Acupuncture to Help Chronic Pain

Medically Reviewed
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The placement of acupuncture needles is thought to activate the release of certain chemicals throughout the body, or reduce this activity, to help with healing. Getty Images; Canva; Everyday Health

Acupuncture involves using thin needles to puncture the skin at specific points on the body. This technique is a practice used in traditional Chinese medicine (TCM), which has been around for thousands of years.

How It Works

Needles are placed on the skin to activate qi, which in TCM is considered the life force, the energy of the body that helps keep you well. In Western biomedical words, the points where the needles are placed are believed to activate the central nervous system to release chemicals throughout the body, or reduce this activity, that can help with healing.

In China, acupuncture is often used as a go-to treatment for everything from asthma to diabetes, but in the United States, it is more often used as a complementary treatment alongside other treatments or drugs for conditions like low back pain, joint pain, and headaches, and sometimes to help ease nausea and vomiting.

Chronic Pain Symptom Relief

In a meta-analysis of studies published in The Journal of Pain, researchers at the Acupuncture Trialists' Collaboration found:

  • Acupuncture is effective for the treatment of chronic pain.
  • The effects of acupuncture persist over time.
  • The benefits of acupuncture cannot be explained solely by the placebo effect.
In a series of papers about chronic pain published in The Lancet, authors analyzed reviews of studies about chronic pain and treatment approaches. They included research that found mixed evidence regarding whether active acupuncture is more effective than sham acupuncture. Sham acupuncture is the research study approach used as a control acupuncture group; the skin isn’t penetrated, and instead, a device places pressure on the skin or needles are placed outside of the common points used for treatment.

The researchers summarized the inherent challenges of performing truly controlled acupuncture studies and forming general conclusions about acupuncture's effectiveness because of, for example, the high variety of unique characteristics in patients, the variety of types of acupuncture and point prescriptions, and the variety of durations of treatments used in clinical practice.
Researchers further reported in The Journal of Pain?that for those with nonspecific musculoskeletal pain, osteoarthritis (OA), headache, or shoulder pain, acupuncture relieved pain compared with sham and no-acupuncture control groups. Additionally, they noted that treatment effects might persist up to a year. However, the researchers stated that the effect is highly dependent on the choice of control treatment.

Other studies and reviews have shown that acupuncture helps with the following specific types of pain.

Back Pain

In a review of studies regarding acupuncture and low back pain, researchers searched seven databases and found that acupuncture is more clinically effective in pain relief and functional improvement than no treatment at short-term follow-up. Based on five systematic reviews, they also found that acupuncture as an adjunct to conventional therapy provides short-term clinically relevant improvements in pain and functional measures for chronic low back pain.

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Additionally, a review that looked at 11 randomized, controlled trials and compared nonsteroidal anti-inflammatory drugs to acupuncture for low back pain found that acupuncture may improve symptoms more effectively.

Acupuncture may have a favorable effect on self-reported pain and functional limitations on nonspecific chronic low back pain, according to another systematic review and meta-analysis. However, the researchers noted that results depended on certain limitations to how therapy was administered.

Joint Pain

Acupuncture for OA in the hand, hip, and knee is conditionally recommended in the 2019 American College of Rheumatology and Arthritis Foundation guidelines. In this case, “conditionally” means that while it might be worth using acupuncture, more research is needed to verify its effectiveness.

Acupuncture was effective for the treatment of chronic pain, including knee OA, according to a systematic review that looked at 29 trials totaling 18,000 patients. The researchers also found that compared with sham acupuncture, acupuncture was more effective.

However, the Arthritis Foundation points out that while patients share anecdotal evidence that acupuncture has helped them, most studies have found that acupuncture offers minimal pain and stiffness relief for OA. Additionally, the foundation notes that benefits stated by people who use acupuncture for OA may be partially due to “participants' greater expectations that?acupuncture can help.”

Headache

Compared with sham acupuncture and waiting list control groups, acupuncture showed persisting superiority and clinically relevant benefits for at least 24 weeks in those experiencing migraines. The 24-week randomized clinical trial consisted of four weeks of treatment followed by 20 weeks of follow-up. Researchers reported that acupuncture reduced migraine frequency and the number of?days with migraine, as well as decreased pain intensity.

General Health and Wellness Benefits of Acupuncture

The National Institutes of Health states, “Some psychological and/or physical approaches used in traditional Chinese medicine practices, such as acupuncture … may help improve quality of life and certain pain conditions.”

