Although there have been numerous controlled studies of acupuncture, there is no condition for which acupuncture's supporting evidence is strong.
There are several reasons for this, but one is fundamental: even with the best of intentions, it is difficult to properly ascertain the effectiveness of a hands-on therapy such as acupuncture.
Only one form of study can truly prove that a treatment is effective: the double-blind, placebo-controlled trial. However, it is not easy to fit acupuncture into a study design of this type. One problem is designing a form of placebo acupuncture, and an even more challenging problem is to keep participants and practitioners in the dark regarding who is receiving real acupuncture and who is receiving fake. Without such blinding, the results of the study can be skewed by numerous factors. For a discussion of these factors, see
Why Does This Database Rely on Double-blind Studies?
In an attempt to approximate double-blind studies of acupuncture, researchers have resorted to a number of clever techniques. Perhaps the most common involves sham acupuncture. In such studies, a fake version of acupuncture is used to keep participants in the dark. However, because the acupuncturist knows that this is a fake treatment, he or she may subtly convey a lack of confidence in the outcome. Such studies are called single-blind and are not fully trustworthy. (The only exception are studies in which the patient is anesthetized prior to the acupuncture, and is therefore, presumably, incapable of receiving this sort of "top spin.")
To get around this problem and produce a truly double-blind study, some studies may employ technicians trained only to insert needles, rather than real acupuncturists. Such technicians might be given a list of real acupuncture points or phony acupuncture points, without being told which is which. However, it is not reasonable to suppose that an essentially untrained technician can give an acupuncture treatment as effective as that of a real acupuncturist. Furthermore, using a fixed set of points to treat a problem is not true to traditional acupuncture, which always individualizes treatment to the person.
Another approach is to use real acupuncturists to deliver treatment, but to have a separate person evaluate the effects of that treatment. Such studies may be described as partially double-blind (or observer blind); they prevent researchers from biasing their own observations, but they still do not eliminate the problem that the acupuncturist might communicate confidence (or lack of it) to the participants. The placebo effect in acupuncture is very sensitive to expectation; in one study, patients who believed they were getting real acupuncture experienced benefits and those who believed they were getting fake acupuncture failed to experience benefits.
Whether or not they were
receiving real or fake acupuncture proved to be irrelevant; it was the belief that mattered. One naturally doubts whether acupuncturists are sufficiently adept at hiding their true feelings from their patients. Osteopathic physician Kerry Kamer suggested a whimsical approach to testing acupuncture: for the placebo group, use actors trained to convey confidence while performing fake acupuncture. However, such studies have not yet been reported.
Despite their limitations, most of the best studies available at present are the single-blind or partially double-blind designs described earlier. Although imperfect, they at least can give us some idea whether true acupuncture might be effective.
There is another problem to consider as well: acupuncture causes a very strong placebo effect, whether it is real or fake. This phenomenon tends to diminish the difference in results between the treatment group and the placebo group and can potentially hide a true benefit by making it too small to reach
. As an example, consider a study in which 67 people with hip arthritis received either random needle placement or actual acupuncture.
The results showed improvement in both groups, but to the same extent. Does this mean that traditional acupuncture is actually no better than random acupuncture? Not necessarily. The study could simply have been too small to identify benefits that did occur. In studies that show a strong placebo effect, it may be necessary to enroll hundreds of participants to show benefit above statistical “background noise.” Keep this in mind regarding all of the negative trials described below. A small study can fail to find benefit, but it cannot actually prove lack of benefit.
Some studies have compared acupuncture to other therapies, such as physical therapy or
. Trials of this kind are good for determining relative cost effectiveness, but they cannot be taken as proof of efficacy for one simple reason: these other therapies have never been proven effective themselves.
Numerous acupuncture studies failed to use placebo treatment or had no control group at all. Such studies prove nothing and generally are not reported here.
There is one additional problem in evaluating the evidence for acupuncture: Many of the studies were performed in China, and there is evidence of systematic bias in the Chinese medical literature.
In 1998, researchers evaluating the acupuncture studies from China discovered that every one found acupuncture effective. This led them to look further into other Chinese medical research. Review of controlled trials involving other therapies, including standard drugs, showed that Chinese trials reported positive results 99% of the time. Although some bias exists in all medical publications, this finding suggests a particularly high rate of bias in the Chinese research record. A subsequent analysis in 2007 continued to find grossly inadequate standards of rigor in Chinese studies of Chinese medicine.
Given all the above caveats, the following sections address the science regarding acupuncture. They begin with conditions in which acupuncture research has been mostly positive, continue with those for which the record is mixed, and conclude with those in which the tested form of acupuncture has not proved effective. Note that we also include studies of acupressure and electroacupuncture.
Nausea and Vomiting
Numerous studies have evaluated treatment on a single acupuncture point—P6—traditionally thought to be effective for relief of various forms of nausea and vomiting. This point is located on the inside of the forearm, about 2 inches above the wrist crease. Most studies have investigated the effects of pressure on this point (acupressure) rather than needling. The most common methods involve a wristband with a pearl-sized bead in it situated over P6. The band exerts pressure on the bead while it is worn, and the user can press on the bead for extra stimulation.
Although the research record is mixed, on balance it appears that P6 stimulation offers at least modest benefits for nausea. This approach has been studied in anesthesia-induced nausea and other forms of nausea.
General anesthetics and other medications used for
frequently cause nausea. Many controlled studies involving women who have had gynecologic surgery found that P6 stimulation of various types reduced postsurgical nausea compared to placebo.
On the negative side, a double-blind, placebo-controlled study of 410 women undergoing gynecologic surgery failed to find P6 acupressure more effective than fake acupressure (both were more effective than no treatment).
A small trial of acupuncture in gynecological surgery also failed to find benefit,
as did three studies of acupressure for women undergoing C-section.
Studies of acupuncture or acupressure in other forms of surgery have produced about as many negative results as positive ones.
A 2004 review of the entire literature regarding P6 stimulation for postoperative nausea found a total of 26 studies.
All of these studies suffered from significant flaws; however, on balance the reviewers found that stimulation of P6 does reduce postoperative nausea as compared to placebo.
Similarly, a 2008 review of 6 placebo-controlled trials investigating the effectiveness of P6 stimulation on nausea and vomiting both during and after cesarean section found some benefit, though the authors concluded that the results were largely inconsistent.
