Acupuncture for pain is a topic widely researched among those suffering from both chronic and acute conditions in their body. When pain medications aren’t providing relief, and cause unhealthy side effects, acupuncture may be an option for those wishing to live pain free.

The Center for Complimentary and Integrative Health (formerly NCCAM) offers this guide on what you need to know about acupuncture for those who want to learn more.

Physical pain is a common occurrence for many Americans; in fact, a national survey found that more than one-quarter of U.S. adults had recently experienced some sort of pain lasting more than a day. In addition to conventional treatments, such as over-the-counter and prescription medications, people may try acupuncture in an effort to relieve pain. This fact sheet provides basic information about pain and acupuncture, summarizes scientific research on acupuncture for specific kinds of pain, and suggests sources for additional information.

• People use acupuncture for various types of pain. Back pain is the most commonly reported use, followed by joint pain, neck pain, and headache.
• Acupuncture is being studied for its efficacy in alleviating many kinds of pain. There are promising findings in some conditions, such as chronic low-back pain and osteoarthritis of the knee; but, for most other conditions, additional research is needed. The National Center for Complementary and Alternative Medicine (NCCAM) sponsors a wide range of acupuncture research.
• Acupuncture is generally considered safe when performed correctly.
• Traditional Chinese medicine is whole medical system that originated in China. It is based on the concept that disease results from disruption in the flow of qi and imbalance in the forces of yin and yang. Practices such as herbs, meditation, massage, and acupuncture seek to aid healing by restoring the yin-yang balance and the flow of qi theory, acupuncture regulates the flow of qi.
• In traditional Chinese medicine, the vital energy or life force proposed to regulate a person’s spiritual, emotional, mental, and physical health and to be influenced by the opposing forces of yin and yang (vital energy) through the body. Research to test scientific theories about how acupuncture might work to relieve pain is under way.
• Tell all your health care providers about any complementary and alternative practices you use. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care. For tips about talking with your health care providers about complementary and alternative medicine (CAM), see NCCAM’s Time to Talk campaign.

Pain is a feeling triggered in the nervous system. It may be sharp or dull, off-and-on or steady, localized (such as back pain) or all over (such as muscle aches from the flu). Sometimes, pain alerts us to injuries and illnesses that need attention. Although pain usually goes away once the underlying problem is addressed, it can last for weeks, months, or even years. Chronic pain may be due to an ongoing condition (such as arthritis) or to abnormal activity in pain-sensing regions of the brain, or the cause may not be known.

To relieve their pain, many people take over-the-counter medications—either acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs, including aspirin, naproxen, and ibuprofen). Stronger medications, including NSAIDs in higher dosages and narcotics, are available by prescription only.

Acupuncture, among the oldest healing practices in the world, is part of traditional Chinese medicine. Acupuncture practitioners stimulate specific points on the body—most often by inserting thin needles through the skin. In traditional Chinese medicine theory, this regulates the flow of qi (vital energy) along pathways known as meridians.

According to the 2007 National Health Interview Survey, which included a comprehensive survey of CAM use by Americans, 1.4 percent of respondents (an estimated 3.1 million Americans) said they had used acupuncture in the past year. A special analysis of acupuncture data from an earlier NHIS found that pain or musculoskeletal complaints accounted for 7 of the top 10 conditions for which people use acupuncture. Back pain was the most common, followed by joint pain, neck pain, severe headache/migraine, and recurring pain.

Acupuncture has been studied for a wide range of pain conditions, such as postoperative dental pain, carpal tunnel syndrome, fibromyalgia, headache, low-back pain, menstrual cramps, myofascial pain, osteoarthritis, and tennis elbow.

Overall, it can be very difficult to compare acupuncture research results from study to study and to draw conclusions from the cumulative body of evidence. This is because studies may use different acupuncture techniques (e.g., electrical vs. manual), controls (comparison groups), and outcome measures.

One particularly complex factor in acupuncture research is choosing the controls for a clinical trial. The choice depends in part on whether the researchers want to study a particular aspect of acupuncture (e.g., effects on the brain) or to determine whether acupuncture is useful compared with other forms of care.

Scientific evidence on CAM therapies includes results from laboratory research as well as clinical trials (studies in people). It encompasses both “positive” findings (evidence that a therapy may work) and “negative” findings (evidence that it probably does not work or that it may be unsafe). Scientific journals publish study results, as well as review articles that evaluate the evidence as it accumulates; fact sheets from NCCAM—like this one—base information about CAM research primarily on the most rigorous review articles, known as systematic reviews and meta-analyses.