How Acupuncture Benefits Other Symptoms and Conditions

While more research is needed to determine how effective acupuncture is for various conditions, some research shows it may benefit the following.

Vertigo?Sixty?participants from a hospital's emergency department were divided into acupuncture and control groups. The researchers analyzed the effect of treating dizziness and vertigo based on data collected from the questionnaires for Dizziness Handicap Inventory and Visual Analog Scale (VAS), along with heart rate variability. They found that acupuncture demonstrated a significant immediate effect in reducing discomforts and VAS of both dizziness and vertigo.

A review that?evaluated acupuncture for the treatment of cervical vertigo found that acupuncture may be more effective in improvement of clinical symptoms and average blood flow velocity of the vertebral-basilar artery compared with conventional medicine therapy for cervical vertigo.

Endometriosis Acupuncture improved relief from endometriosis symptoms more than other approaches like exercise, electrotherapy, and yoga, according to a meta-analysis of studies.

Studies have also found that acupuncture can reduce pain from endometriosis along with the blood level of CA-125, a protein associated with the disease. Researchers theorize that as acupuncture seems to promote relaxation, it reduces the muscle tension and stress that come with chronic pain.

Psoriatic Arthritis A case report of one patient with psoriatic arthritis (PsA) found that treatment approaches including acupuncture, turmeric, sarsaparilla root, and vitamin D3, might reduce symptoms of PsA.

Rheumatoid Arthritis In a review of 43 studies on acupuncture and rheumatoid arthritis (RA) conditions, researchers concluded that acupuncture alone or combined with other treatments is beneficial to the clinical conditions of RA without adverse effects, can improve function and quality of life, and is worth trying. They noted benefits such as an anti-inflammatory effect, an antioxidative effect, and the regulation of immune system function. However, according to the researchers, there is inconsistency in the evidence and a lack of well-designed human-animal double-blind, randomized, controlled trials.

Fatigue One study?looked at two types of acupuncture and usual care for fatigue. The first group in the trial received Chinese acupuncture plus usual care, the second got Korean acupuncture with usual care, and the third received only usual care. Researchers found that four weeks of acupuncture in addition to usual care could improve fatigue symptoms.

Fibromyalgia When researchers compared acupuncture therapy to sham acupuncture or conventional medication in 12 randomized, controlled trials, they found that acupuncture was significantly better than sham acupuncture for relieving pain and improving the quality of life, with low- to moderate-quality evidence in the short term. In the long term, acupuncture was superior to sham acupuncture.

Ulcerative Colitis Acupuncture by itself and acupuncture combined with conventional medicine may be effective in treating ulcerative colitis (UC) compared with conventional medicine alone, according to a systematic review and meta-analysis of randomized clinical trials. However, the researchers warned that their findings should be interpreted thoughtfully due to high or unclear risk of bias in the 13 trials they analyzed.

Another review of studies shows why it’s hard to get an overall understanding of the benefits of acupuncture for UC.?When researchers looked at 63 studies published between 1995 and 2015, the study designs were varied, such as whether the study analyzed acupuncture as an only therapy, in combination with medication, or in addition to other alternative remedies. Other differences included the placement of the needles on the body, how long treatment continued, and how outcomes were measured.

Although these differences and variability make acupuncture difficult to study, it’s revealing that so many studies and reviews show positive effects.
Crohn’s Disease A research review?found that acupuncture, particularly when combined with moxibustion — another therapy from TCM that involves burning herbs on targeted parts of the body to stimulate acupuncture points — can improve quality of life as well as lab measures of Crohn’s disease.

Allergies Acupuncture appeared to significantly reduce the number of days of antihistamine use while improving rhinitis-specific quality of life and seasonal allergic rhinitis symptoms.

Asthma Acupuncture can help with asthma. One study found that patients with allergic asthma who added 15 acupuncture sessions to routine care over the course of three months saw greater improvements in disease-specific and health-related quality of life compared with patients who received only routine care.

A review of research found that acupuncture in addition to asthma treatments?led to a statistically significant improvement in symptom response rates and resulted in lower levels of interleukin-6 (IL-6), which the body produces in response to infections and injuries.

Too much IL-6 can contribute to chronic inflammation.

Chronic inflammation is a hallmark of asthma.
Cancer For cancer survivors with chronic musculoskeletal pain, electroacupuncture (electrical stimulation of acupuncture needles after insertion, which is used by some acupuncture practitioners depending on their training and style of practice) reduced average pain severity scores and improved physical and mental quality of life.