One particularly interesting aspect of studies of acupressure for postsurgical nausea is that here a single-blind study is probably as good as a double-blind study. If the acupressure wrist band is not put on till after anesthesia has begun, no amount of confidence or lack of it by the practitioner is likely to alter the placebo effect experienced by the unconscious patient. Thus, studies of acupressure/acupuncture for this condition have a higher potential validity than studies for any of the other conditions listed below. The fact that benefits have been seen strongly suggests that stimulation of P6 does in fact affect nausea. That there is no clear physiological reason why this should be so makes this an intriguing finding, even if the benefit is too slight to make much real difference in postoperative care.
Nausea and Vomiting of Pregnancy
Several controlled studies have evaluated the benefits of acupressure or acupuncture in the
nausea and vomiting of pregnancy
, commonly called morning sickness. The results for acupressure, though not acupuncture, have generally been positive.
For example, a double-blind, placebo-controlled study of 97 women found evidence that wristband acupressure may work.
Participants wore either a real wristband or a phony one that appeared identical. Both real and fake acupressure caused noticeable improvement in more than half of the participants. However, women using the real wristband showed better results in terms of the duration of nausea. Intensity of the nausea symptoms was not significantly different between groups.
These results are consistent with other studies of acupressure for morning sickness,
though two studies failed to find benefit for severe morning sickness.
However, one large trial of
instead of acupressure failed to find benefit. This single-blind, placebo-controlled study of 593 pregnant women with morning sickness compared the effects of traditional acupuncture, acupuncture at P6 only, acupuncture at “wrong” points (sham acupuncture), and no treatment.
As noted earlier, the placebo effect of acupuncture can be very strong. Women in all three treatment groups (including the fake acupuncture group) showed significant improvements in nausea and dry retching compared to the no-treatment group. However, neither form of real acupuncture proved markedly more effective than fake acupuncture.
In a review of 8 trials involving over 1,200 pregnant women, there was no reliable evidence that acupressure or acupuncture reduced nausea and vomiting.
One of these studies involving 230 pregnant women, though, did find that nausea improved over time with the use of electrostimulation, in which a mild electrical current passes to the acupuncture point.
Other Forms of Nausea
A single-blind, placebo-controlled study found acupressure helpful for
though a similar study did not.
A single-blind, placebo-controlled trial of 104 people undergoing high-dose
for breast cancer found that electrical stimulation on P6 significantly reduced episodes of vomiting.
A small study in children receiving chemotherapy for a variety of cancers suggested that acupuncture may reduce the need for antinausea medication.
Similar improvements were seen in four other studies of acupuncture or acupressure in patients having chemotherapy or radiation .
In a small sham-controlled study, acupressure wristbands showed promise, although the benefit seen just missed the conventional cutoff for statistical significance.
However, equivocal or absent effectiveness were seen in three other studies of wristbands,
and one study failed to find more benefit with real acupuncture than fake acupuncture.
Several small controlled studies have found acupuncture helpful for
. For example, a single-blind, placebo-controlled trial of 52 people with rotator cuff (shoulder) tendonitis found evidence that acupuncture is more effective than placebo.
In another study, 117 people with rotator cuff injury (including tendonitis) were randomized to receive corticosteroid injections plus exercise or 10 acupuncture treatments plus exercise.
Both groups experienced similar improvements in shoulder function and pain. Finally, in a sizable randomized trial, 425 patients receiving physical therapy for their persistent shoulder pain were divided into two groups: one received single-point acupuncture while the other received a sham treatment (mock transcutaneous electrical nerve stimulation) for three weeks. The acupuncture group showed significant improvement over the control group one week after treatment.
However, not all studies have been positive. In a small trial of 32 patients with rotator cuff tendonitis, acupuncture was no better than placebo TENS (transcutaneous electrical nerve stimulation) when added to exercise.
Benefits were also seen in four other studies of people with shoulder or elbow tendonitis.
In a study of 82 people with elbow tendonitis, deep acupuncture was more effective than shallow acupuncture placebo in the short term, but by 3 months there was no difference between the groups.
A comparative trial of 20 people found weak evidence that electroacupuncture may be more effective than ordinary acupuncture for elbow tendonitis.
A 2004 systematic review found a total of five positive controlled studies on acupuncture for tennis elbow and concluded that "strong evidence" supports the use of acupuncture for this condition.
However, this characterization of the evidence as strong would seem to be premature.
For the reasons
described in the beginning
of this section, virtually all studies of acupuncture are single-blind, and such studies (except when performed on anesthetized patients) cannot exclude the possible effect of confidence conveyed by practitioners performing valid treatment as compared to lack of confidence by those delivering sham treatment.
Two other trials failed to find laser acupuncture effective as compared to either sham
or other comparable treatments in patients with elbow tendonitis.
Moreover, 8 sessions of true acupuncture were no better than sham acupuncture in 123 subjects treated for persistent arm pain due to repetitive use.
, acupuncture has shown some promise for reducing symptoms of morning sickness. This treatment has additionally been studied for aiding other aspects of pregnancy.
A number of studies, including a 2011 review of 13 trials, found evidence that acupuncture is helpful in reducing
In a study involving 212 women in active labor, researchers found that, in countries where epidural anesthesia is not available, acupuncture can help to reduce pain compared to standard care early in labor.
Not all of the evidence supports the use of acupuncture for labor pain, though. For example, in one study, sterile water injections were found to be more effective than acupuncture for lower back pain and relaxation during labor. It is unclear whether or not the patients in the study knew which treatment they were receiving at the time.
In a placebo-controlled trial and one review of 10 mostly low quality trials, real acupuncture was no better than sham acupuncture in relieving pelvic pain during pregnancy prior to labor.
Along the same lines, a study involving 105 women giving birth to their first baby found no differences in the need for pain relief between real or sham acupuncture.
A study of 45 pregnant women found that use of acupuncture on the expected birth due date significantly sped up the actual date of delivery.
However, this trial used a no-treatment control group instead of sham acupuncture. Another study that failed to use sham treatment found minimal evidence that use of acupuncture may help stimulate normal term labor.
A study of 106 women evaluated whether acupuncture can speed up delivery after prelabor rupture of membranes (“water breaking” too early), and failed to find benefit.
However, again no adequate control group was used; this is equally a problem for a negative as for a positive study.
Finally, in a placebo-controlled trial, real acupuncture administered for 2 days prior to a planned induction of labor (artificial stimulation of labor) was no better than sham acupuncture at preventing the need for induction or shortening the time of labor.
