Acupuncture for chronic pain: what the evidence shows

Living with chronic pain can be challenging. Many people look for different ways to manage their pain and improve their daily lives. Acupuncture is one approach that some consider. But what does the research say about how well acupuncture works for chronic pain?

This article looks at what some major studies have found. We will explore whether acupuncture helps reduce chronic pain, how it compares to other treatments, and what this evidence might mean for you.

Acupuncture for various chronic pain conditions

A large study published in The Journal of Pain combined data from many individual patients to get a clearer picture of acupuncture's effects. This type of study, called an individual patient data (IPD) meta-analysis, gathered information from 39 trials involving 20,827 patients [1].

The researchers looked at acupuncture for four types of chronic pain: * Nonspecific musculoskeletal pain * Osteoarthritis * Chronic headache * Shoulder pain

The study compared acupuncture to two control groups: 1. Sham acupuncture: A procedure designed to mimic acupuncture without using true acupuncture points or deep needle insertion. 2. No acupuncture control: No specific acupuncture treatment was given.

What the study found [1]: * Acupuncture vs. no acupuncture: Acupuncture was found to be better than no acupuncture for each pain condition. The difference between these groups was close to 0.5 standard deviations (SDs). * Acupuncture vs. sham acupuncture: Acupuncture was also better than sham acupuncture, but the difference was smaller, close to 0.2 SDs. * Lasting effects: The study found clear evidence that the benefits of acupuncture lasted over time. The treatment effect only decreased by about 15% after one year. * Beyond placebo: The researchers concluded that the pain relief from acupuncture cannot be explained only by placebo effects. They noted that factors beyond specific needling at correct points contribute to the overall effect.

Acupuncture for chronic nonspecific low back pain

Chronic nonspecific low back pain is a common condition without a clear cause, lasting more than three months. A Cochrane review, which is a detailed summary of research, looked specifically at acupuncture for this type of back pain [2]. This review included 33 studies with 8,270 participants.

For more information on this topic, you can read our guide on acupuncture for back pain.

Comparing acupuncture to sham intervention [2]: * Pain relief: Low-certainty evidence suggested that acupuncture might reduce pain in the immediate term (up to seven days) compared to sham. However, the average difference in pain scores (about 9.22 points on a 0-100 scale) was not considered a clinically important change. * Function: Very low-certainty evidence showed that acupuncture was not more effective than sham in improving back-specific function in the immediate term. * Quality of life: Low-certainty evidence indicated that acupuncture did not seem to be more clinically effective than sham for quality of life in the short term. * Reasons for low certainty: The researchers noted that the certainty of this evidence was low to very low due to potential issues like risk of bias, inconsistent results across studies, and imprecise findings.

Comparing acupuncture to no treatment [2]: * Pain relief: Moderate-certainty evidence found that acupuncture led to greater and clinically important pain relief compared to no treatment. The average difference in pain scores was about 20.32 points on a 0-100 scale. * Function: Acupuncture also improved back function compared to no treatment. * Reasons for moderate certainty: The evidence was downgraded to moderate certainty due to the risk of bias in the studies.

Comparing acupuncture to usual care [2]: * Pain and function: Low-certainty evidence suggested that acupuncture might reduce pain (by about 10.26 points on a 0-100 scale, which was not clinically important) and improve back-specific function immediately after treatment compared to usual care. * Quality of life: Moderate-certainty evidence from one trial found that acupuncture was more effective in improving physical quality of life, but not mental quality of life, in the short term.

Acupuncture for preventing episodic migraine

Migraine headaches can be debilitating, and many seek ways to prevent them. Another Cochrane review focused on acupuncture for preventing episodic migraine [3]. This review included 22 trials with a total of 4,985 participants.

Comparing acupuncture to no acupuncture [3]: * Headache frequency: Acupuncture was linked to a moderate reduction in headache frequency compared to no acupuncture after treatment. * Response rate: After treatment, 41% of people receiving acupuncture had their headache frequency at least halved, compared to 17% of those receiving no acupuncture. * Long-term benefit: The only trial with a 12-month follow-up found a small but significant benefit from acupuncture.

Comparing acupuncture to sham acupuncture [3]: * Headache frequency: Both after treatment and at follow-up, acupuncture was linked to a small but statistically significant reduction in headache frequency compared to sham acupuncture. * Response rate: After treatment, 50% of people receiving true acupuncture and 41% receiving sham acupuncture had their headache frequency at least halved. At follow-up, these numbers were 53% and 42%, respectively.

Comparing acupuncture to prophylactic drugs [3]: * The review found no significant difference in headache frequency reduction between acupuncture and preventative drug treatments.

Overall, the quality of evidence for migraine prevention was rated as moderate [3].

Understanding sham acupuncture in studies

When researchers study a treatment like acupuncture, they often use a "sham" control group. The goal of a sham treatment is to make patients believe they are receiving the real treatment, even if they aren't, to help understand the placebo effect.

However, designing a perfect sham for acupuncture is difficult. Traditional acupuncture involves specific points and needle insertion. Sham acupuncture might involve [1]: * Needles inserted at non-acupuncture points. * Very shallow needle insertion, or no penetration at all. * Devices that look like needles but retract without piercing the skin.

The challenge is that even these sham methods might have some physical or psychological effects. For example, simply touching the skin with a needle, even if not at a specific point, could create a sensation or expectation that provides some relief. This means that sham acupuncture is not always a completely "inactive" placebo.

This is why studies often show a smaller difference when comparing real acupuncture to sham acupuncture than when comparing real acupuncture to no treatment at all [1]. The sham treatment itself might be providing some level of benefit. This doesn't mean acupuncture isn't effective, but it helps researchers understand the different factors that contribute to the overall treatment effect.

To learn more about what acupuncture feels like, you can read our article on what treatment feels like.

Limitations of the evidence

While the studies discussed provide valuable insights, it's important to understand their limitations: * Certainty of evidence: As seen in the Cochrane reviews, the certainty of evidence can range from very low to moderate. This means that future research might change our understanding of how effective acupuncture is for certain conditions [2, 3]. * Risk of bias: Many studies had a risk of bias, especially performance bias, because it's hard to blind the acupuncturist (they know if they are giving real or sham acupuncture) [2]. * Modest effects: While acupuncture often shows a statistically significant benefit over sham or no treatment, the actual size of this benefit can be modest for some conditions [1, 2, 3]. * Complexity of acupuncture: Acupuncture is a complex treatment. The studies suggest that factors beyond just the specific needle placement contribute to its effects [1].

What this means for you

The research suggests that acupuncture may offer benefits for chronic pain, including musculoskeletal pain, osteoarthritis, chronic headaches, and low back pain [1, 2, 3]. These effects appear to last over time [1].

While acupuncture often shows a clear benefit over receiving no treatment, the difference compared to sham acupuncture can be smaller. This highlights the complex nature of pain relief and the many factors that contribute to how a treatment works.

If you are considering acupuncture for chronic pain, a licensed practitioner can assess your specific situation and help you decide if it might be a suitable option for you. They can discuss the potential benefits and any risks involved.

Understanding the potential costs of treatment is also important. You can find more information in our cost guide.