• Carpal tunnel syndrome—Although a 1997 NIH consensus statement on acupuncture concluded that acupuncture was promising for carpal tunnel syndrome, additional research confirming acupuncture’s efficacy for this condition is scant.
• Fibromyalgia—Evidence on acupuncture for fibromyalgia is mixed. Some reviews of the scientific literature have found the evidence promising. However, another review that focused on the few rigorous randomized controlled trials on acupuncture as an adjunct therapy for fibromyalgia did not find a benefit. Additionally, a 2003 assessment by the Agency for Healthcare Research and Quality concluded that the evidence was insufficient and the beneficial effects of acupuncture for fibromyalgia could not be determined.
• Headache/migraine—Study results on acupuncture for headache are conflicting. Some literature reviews found evidence to support the use of acupuncture for headache, but others noted that most of the studies were of poor quality. A 2008 review of randomized trials on acupuncture highlighted a few well-designed trials whose findings indicate that acupuncture reduces migraine symptoms and is as effective as headache medications. In addition, a 2009 review found that acupuncture may help relieve tension headaches. However, two large trials that looked at acupuncture for migraines found no difference between actual and simulated acupuncture, both of which were equal to conventional care or superior to no treatment.
• Low-back pain—According to clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007, acupuncture is one of several CAM therapies physicians should consider when patients with chronic low-back pain do not respond to conventional treatment. In early, small studies, combining actual acupuncture with conventional treatment was more effective than conventional treatment alone for relieving chronic low-back pain; but actual acupuncture was not more effective than simulated acupuncture or conventional treatment. However, a large, rigorously designed clinical trial reported in May 2009 found that actual acupuncture and simulated acupuncture were equally effective—and both were more effective than conventional treatment—for relieving chronic low-back pain. There is insufficient evidence to draw definite conclusions about the effectiveness of acupuncture for acute low-back pain.
• Menstrual cramps—Two literature reviews have suggested that acupuncture may help with pain from menstrual cramps, but the research is limited.
• Myofascial pain—The evidence for acupuncture and myofascial pain (in which pain occurs in sensitive areas, known as trigger points, in the muscles) is mixed. Some literature reviews have found the evidence promising, but another review indicated that “needling therapies” for myofascial trigger point pain were not more effective than placebo.
• Neck pain—Studies of acupuncture for chronic neck pain have found that acupuncture provided better pain relief than some simulated treatments. However, the studies varied in terms of design and most had small sample sizes.
• Osteoarthritis/knee pain—Acupuncture appears to be effective for osteoarthritis, particularly in the area of knee pain. Recent literature reviews have found that acupuncture provides pain relief and improves function for people with osteoarthritis of the knee. However, authors of a 2007 systematic literature review suggested that although some large, high-quality trials have shown that acupuncture may be effective for osteoarthritis of the knee, differences in the design, size, and protocol of the studies make it hard to draw any definite conclusions from the body of research. These authors concluded that it is too soon to recommend acupuncture as a routine part of care for patients with osteoarthritis.
• Postoperative dental pain—Although recent data on acupuncture for postoperative dental pain are scant, literature reviews based on earlier evidence have identified acupuncture as a promising treatment for dental pain—especially pain following tooth extraction. For example, a 1999 study of 39 dental surgery patients found that acupuncture was superior to placebo (simulated acupuncture) in preventing postoperative pain. However, a 2005 study of 200 dental surgery patients found no significant analgesic effect for acupuncture compared to simulated acupuncture, although patients who believed they received acupuncture reported significantly less pain than those who believed they received a placebo.
• Tennis elbow—Study results on the use of acupuncture for tennis elbow (lateral epicondyle) pain are mixed. An early review of clinical trials reported that data on acupuncture for lateral epicondyle pain were insufficient and of poor quality; however, recent reviews have found the evidence promising, noting strong evidence that acupuncture provides short-term pain relief for lateral epicondyle pain.

NCCAM thanks the following people for their technical expertise and review of this publication: Ted Kaptchuk, O.M.D., Harvard Medical School; Lixing Lao, Ph.D., University of Maryland Center for Integrative Medicine; Vitaly Napadow, Ph.D., Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital; and Partap Khalsa, D.C., Ph.D., and Richard Nahin, Ph.D., M.P.H., NCCAM.

This publication is not copyrighted and is in the public domain. Duplication is encouraged.

NCCAM has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider. The mention of any product, service, or therapy is not an endorsement by NCCAM.

NCCAM Pub No.: D435
Date Created: May 2009
Last Updated: August 2010