Acupuncture has also been studied for converting breech presentation of the unborn infant to normal positioning. In a study of 240 women at 33 to 35 weeks gestation, acupuncture combined with
caused the breech presentation to convert in 54% of women, while only 37% of women in the no-treatment control converted.
Yet again, placebo acupuncture would have been better than no treatment. A much smaller study also found benefits with acupressure.
In 2008, researchers published a review of 6 randomized controlled trials that investigated acupuncture-like therapies (moxibustion, acupuncture, or electro-acupuncture) applied to a specific point (BL 67). They concluded that these therapies were effective at decreasing the incidence of breech presentations at the time of delivery.
Again, however, not all of these studies employed a sham acupuncture group for comparison.
According to a small, randomized trial, acupuncture may also help to reduce pain after labor in women undergoing an episiotomy.
Acupuncture has shown inconsistent benefit as a treatment for
While the results of numerous smaller studies suggest that acupuncture is an effective treatment for osteoarthritis (of the knee, in particular), larger studies have generally found it be no more effective than sham (fake) acupuncture.
A 2006 meta-analysis (systematic statistical review) of studies on acupuncture for osteoarthritis found 8 trials that were similar enough to be considered together.
A total of 2,362 people were enrolled in these studies. The authors of the meta-analysis concluded that acupuncture should be regarded as an effective treatment for osteoarthritis.
However, as it happens, one study comprised almost half of all the people considered in this meta-analysis, and it failed to find real acupuncture more effective than sham acupuncture. In this study, 1,007 people with knee osteoarthritis were given either real acupuncture, fake acupuncture, or standard therapy over six weeks.
Though both real acupuncture and fake acupuncture were more effective than no acupuncture, there was no significant difference in benefits between the two acupuncture groups.
In general, larger studies are more reliable than small ones. For this reason, it is always somewhat questionable when meta-analysis combines one very large negative study and a number of smaller positive ones to come up with a positive outcome.
Another review, published in 2007, nuanced its conclusions differently.
It concluded that real acupuncture produces distinct benefits in osteoarthritis as compared to no treatment, but that fake acupuncture is very effective for osteoarthritis too. When comparing real acupuncture to fake acupuncture, the difference in outcome—while it might possibly be statistically significant—is so trivial as to make no difference in real life. In other words, virtually all of the benefit of acupuncture for osteoarthritis is a placebo effect.
A similar effect was found in another review of 11 randomized trials. Acupuncture decreased pain in people with osteoarthritis pain compared to those who had sham acupuncture or no treatment. Follow-up ranged from 1-12 months.
We might add that the apparent slight statistical difference between real and fake acupuncture could easily have been due to problems of single-blind studies, as discussed
. To review, acupuncturists who know they are performing real acupuncture may subconsciously convey more confidence to their patients than those who know they are performing fake acupuncture. The history of medical studies makes it clear that such unconscious communications can greatly affect results; since, in fact, the evidence shows only a
difference between the results of real and fake acupuncture, it is quite possible that this transmission of confidence (or lack of it) is the entire cause of the difference, and that the specific techniques and theories of acupuncture themselves play no role at all.
Acupuncture has shown some promise for various types of headaches, including migraines and tension headaches; however, the research record remains mixed, and the best designed studies have generally failed to find benefit.
In a 2008 analysis of 5 randomized controlled trials that were considered highest in quality, researchers determined that real acupuncture has limited benefit over sham acupuncture for tension headache.
Subsequently, in a large randomized trial involving 3,182 headache patients, the group that received 15 acupuncture sessions over 3 months experienced significantly fewer headache days and less pain compared to the group receiving usual care.
However, there was no placebo group. A 2011 review of 16 randomized trials involving 1,535 migraine sufferers compared acupuncture with conventional treatment.
Acupuncture appeared to be more effective than conventional treatment, but there were a number of problems with the studies. For example, there was no consistent definition of conventional treatment or measures of effect.
Another study, though, found more persuasive evidence for migraines.
In this study, 140 migraine sufferers were randomized to receive acupuncture plus placebo or sham acupuncture plus flunarizine (a medication used to prevent migraines). At 16 weeks, those in the acupuncture and placebo group experienced more migraine-free days than the sham acupuncture and medication group. A drawback of this study is that flunarizine is not a commonly used medication for migraine prevention.
In a review of five randomized trials with 3,962 patients, acupuncture was effective in reducing migraine and tension-type headache pain when compared to patients receiving no acupuncture. However, four randomized trials comparing acupunture to sham acupuncture among 1,414 patients showed mixed results. Two trials found significant pain reduction and two did not.
In a single blind randomized trial of 480 adults with migraine headaches, 20 sessions of real acupuncture over 4 weeks reduced the number of headache days compared to sham acupuncture 12 weeks after treatment. However, this effect was delayed: there were no significant differences between the groups after 4 weeks after treatment.
A 2006 review of the literature found 10 controlled studies of acupuncture for chronic neck pain.
The pooled results suggest that acupuncture may be more effective than fake acupuncture, at least in the short term. However, the overall quality of the studies was low.
Other randomized trials have found that real acupuncture (versus placebo treatment) improved the quality of life in people with chronic neck pain.
Interestingly, in a study of 177 people with chronic neck pain, fake acupuncture proved more effective than massage!
In a pilot study, 10 weeks of acupuncture combined with physical therapy appeared to be more effective than either acupuncture or physical therapy alone for chronic neck pain, at least over the short-term.
There has been some study of acupuncture for acute neck pain; however, in one of the best of these studies, use of laser acupuncture failed to provide benefit for whiplash injuries.
In another study, 124 people with chronic or acute whiplash were randomized to receive 12 sessions of real or sham electroacupuncture.
While those receiving real electroacupunture did have less pain, the results were not clinically significant, and there were no improvements in disability or quality of life.
The evidence regarding acupuncture treatment of dental pain is mixed. A literature review published in 1998 identified four meaningful studies on acupuncture for reducing pain during dental procedures.
Three of the studies found positive results, but the largest (with 110 participants) found no benefit.
It was largely on the basis of this review that acupuncture was discussed in the media as a “proven” treatment for dental pain. However, these mixed results hardly constitute proof.
More recent studies have also shown mixed results.
At present, therefore, the available evidence does not provide a reliable basis for concluding that acupuncture is effective for dental pain.
