Acupuncture has been practiced in China and other Asian countries for thousands of years. Modern scientists have made great strides in studying its effects on a wide variety of health problems, yet many individuals and even doctors are unaware of the wealth of research available about its effectiveness. Evidence-based medicine (EBM) is the conscientious, explicit, judicious, and reasonable use of modern, best evidence in making decisions about the care of individual patients using the best available research information. Most physicians would agree with this approach to medicine, yet medical professionals, are, above all people, and as people, we all have our biases. Many physicians hesitate to prescribe acupuncture because they believe that there is not enough scientifically-based evidence as to its safety and efficacy. This attitude ignores the over 10,000 random control trials that have been conducted on acupuncture since 1975. To be fair most practicing physicians cannot be expected to read the thousands of medical research studies published each year. Review studies however synthesize the results of many studies together and give the practicing physician an overview of the current research on a particular topic. A recent systematic review of 2471 reviews analyzed the results of a great many observational studies and random controlled trials. The review found acupuncture to be effective for the treatment of chronic pain and significant differences between true and sham acupuncture indicate that acupuncture is more than just a placebo and is a reasonable referral option for patients with chronic pain. With moderate to good levels of evidence on its effects on over 70 different disorders.
Read more about the evidence base from the National Institutes of Health behind the modern application of acupuncture in medicine.
Acupuncture is a technique in which practitioners stimulate specific points on the body, usually by inserting thin needles through the skin. Studies suggest that acupuncture stimulates the release of the body’s natural painkillers and affects areas in the brain involved in processing pain. Results from a number of studies, however, suggest real acupuncture may help ease types of pain that are often chronic, such as low-back pain, neck pain, osteoarthritis/knee pain, and carpal tunnel syndrome. It also may help reduce the frequency of tension headaches and prevent migraine headaches. For more information, see NCCIH’s acupuncture fact sheet. Research has shown that acupuncture reduces nausea and vomiting after surgery and chemotherapy. It can also relieve pain. Researchers don’t fully understand how acupuncture works. It might aid the activity of your body’s pain-killing chemicals. It also might affect how you release chemicals that regulate blood pressure and flow.
Biological Plausibility
Modern research into the neurophysiological mechanism of action has yielded much in understanding how acupuncture relieves pain. Physiological and imaging studies suggest that acupuncture triggers the release of endogenous opioid-like substances, including enkephalin, endorphin, dynorphin and endomorphin. Studies demonstrate that the limbic system plays an important role in acupuncture-induced analgesia. Studies have found that only acupuncture stimulation with De Qi sensation activated the hypothalamus. “De Qi” sensation is frequently described by patients as soreness, numbness, tingling, ache, fullness, or warm sensation that is achieved during manipulation of the acupuncture needles. Future studies will continue to shed light into the mechanisms of this ancient pain control technique. (Acupuncture analgesia: I. The scientific basis. ANESTHESIA & ANALGESIA, Vol. 106, No. 2, February 2008), http://bja.oxfordjournals.org/content/115/2/183.abstract, Perioperative Acupuncture and Related Techniques Anesthesiology. 2005 May; 102(5): 1031–1078. Grigory V. Chernyak, M.D.* and Daniel I. Sessler, M.D.)
Along with research into understanding the underlying physiology, clinical research on acupuncture has also grown. Over 10,000 randomized controlled trials on acupuncture have been published.
2,471 Systematic reviews of the available randomized controlled trials of acupuncture therapies were published in the Web of Science between 2000 and 2020, with the number of systematic reviews increasing annually.
Published systematic reviews of 1578 randomized trials and 893 observational studies were mainly focused on the following therapeutic areas:
- musculoskeletal and connective tissue diseases (865, 35.0%), neurological conditions (304, 12.3%),
- cancer (287, 11.6%),
- cardiovascular diseases (235, 9.5%).
The country of the first author listed in acupuncture systematic reviews was:
- China (996, 40.3%),
- US (358, 14.5%),
- UK (316, 12.8%),
- South Korea (259, 10.5%),
- Australia (178, 7.2%),
- Canada (117, 4.7%),
- Germany (106, 4.3%),
- elsewhere (141, 5.7%).
Despite minor limitations, systematic reviews of acupuncture therapies are generally methodologically rigorous. A review study analysis of all the review studies was published in the British Medical Journal and they found the following key messages
Key messages
- A large number of systematic reviews of acupuncture exist which are overall methodologically rigorous
- Clinical practice and health policy underuse beneficial acupuncture therapies for which rigorous systematic reviews have documented high or moderate certainty evidence
- Acupuncture funding and research need to focus on conditions for which acupuncture therapies have had substantial beneficial effects but for which evidence is of low certainty
- A coordinated multistakeholder effort to generate acupuncture evidence and support its implementation will enable a more evidence-based approach to practice and research
Lu L, Zhang Y, Tang X, Ge S, Wen H, Zeng J et al. Evidence on acupuncture therapies is underused in clinical practice and health policy BMJ 2022; 376 :e067475 doi:10.1136/bmj-2021-067475