In a meta-analysis of studies, researchers found that acupuncture or acupressure lowered pain intensity for cancer pain. Moreover, some studies suggested that acupuncture for cancer patients taking opiate pain medications could lead to a reduction in their use.

Memorial Sloan Kettering Cancer Center states that acupuncture is safe and effective for treating side effects of cancer treatment such as:

And a review and meta-analysis of studies found that acupuncture rarely causes serious adverse effects.

Weight Loss Some small studies may show that acupuncture helps with weight loss.

And a review of studies found that acupuncture may be an effective treatment for obesity when used with dietary interventions. Yet the researchers noted that the evidence is not fully convincing because of the poor methodological quality of the trials reviewed and called for higher quality studies to determine acupuncture’s effect on obesity.

Sexual Function There is not much research on acupuncture and sexual health, however, one small?study of women and men with sexual dysfunction found that at the end of nine sessions of acupuncture, women reported improved libidos and men experienced improvement in multiple sexual functions, including erection, timing of ejaculation, and ability to orgasm.

How to Get Acupuncture

If you’re interested in acupuncture, finding a licensed acupuncturist is the next step, and finding one who has experience in the condition causing you discomfort is even better. There are several types of licensed acupuncturists or licensed health professionals who can provide acupuncture:

  • Medical doctors can receive extra training in acupuncture. Many of these doctors are members of the American Academy of Medical Acupuncture. Visit the referral directory on that group's website.
  • People specifically train in acupuncture after completing a multiyear master’s program in acupuncture or TCM and passing a national certification exam. You can find a certified practitioner on this website (click on “Find a Practitioner,” then input your city and state). You can also find updates about licensure on your individual state’s regulatory board website, similar to looking up an MD’s license status.
  • Naturopathic physicians are trained to give acupuncture. Find a practitioner at the website of the American Association of Naturopathic Physicians. Put your ZIP code into the group's?online directory.

What to Expect During an Acupuncture Session

During an acupuncture visit, an acupuncturist will ask about your medical history and any symptoms you’re experiencing and examine you. Then a treatment plan will be created based on their evaluation of the causes and perpetuating factors for your concerns, similar to other health practitioners.

For the specific acupuncture treatment, they’ll have you sit or lie down on a table, often in a dimly lit room, and they will insert needles into acupuncture points on areas of your body. Needles typically remain inserted between 20 and 45 minutes while you rest comfortably in the treatment room. Some practitioners may also include moxibustion, cupping, acupressure, electrical stimulation to the needles, or external heat to your body.

Practitioners will often include you in your care by providing homework, such as dietary or lifestyle recommendations. While sessions may vary in time depending on your needs, the first session may last one to two hours, and sessions after that can range on average from 30 minutes to an hour.

While you might wonder if acupuncture will hurt, many people describe their first session as pleasurable and relaxing, and most even fall asleep. Other ways people describe feeling after acupuncture include:

  • Floating with a tingling, warm sensation
  • Heaviness, heat, and cold

How frequently you'll need to receive acupuncture depends on what you are seeking relief from. If you have a chronic issue, you may need to go more frequently than if you have an acute problem. The College of Traditional Chinese Medicine Practitioners and Acupuncturists of Newfoundland and Labrador (CTCMPANL) points out that “a small number of patients will experience a worsening of symptoms as the body’s energies are returning to normal, but this is usual and is followed quickly by improvement.”

Fees: Is Acupuncture Expensive? And Will Insurance Cover It?

Many health insurance plans don’t cover acupuncture. However, in January 2020, the Centers for Medicare and Medicaid Services (CMS) stated that it would cover acupuncture for Medicare patients with chronic low?back pain. This was the first condition that Medicare decided to cover related to acupuncture.

In an out-of-pocket cost analysis that included acupuncture prices from 723 clinics throughout 41 metropolitan regions, the following was discovered:

First-Time Visit

  • Cost range for a first-time acupuncture visit was $15 to $400.
  • The median for all 723 clinics was $112.

Follow-Up Visits

  • For the follow-up visits, the cost range was $15 to $300.
  • The median price was $80 for all 723 clinics.

Considerations

The CTCMPANL points out the following possible side effects and risks of receiving acupuncture:

  • The symptoms you receive treatment for may get worse for a few days after having acupuncture.
  • You might experience changes in sleep, appetite, bowels, urination, or your emotional state, but all of these are a sign that acupuncture is starting to work.
  • Fainting, infection, and bruising may occur.
  • In very rare, unlikely cases, acupuncture could puncture vital organs.

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