Although some animal studies suggest that ear acupuncture or electroacupuncture may have some benefits for
study results in humans have been mixed at best, with the largest studies reporting no benefits.
For example, while benefits were seen in a much smaller single-blind trial,
a single-blind, placebo-controlled trial that evaluated 620
adults found acupuncture no more effective than sham acupuncture or relaxation training.
Similarly, a single-blind, placebo-controlled study enrolling 236 residential clients found no benefit for cocaine addiction from ear acupuncture.
Finally, in a placebo-controlled trial involving 83 people addicted to drugs attending a methadone detoxification clinic, the addition of ear acupuncture did not improve withdrawal symptoms or cravings.
Methadone, a relatively weak narcotic, is commonly used to treat narcotic addition over the long-term.
The situation is much the same for
. A single-blind, placebo-controlled study of 503 alcoholics failed to find evidence of benefit with 3 weeks of ear acupuncture.
In addition, a 10-week, single-blind, placebo-controlled study of 72 alcoholics found no difference in drinking patterns or cravings between sham acupuncture and real acupuncture groups.
There are two other small trials that also failed to find significant benefits.
However, one single-blind trial of 54 people did find some evidence of improvement.
A single-blind, controlled trial of 100 people with heroin addiction evaluated the potential benefits of ear acupuncture.
However, a high dropout rate makes the results difficult to interpret.
In a 1999 meta-analysis of 12 placebo-controlled trials, acupuncture was not found more effective than sham acupuncture for
An observer-blind, sham-controlled study of 330 adolescent smokers also found no benefit.
A 2011 analysis of 12 trials (involving over 2,000 people) found that the people who received real acupuncture had more short-term success in quitting smoking compared to those in the sham group. However, over the long-term, there was no difference between the groups.
From other studies in the same analysis, researchers also found no evidence that acupuncture was more effective, over the short- or long-term, than nicotine replacement therapy (eg, gum or patch) or psychological interventions.
A review of 6 randomized controlled trials with 823 patients found acupuncture was over 3 times more effective than sham acupuncture for smoking cessation. The patients were only followed for an average of 6-12 months, highlighting that acupuncture is more successful in the short-term.
While most addiction studies involve ear acupuncture, a randomized trial compared real versus sham acupuncture on body points. The study found no difference in quit rates, depression, or anxiety.
One study found that acupuncture may not be effective on its own, but may (in some unknown manner) increase the effectiveness of stop-smoking education. In this sham-controlled study of 141 adults, acupuncture plus education was twice as effective as sham acupuncture plus education and four times as effective as acupuncture alone.
However, these benefits were only seen in the short term. At long-term follow-ups, the relative advantage of acupuncture disappeared.
Thus far, research has not produced convincing evidence that acupuncture is effective for
. Many studies widely cited as providing such evidence were actually invalid due to lack of a proper control group.
There is no doubt that people with back pain given acupuncture report benefits, but the problem is that people given fake acupuncture also experience benefits, often to a similar degree.
In a review of 23 randomized trials involving over 6,000 patients with chronic low back, researchers concluded that acupuncture is more effective than no treatment for short-term pain relief, but there was no significant difference between the effects of true and sham acupuncture.
They also found that acupuncture can be a useful addition to conventional therapies.
A 6-month patient- and observer-blind trial of 1,162 people with back pain compared real acupuncture, fake acupuncture, and conventional therapy.
Both real and fake acupuncture proved to be twice as effective as conventional therapy according to the measures used. However, there was only a minimal difference between real and fake acupuncture. These results do not, in fact, indicate that acupuncture is effective per se; rather, it shows the significant power of acupuncture as a placebo.
Similarly, in a single-blind, controlled study (using sham acupuncture and no treatment) of 298 people with chronic back pain, use of real acupuncture failed to prove significantly more effective than sham acupuncture.
Also, in a fairly large randomized trial involving 638 adults with chronic back pain, there was no difference in pain at one year in patients receiving real compared to fake acupuncture (with neither group improving significantly over standard care). Both real and sham acupuncture were, however, associated with improved function at one year. Other studies enrolling a total of over 300 people have also failed to find benefit.
A trial compared the effects of acupuncture, massage, and education (such as videotapes on back care) in 262 people with chronic back pain over a 10-week period.
The exact type of acupuncture and massage was left to practitioners, but only 10 visits were permitted. At the 10-week point, evaluations showed benefit with massage but not with acupuncture. One year later, massage and education were nearly equivalent, and both were superior to acupuncture.
One small study found chiropractic spinal manipulation
effective than anti-inflammatory medication or acupuncture for low back pain.
In another trial, acupressure-style massage was found to be more effective for back pain than Swedish massage.
However, Swedish massage has not been proven effective for back pain, so this does not prove that acupressure-style massage is effective.
Two single-blind, placebo-controlled trials, one with 30 participants and another with 60, also failed to find evidence of benefit.
Two studies did find possible slight benefits with electrical acupuncture for chronic low back pain.
An additional study found acupressure more effective than physical therapy for low back pain,
and another found some potential benefit with electric acupuncture.
Low level laser therapy (LLLT) is a technique similar to electro-acupuncture that uses precision laser energy instead of electricity conducted through a needle. In a detailed review of 7 randomized trials, researchers were unable to draw any conclusions regarding the effectivenes of LLLT for nonspecific low back pain.
Several other studies have compared acupuncture to other treatments for back pain, such as transcutaneous electrical nerve stimulation (TENS), physical therapy, and chiropractic care, and found them equally effective.
However, because TENS, physical therapy, and chiropractic care have not been proven effective for back pain, studies of this type cannot be taken as evidence that acupuncture is effective. One study did find acupressure massage more effective than standard physical therapy; however, it was performed in a Chinese population that may have had more faith in this traditional approach than in physical therapy.
Heat sensitive moxibustion was found to be better than acupuncture in managing lumbar disc herniation in a review of 4 low quality randomized trials.424
One small double-blind, placebo-controlled study found real acupuncture more effective than sham acupuncture for
(This study used nonacupuncturists given real or fake acupuncture protocols to apply, unbeknownst to them.) In addition, a controlled study of 61 women evaluated the effects of a special garment designed to stimulate acupuncture points related to menstrual pain.
Unfortunately, in this latter study, researchers chose to compare treatment to no treatment, rather than to sham treatment. For this reason, the results (which were positive) mean little.
