does not work, they can be useful in assessing how a particular treatment (such as acupuncture) compares to another (such as "sham" acupuncture or medication).

However, even this can be challenging – both acupuncture and placebo treatments can stimulate the release of natural painkilling substances called endorphins, which can make it difficult to distinguish between them.

What evidence is there for acupuncture?

One of the largest and most respected organisations that carries out and publishes systematic reviews into the effectiveness of medical treatments is The Cochrane Collaboration.

A number of systematic reviews into the effectiveness of acupuncture have been published by The Cochrane Collaboration, and the basic results are summarised below.

Some positive evidence

Systematic reviews carried out by The Cochrane Collaboration have found there is some evidence acupuncture may have a beneficial effect on the following conditions:

chronic lower back pain
tension-type headaches
migraines
nausea and vomiting after chemotherapy
nausea and vomiting after surgery
osteoarthritis
neck pain
irritable bowel syndrome (IBS)

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, the existence of some positive evidence does not mean acupuncture definitely works for these conditions.

In many cases, the evidence appears contradictory. For example, some high-quality studies may suggest acupuncture is no better than "sham" acupuncture, whereas some lower-quality studies may suggest acupuncture is better than an established medical treatment.

The issue is sometimes also further complicated by the fact some "sham interventions" include active needling and are therefore not true placebos.

In addition, it can be difficult to make sure the patients involved in acupuncture studies are unaware of the specific treatment they are receiving (known as "blinding").

This is because it is obvious whether you are receiving a conventional medical treatment such as medication or if you are receiving acupuncture, for example. This is a problem as it means the preconceptions of the person being treated may influence the result.

Some systematic reviews, however, have demonstrated the effects of acupuncture over sham treatment in studies where patients are unaware whether they are having real acupuncture or sham treatment.

For example, one large meta-analysis (a type of systematic review) not carried out by The Cochrane Collaboration included data from more than 17,000 patients. It compared acupuncture to sham acupuncture or no acupuncture without patients being aware of whether they had received real or sham treatment.

This review found acupuncture to be superior to both sham and no treatment for headaches, osteoarthritis, back pain and neck pain.

Little or no evidence

In many conditions where acupuncture is used, there is not enough good quality evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.

For example, systematic reviews published by The Cochrane Collaboration have suggested more research is needed to assess whether acupuncture is effective for:

asthma
glaucoma
schizophrenia
depression
shoulder pain
elbow pain
rheumatoid arthritis
Bell's palsy
restless legs syndrome
insomnia
vascular dementia
stroke, stroke rehabilitation and swallowing problems caused by stroke

More research is needed to establish whether acupuncture is better or worse than best standard treatments for these conditions.

More information and research

If you want to find out more about studies into acupuncture, you can search for high-quality research using the NHS Evidence and Cochrane Library websites.