In yet another trial, a seed-pressure method of auricular acupressure appeared to improve menstrual pain compared to sham auricular acupressure in 74 women.
The potentially inadequate blinding of participants in this study, however, may have limited these results.
Indeed, in a review of 30 controlled trials on menstrual pain, researchers were unable to draw conclusions about the effectiveness of acupuncture and similar treatments
for menstrual pain due to widespread study design problems.
While a review of 27 trials with 2,960 patients concluded that acupuncture might be more effective than medications or herbs for relieving menstrual pain, the studies were of limited quality.
A smaller, but more recent review from 2011 included 6 acupuncture trials involving 673 women and 4 acupressure trials involving 271 women.
Acupuncture was associated with pain relief when compared to a placebo (sham) control, anti-inflammatory medication (NSAIDs), and Chinese herbs. Similarly, acupressure was associated with symptom improvement when compared to placebo. As in previous reviews, however, researchers found enough weaknesses in the trials to recommended the need for more high-quality studies.
A randomized trial of 66 women with primary dysmenorrhea showed improvement in pain scores with 16 twice-weekly acupuncture-like transcutaneous electrical nerve stimulation (AL-TENS) compared to sham AL-TENS.
Acupuncture is widely used in China for treatment of acute
. A few controlled studies have been published over the last 10 years, but the best-designed and largest studies failed to find benefit.
For example, a single-blind, placebo-controlled trial of 104 people who had just experienced a stroke failed to find any benefit with 10 weeks of twice-weekly acupuncture.
Similarly, a single-blind, controlled study of 150 people recovering from stroke compared acupuncture (including electro-acupuncture), high-intensity muscle stimulation, and sham treatment. All participants received 20 treatments over a 10-week period. Neither acupuncture nor muscle stimulation produced any benefits.
A 10-week study of 106 people, which provided a total of 35 traditional acupuncture sessions, also failed to find benefit.
Also, 92 patients who received either 12 acupuncture treatments or a comparable sham (fake) treatment demonstrated the same level of improvement up to one year later.
Finally, a 2011 systematic review, which included 10 randomized trials and 711 patients who had a stroke, failed to find evidence that acupuncture (compared to sham treatment) helped with recovery.
A few studies did find benefit, but they were very small, and some did not use a placebo group.
One trial of 62 patients found that a 3-week program of transcutaneous electrical stimulation of acupuncture points (beginning about 9 days after stroke) improved muscle tone and
strength in the affected leg.
A large review including 56 mostly poor quality trials reported that acupuncture may benefit post-stroke rehabilitation (based on an analysis of 38 trials),
and another review of 9 trials found limited evidence in support of moxibustion for stroke rehabilitation.
Another systematic review focusing on scalp acupuncture did find positive results.
The review included 7 randomized trials that compared scalp acupuncture to conventional treatment in 230 stroke patients. Those who were in the acupuncture group had fewer neurological problems compared to the patients who had standard care.
These kinds of trials, however, cannot be blinded (ie, patients know whether or not they have received acupuncture). A review published in 2011 found that scalp acupuncture improved neurologic deficits in 7 randomized trials of 458 stroke patients when compared to usual care. Patients were assessed on consciousness, gaze, facial weakness, language, walking ability, and motor function.
A randomized trial of 120 post-stroke patients with hemiplegia and stage I shoulder-hand syndrome compared electric acupuncture and massage to rehabilitation therapy for 6 weeks. Patients having electronic acupuncture and massage had significant improvement in pain with passive movement, and functional ability. Patients with electric acupuncture were also less likely to progress to the next stages of shoulder-hand syndrome at 3 months.420
Acupuncture has been explored as a means of
reducing pain after surgery
with encouraging but not unequivocal results. A double-blind, placebo-controlled study of 42 people undergoing arthroscopic knee surgery found that the use of acupuncture during surgery did not reduce pain levels during the subsequent 24 hours.
Another double-blind, placebo-controlled trial of 50 women undergoing hysterectomy found no benefit with electroacupuncture,
and a double-blind study of 71 people undergoing abdominal surgery failed to find acupressure helpful.
However, some benefits of acupressure were reported in a single-blind trial of 40 patients undergoing arthroscopic knee surgery.
A small randomized trial involving 22 patients found that preoperative electroacupuncture, compared to sham transcutaneous electrical nerve stimulation (TENS), reduced pain and the need for pain medication after cardiac surgery.
In addition, a special form of needle insertion called intradermal acupuncture reduced postsurgical pain in 107 people undergoing abdominal surgery.
Ear acupuncture has also shown promise.
For example, in an analysis of 5 trials, patients who received ear acupuncture (auricotherapy) did not use pain medication as much as those in the control groups (sham auriculotheapy, placebo, or usual care).
Additionally, in a 2008 review of 15 randomized controlled trial, researchers determined that acupuncture (of the ear and other acupuncture points) is capable of reducing pain and the need for opioid medications (morphine and related agents) immediately following surgery compared with sham acupuncture.
In a randomized trial of 80 patients having total knee arthroplasty, acupuncture was associated with greater reduction in pain and swelling, and quicker return to preoperative range of motion compared to range of motion exercises alone.422
Electric accupuncture was associated with significantly improved time to defectation in 165 patients with colorectal cancer who had laparoscopic surgery. Electric acupuncture was compared to sham electric acupuncture and no acupuncture. Electroaccupuncture was also associated with reduced pain, less pain medication, and improved time to walking.423
Acupuncture has also been studied as a potential treatment for other surgery-related problems. For example, gastroparesis is a common complication of abdominal surgery. With this condition, the stomach is unable to properly empty its contents after eating. In a controlled trial, 63 people who underwent abdominal surgery were randomized to receive acupuncture or a standard medication used to treat gastroparesis (metoclopramide given intravenously 3 times a day).
According to the researchers, those in the acupuncture group experienced a higher cure rate.
Other Studied Uses
Bee venom acupuncture (BVA), which involves the injection of diluted bee venom directly into acupoints, has been used for the treatment of pain. A recent analysis of four well-designed, randomized trials, comparing bee venom plus classic acupuncture against saline injection plus classic acupuncture, found that the BVA-classic acupuncture combination was significantly more effective for musculoskeletal pain.
Acupressure and acupuncture have been tried for
with mixed results. A single-blind, placebo-controlled study involving 84 nursing home residents found that real
acupressure was superior to sham acupressure for improving sleep quality.
Treated participants fell asleep faster and
slept more soundly. In a similar study, researchers found that performing acupressure on a single point on both wrists for five weeks improved sleep quality among residents of long-term care facilities compared to lightly touching the same point. .
Another single-blind, controlled study reported
benefits with acupuncture, but failed to include a proper statistical
analysis of the results.
For this reason, no conclusions can
be drawn from the report. In another trial, 98 people with severe kidney
disease were divided into three groups: no extra treatment, 12 sessions of
fake acupressure (not using actual acupuncture points), and 12 sessions of
Participants receiving real acupressure experienced
significantly improved sleep as compared to those receiving no extra
treatment. However, fake acupressure was just as effective as real
In a fourth randomized trial involving 28 women, six weeks of auricular (outer ear) acupuncture was more effective than sham acupuncture.
In one study, magnetic pearls used to stimulate acupuncture points in the ear seemed to show some benefit
as compared to nonmagnetic stimulation of ear points.
A small, single-blind, placebo-controlled study of 60 adults with primary insomnia found that 3 weeks of electroacupuncture improved sleep efficiency and decreased wake time after sleep onset.
Acupuncture and acupressure showed some promising results in a review of 33 randomized trials with 2,293 patients ranging in age from 15-98. Needle acupuncture improved sleep quality in 13 trials consisting of 965 patients. However, only two of these trials compared acupuncture to sham acupuncture. In the other 11 trials, needle acupuncture was added to medications or Chinese herbs. Electroacupuncture, acupressure and magnetic acupuncture also showed benefit, but studies were small and limited by methodological shortcomings.
Chronic Fatigue Syndrome
A sham-controlled study found some evidence that acupuncture may be useful for
chronic fatigue syndrome
Although anesthesia apparently performed entirely with acupuncture first raised Western interest in acupuncture, the original demonstrations of acupuncture anesthesia have been discredited. It now appears that if acupuncture has any anesthetic effect at all, it is extremely modest.
At most, acupuncture may be capable of slightly decreasing the required dose of general anesthetic necessary to induce anesthesia (but even this has not been consistently seen in studies).
One study found possible marginal benefit with acupuncture and moxibustion for the treatment of
A 6-month, single-blind, controlled study of 67 women with frequent
found that acupuncture therapy reduced the frequency of infection.
Another study found that acupuncture may be helpful for hyperactive bladder (frequent need to urinate without the presence of an infection).
A study of 52 people with
(hay fever) found that acupuncture plus
Traditional Chinese herbal treatment
was slightly more effective than fake acupuncture plus fake Chinese herbal treatment.
However, another study failed to find acupuncture alone beneficial for allergic rhinitis.
Moreover, a carefully conducted review of 7 placebo-controlled trials failed to find convincing evidence for acupuncture’s effectiveness against allergic rhinitis.
A Chinese study found that acupuncture plus moxibustion was more effective for
than drug treatment.
However, in a review of 6 studies involving 537 Bell's palsy sufferers, researchers could draw no conclusions about the beneficial effects of acupuncture due to poor study quality.
In another review of 10 randomized trials of 975 patients, acupuncture alone or with drug therapy was associated with symptom improvement compared to drug therapy alone. For the same reasons as the previous review, it is not clear if acupuncture is an effective treatment.421
The evidence has been mixed regarding whether acupuncture is beneficial for
. Five small controlled studies reported that acupuncture can improve menopausal symptoms. But, most of these studies suffered from significant problems in design or statistical analysis.
Two trials failed to find acupuncture beneficial for hot flashes.
However, a trial of 175 perimenopausal and postmenopausal women concluded that adding acupuncture to usual care reduced hot flash frequency compared to usual care alone in the first four weeks after treatment.
A large randomized trial involving 267 post-menopausal women found that the addition of acupuncture to self-care advice significantly reduced the frequency and intensity of hot flashes in the first 12 weeks.
However, the benefits were lost 6 months later.
In another, similar trial, 81 women were randomized to receive either 12 months of real acupuncture followed by 6 months of sham acupuncture or 6 months of sham followed by 12 months of real acupuncture.
After 6 months, the women in the treatment group reported fewer hot flashes compare to those in the sham group. This affect did not last, though. After 12 months, both groups reported a similar frequency of hot flashes.
A review of 6 trials did not find promising results.
True acupuncture was no more effective than sham acupuncture for menopause.
small study found no benefit for the psychological distress associated with menopause.
Results were similar in a small single-blind randomized trial of 54 women. Acupuncture was compared to sham acupuncture for hot flashes in peri-menopausal and post-menopausal women. There was no difference between the groups in a combined measure of hot flash frequency and severity 8 weeks after treatment ended.
Another small placebo-controlled study in breast cancer patients suffering from hot flashes due to their treatments suggested some benefit for acupuncture, though the results were inconclusive for similar reasons.
However, another study did not find acupuncture effective in these patients,
and a 2008 review of all existing studies on the subject concluded that the evidence does not support a beneficial effect for acupuncture in breast cancer patients suffering from hot flashes.
Acupuncture has been studied for use in cancer treatment support. In a small randomized trial of 43 breast cancer patients, 6 weeks of acupuncture twice-weekly reduced joint pain attributed to aromatase-inhibitor therapy.
Another small randomized trial of 70 patients found that acupuncture may decrease dry mouth and pain after neck dissection for cancer treatment.
A systematic review of 3 randomized trials involving 123 people with head and neck cancer found that real acupuncture was more effective than sham acupuncture in reducing the risk of dry mouth (xerostomia) due to radiation therapy.
A subsequent study also supports the use of acupuncture in reducing dry mouth in such patients. But, unlike the previous trial, this one compared acupuncture to standard care (rather than to sham treatment).
Many cancer patients suffer unrelenting pain, which is often challenging to effectively treat while maintaining an acceptable quality of life. Researchers reviewed 3 small, randomized trials involving 204 patients on the effectiveness of acupuncture for cancer-related pain.
The authors concluded that there was insufficient evidence to say whether or not that acupuncture is helpful in relieving this type of pain. More high-quality studies are needed.
People with cancer often experience fatigue. Acupuncture has shown a bit of promise for improving this symptom.
A 2006 review of acupuncture for treatment of
found five controlled studies, none of which were of high quality.
The autors of another review of 7 trials were unable to determine the effectiveness of acupuncture for fibromylgia due to the unreliability of the studiies.
Overall, the results do not provide reliable evidence that acupuncture is helpful.
Depression, Anxiety, and Stress
Evidence for acupuncture’s effectiveness for
has been mixed. In a study of 151 depressed patients, twelve sessions of acupuncture failed to prove more effective than fake acupuncture.
However, another sham-acupuncture controlled trial evaluated 43 people with depression and 13 people with generalized
The results suggest that 10 (but not 5) acupuncture sessions can significantly improve symptoms. One study of 80 patients with major depressive disorder found that adding acupuncture to a lower dose of antidepressant (fluoxetine) improved anxiety and had a similar overall therapeutic effect as sham acupuncture with a higher dose of antidepressant.
In a mathmatical review of the results of 8 randomized trials, the impact of acupuncture on depression was unconvincing.
However, in another review of 20 trials involving 2,000 patients with major depression, real acupunture's effectiveness was comparable to that of antidepressants, but was no more effective than sham acupuncture for this population.
Another trial compared real and sham ear acupuncture in healthy people and found some evidence that real acupuncture can relieve normal daily
A small study found acupuncture more effective than sham acupuncture for
A 2010 review of 9 mostly poor quality trials determined that there is currently insufficient evidence to conclude that acupuncture is effective for premenstrual syndrome.
Although open trials appeared to show benefit,
at least 3 controlled studies failed to find acupuncture helpful for improving the success rate of
A 2008 analysis of 7 randomized trials found that, on balance, acupuncture may significantly improve the odds of pregnancy in patients undergoing
IVF. However, since not all of these studies used sham (fake) acupuncture as a control, the reliability of this conclusion is questionable.
Moreover, a second analysis in the same year of 13 randomized controls trials investigating the effectiveness of acupuncture in 2,500 women undergoing a specialized IVF procedure, in which sperm is injected directly into the egg, found no evidence of any benefit.
But the story does not end here. In a subsequent review of 13 trials, a different group of researchers concluded that acupuncture may improve the success rate of IVF, but only if it is used on the day of embryo transfer (when the fertilized egg is placed into the womb).
According to this study, acupuncture is not effective when used up to 3 days after embryo transfer or when eggs are being retrieved from the ovaries.
Acupuncture may be more effective than sham acupuncture and as effective as standard treatments for
temporomandibular joint (TMJ) pain
52, 233, 326
One study of 110 people with pain found acupuncture at least as effective as standard occlusal splint therapy.
Another small study involving 40 patients with TMJ pain, however, found no difference between placebo and low-level laser therapy (LLLT) directed at painful points; both groups benefited equally.
However, in a double-blind, randomized trial comparing real LLLT with sham LLLT, the real therapy was more effective for TMJ pain after 8 sessions.
Instead of needles, low-level laser therapy involves the use of laser energy directed on or off acupuncture points.
Although acupuncture is widely used for
, there is only weak, inconsistent evidence that it works.
Acupuncture has shown some promise for reducing symptoms of
and also sleep apnea.
A single-blind trial tested acupuncture on a group of 36 healthy young men and found some evidence of improvement in
However, a single-blind, controlled study of 48 people found that use of acupuncture did not reduce
muscle soreness caused by exercise
Although case reports suggest that acupuncture might be helpful for
a controlled trial failed to find acupuncture more effective than fake acupuncture.
One study purportedly found that acupressure reduced fatigue in people with severe kidney disease.
In fact, it found that both sham acupuncture and real acupuncture reduced fatigue as compared to no treatment, but that real acupuncture was
more effective than fake acupuncture.
One study found minimal benefits for
Another study failed to find any benefits.
In two comprehensive reviews of multiple clinical trials, independent sets of researchers concluded that there was currently no well established evidence for acupuncture’s effectiveness in this condition.
Vocal Cord Dysfunction
A Chinese study reported that acupuncture is helpful for vocal cord dysfunction.
A study that
reported acupuncture's benefits
failed to use a control group and is, therefore, meaningless.
However, another study found that real acupuncture was more effective than sham acupuncture at reducing the symptoms of chronic prostatitis both during treatment and for a 6-month period following treatment.
Another study suggested that electroacupuncture may improve symptoms in men with chronic prostatitis
(or a related condition called chronic pelvic pain syndrome), but this study was very small.
After an acute attack of shingles, pain may linger for months or years, causing what is known as
. A single-blind, placebo-controlled study of 62 people with pain of this type failed to find any benefit with acupuncture.
Two separate groups of researchers conducting detailed reviews of 8 randomized controlled trials found some beneficial effects of acupuncture for
, but were unconvinced that it was more beneficial than sham acupuncture or other standard treatments.
Another review of 11 randomized trials did not find that mediation, progressive muscle relaxation, static magnetic therapy, acupuncture or tai chi relieved pain in patients with rheumatoid arthritis. The 11 trials included a total of 607 patients.
Carpal Tunnel Syndrome
Acupuncture has also been studied as a treatment for
carpal tunnel syndrome
, a common nerve disorder affecting the wrist and hand. Over a 4-week period, 77 people with mild to moderate carpal tunnel syndrome were randomized to receive medication (prednisolone) or 8 sessions of acupuncture.
During the 7-month and 13-month follow-ups, those in the acupuncture group reported a greater improvement in their symptoms compared to the medication group.
In addition, researchers analyzed 6 low-quality, randomized trials investigating acupuncture (and similar therapies) for CTS. In two of those trials (144 subjects), acupuncture was slightly better at improving symptoms than cortisone (steroid) injections, a standard treatment for CTS.
There have been numerous reports about acupuncture treatment for
but most published studies are of low quality, with results being contradictory at best.
One study failed to find acupuncture helpful for shortness of breath associated with advanced cancer.
Chronic Obstructive Pulmonary Disease
Researchers have studied the potential benefits of acupuncture in people with
chronic obstructive pulmonary disease
(COPD). Sixty-eight adults were randomized to receive real or sham acupuncture once a week for 12 weeks.
Those who received the real treatment experienced less shortness of breath after an exercise test compared to the control group.
Peripheral neuropathy (nerve pain in the extremities) is a common complaint in
infection. A placebo-controlled trial of 239 people with HIV found acupuncture no more effective than placebo in peripheral neuropathy.
Interestingly, the study also tested drug therapy for peripheral neuropathy and found it ineffective, as well.
Gastrointestinal (GI) problems, like diarrhea and nausea, are common side effects for people with HIV who are receiving highly active antiretroviral therapy (HAART). One hundred and thirty HIV patients on HAART were randomized to receive 1 of 4 treatments:
, acupuncture plus health education, sham acupuncture plus relaxation therapy, or sham acupuncture plus health education. After 4 weeks of treatment, the people in the acupuncture plus relaxation group experienced a greater improvement in their GI symptoms compared to the other groups.
High Blood Pressure
A substantial study (192 participants) failed to find acupuncture more helpful than fake acupuncture for
high blood pressure
However, another study, this one enrolling 160 people, did report benefit.
A much smaller study also reported benefits,
but there were problems in its statistical analysis.
In a review of 11 randomized controlled trials on the subject, researchers determined that acupuncture’s ability to lower blood pressure remains inconclusive.
Acupuncture is probably not effective for
A single-blind, controlled trial of individualized acupuncture for 34 people with severe epilepsy found no benefit,
and subsequently, a comprehensive review of 11 studies found no reliable evidence of its effectiveness.
A small study found no benefit with standardized acupuncture for
One controlled study failed to find electroacupuncture effective for reducing discomfort during colonoscopy.
Spinal Cord Injuries
A controlled study purportedly found acupuncture helpful for speeding recover in people with spinal cord injuries, but it failed to use a sham-acupuncture control group.
Several controlled and open trials of acupuncture for
(ringing in the ear) found no benefit.
Acupuncture was not effective as treatment for tinnitus symptoms in a review of 13 low-quality randomized trials with 616 patients. Only one of two open trials showed long-term improvement.
Irritable Bowel Syndrome
A number of studies, including systematic reviews, have not found strong evidence to support the use of acupuncture for the treatment of
irritable bowel syndrome
The most recent review included 17 trials involving 1,806 people and compared real acupuncture to a range of control groups, such as sham acupunture, psychotherapy, medication, among others.
In the 5 trials that included real versus sham acupuncture, there were no significant differences between the two treatment groups on IBS symptoms. Other trials with a placebo control showed a positive effect, though. For example, people receiving acupuncture treatments reported more symptom relief compared to those receiving psychotherapy or medication. The researchers highlighted the need for more studies.
In a placebo-controlled trial, 60
women received needle acupuncture, 56 women received laser acupuncture, and 60 women received placebo acupuncture.
The results showed no differences in milk production. In a subsequent trial, 90 women were randomized to receive acupuncture (twice weekly for 3 weeks) or observation.
Those in the acupuncture group were better able to maintain breast-feeding for the first 3 months compared to the control group.
The lack of a placebo control in the latter trial, however, means the two studies are not comparable.
In one small study, light needling at one acupuncture point on both hands was more effective than no needling among 40 infants with
In a small trial, 33 people with
(a condition characterized by abnormally elevated pressure inside the eye) were randomized to receive real auricular acupressure (with massage) or sham acupressure (without massage).
At weeks 3 and 4, subjects in the acupressure group did have an initial improvement in their intraoccular pressure. At weeks 2-4, their visual acuity also improved. However, the results did not last long, and there were no significant differences between the two groups.
Autistic Spectrum Disorder
A review of 10 trials focused on the use of acupuncture as a potential treatment for
autistic spectrum disorder
Three hundred and ninety children and teens (aged 3-18 years old) with autism received treatment from 4 weeks to 9 months. Some of the trials compared real acupuncture to a sham version, while other trials compared acupuncture and traditional treatment plus traditional treatment alone. The authors concluded that there was not enough evidence to support the use of acupuncture to improve the core symptoms of autism (eg, impaired social interactions or thought processes).
Preliminary evidence suggests that acupuncture may help prevent
abnormal heart rhythms
in people with atrial fibrillation who have undergone cardioversion (an electrical shock is delivered to the heart to return it to a normal rhythm).
According to one small trial, laser acupuncture may help to reduce
A randomized trial of 80 women with post-hysterectomy urinary retention showed improvement in bladder function with acupuncture compared to acupoint injection of vitamin B12. Each group had daily treatment over the course of five consecutive days. Improvement was seen in 90% of the acupuncture group after two treatment courses compared to 72.5% in injection group.
Epigastric Discomfort and Ulcer
Functional dyspepsia includes a wide range of symptoms that cause epigastric pain or discomfort. A randomized trial of 72 patients suffering from functional dyspepsia show significant symptom relief with real as opposed to sham acupuncture. Those who had real acupuncture experienced less bloating and early saiety, though the differences were minor and may not have been clinically meaningful.
Trigeminal neuralgia is a condition that involves recurrent short episodes of severe, sudden pain along one or more branches of the trigeminal nerve. It is usually confined to one side of the face ranging from the forehead to the lower jaw. In a randomized trial of 65 patients with trigeminal neuralgia, electroacupuncture with deep needling to reach the sphenopalatine ganglion (adjacent to the trigeminal nerve itself) reduced frequency and intensity of pain compared to superficial needling. Clinical cure was achieved in 28% of patients with deep needling compared to 13% with superficial needling.
Post-traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a type of anxiety disorder. It can occur after extreme emotional trauma that involved the threat of injury or death. In a systematic review of 4 randomized and 2 uncontrolled trials, acupuncture, alone or in combination with cognitive behavioral therapy (CBT), was associated with an improvement in PTSD symptoms in 646 patients. Acupuncture was as effective as CBT or selective serotonin reuptake inhibitors (SSRIs), and when combined with moxibostion, appeared to be more effective than SSRIs.
Persistent hiccups are defined as those lasting more than 48 hours and intractable hiccups last for more than one month. Acupuncture options for hiccups were evaluated in a review of 4 poor-quality trials of 305 patients. Two trials in the review were randomized. One trial of 80 patients found that acupuncture with an injection of frog extract yielded significant improvements in hiccups when compared to acupuncture with an injection of vitamin B6. Hiccup cure rates were similar at 1 month in a second trial of 60 patients when comparing sham acupuncture to real acupuncture.
The other two trials compared acupressure points and time. One quasi-randomized trial found that using 4 acupuncture sites was associated with significantly greater improvement in hiccups compared to using 3 acupuncture sites in one trial of 80 patients. Another quasi-randomized trial of 85 patients found that acupuncture with body acupoints for 1 hour and scalp acupoints for more than 6 hours had a significantly greater improvement in hiccups compared to acupuncture with needles placed in the same body and scalp acupoints for 30 minutes.419