The research into acupuncture and pain management reflects some of the issues involved in acupuncture research in general. It is very challenging to design a study that is both blinded, and in which there is a satisfactory control group. Acupuncture is most frequently compared to either sham acupuncture or analgesic medication. Sham acupuncture often involves needling in the affected region and could therefore be considered an active intervention. It may also involve the use of sham needles, that apply pressure but do not penetrate the skin. However, acupressure is a recognised therapy in its own right. The effects of acupuncture may also be dismissed if patients do not reduce their use of pain medication. This neglects the fact that some patients may be physically or psychologically reliant on their medication and may not be motivated to reduce consumption.

Moreover, acupuncture research differs from drug research in one crucial aspect - it is not profitable. There is little incentive for pharmaceutical companies to fund extensive research into acupuncture, and government funding will always be limited. Therefore, acupuncture studies are often small scale and participants are often not directly comparable – making it hard to meet the standards of proof normally required in scientific research.

However, evidence is accumulating that acupuncture has a real impact on pain that cannot be explained by the placebo effect. Vickers et al (2017) performed a meta-analysis of individual patient data taken from RCTs prior to end of 2015. They considered the effect of acupuncture on 4 chronic pain conditions – non-specific musculoskeletal pain, osteoarthritis, chronic headache, and shoulder pain. They amassed data from 39 studies, including 20,827 patients. They found that acupuncture was superior to sham acupuncture and control in all 4 conditions and that the effects persisted over time. They found no clear correlation between the style of acupuncture and outcome, but results indicated that the number of acupuncture treatments made a significant difference.

Lin JG, Kotha P, Chen YH. Understandings of acupuncture application and mechanisms. Am J Transl Res. 2022 Mar 15;14(3):1469-1481. PMID: 35422904; PMCID: PMC8991130.

Vickers AJ, Vertosick EA, Lewith G, MacPherson H, Foster NE, Sherman KJ, Irnich D, Witt CM, Linde K; Acupuncture Trialists' Collaboration. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018 May;19(5):455-474. doi: 10.1016/j.jpain.2017.11.005. Epub 2017 Dec 2. PMID: 29198932; PMCID: PMC5927830.

Headaches

Everyone experiences a headache from time to time. Sometimes, it may be easy to pinpoint the cause (for example dehydration or excess caffeine) and to deal with the problem. However, for some people, headaches can become frequent and debilitating. Even where the aetiology is known (stress, hormonal fluctuations or neck stiffness), it is not straightforward to find a solution. Many people are reluctant to take prophylactic medication, and frequent ingestion of pain-relieving medication (for example ibuprofen and paracetamol) can be counterproductive or have side effects. Excessive use of pain-relieving drugs can result in a medication overuse headache, and migraine medication such as sumatriptan is only supposed to be taken for a few days at a time.

Anyone suffering from frequent headaches should consult their general practitioner to rule out any serious health issues and to discuss any longer-term use of pain-relieving medication.

However, acupuncture can provide an alternative for people who would like to minimise their use of analgesic medication. There is now a body of evidence supporting the use of acupuncture to help patients that suffer from chronic headache and migraine. A selection of the research is referenced below.

Linde et al (2016) looked at 22 trials involving nearly 5000 patients. The evidence suggested that acupuncture reduced the frequency of migraine attacks by around half. This made it slightly more effective than prophylactic drugs, and with less adverse side effects. The evidence suggests that at least 6 sessions are needed.

Vickers et al (2004) looked at 401 patients in primary care in the UK. They found that acupuncture had clinically relevant benefits for chronic headache sufferers, resulting in improved quality of life, reduced use of medication and fewer visits to the GP.

Jena et al (2008) looked at RCTs with acupuncture, involving over 15,000 patients. They concluded that acupuncture resulted in clinical improvements in headache.

Coeytaux  et al (2016) looked at systematic reviews and meta-analyses examining the impact of acupuncture on headache. They conclude that the evidence supports the use of acupuncture for migraine, tension headache and other chronic headaches.

Coeytaux RR, Befus D. Role of Acupuncture in the Treatment or Prevention of Migraine, Tension-Type Headache, or Chronic Headache Disorders. Headache. 2016 Jul;56(7):1238-40. doi: 10.1111/head.12857. Epub 2016 Jul 13. PMID: 27411557.

Jena S, Witt CM, Brinkhaus B, Wegscheider K, Willich SN. Acupuncture in patients with headache. Cephalalgia. 2008 Sep;28(9):969-79. doi: 10.1111/j.1468-2982.2008.01640.x. Epub 2008 Jul 8. PMID: 18624803.

Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database Syst Rev. 2016 Jun 28;2016(6):CD001218. doi: 10.1002/14651858.CD001218.pub3. PMID: 27351677; PMCID: PMC4977344.

Vickers AJ, Rees RW, Zollman CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R, Wonderling D, Grieve R. Acupuncture of chronic headache disorders in primary care: randomised controlled trial and economic analysis. Health Technol Assess. 2004 Nov;8(48):iii, 1-35. doi: 10.3310/hta8480. PMID: 15527670.

Musculoskeletal pain

Acupuncture is probably best known for its efficacy in the treatment of back pain. However, it can also provide relief for joint pain and non-specific pain conditions such as fibromyalgia.

In a review by Zhang et al (2020), most studies demonstrated the analgesic effects of acupuncture. The evidence from 7 reviews (including 300 RCTs) consistently demonstrated the clinically relevant impact of acupuncture for pain relief and functional improvement regarding back pain. 6 reviews also suggested that acupuncture was superior to control in the treatment of fibromyalgia.

Li et al (2019) reviewed 12 systematic reviews published between 2006 and 2017 and concluded that acupuncture compared favourably with western medicine in the treatment of knee arthritis and had fewer adverse reactions.

However, methodological limitations and heterogeneity of studies have made it hard to draw firm conclusions. Not all studies on arthritis of the knee have demonstrated the superiority of verum acupuncture over sham acupuncture, and some research cannot be considered statistically significant because of the small numbers of participants involved.

Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache. J Clin Outcomes Manag. 2009 May 1;16(5):224-230. PMID: 20445762; PMCID: PMC2863344.

Tu JF, Yang JW, Shi GX, Yu ZS, Li JL, Lin LL, Du YZ, Yu XG, Hu H, Liu ZS, Jia CS, Wang LQ, Zhao JJ, Wang J, Wang T, Wang Y, Wang TQ, Zhang N, Zou X, Wang Y, Shao JK, Liu CZ. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2021 Mar;73(3):448-458. doi: 10.1002/art.41584. Epub 2021 Jan 15. PMID: 33174383.

Zhang Q, Yue J, Golianu B, Sun Z, Lu Y. Updated systematic review and meta-analysis of acupuncture for chronic knee pain. Acupunct Med. 2017 Dec;35(6):392-403. doi: 10.1136/acupmed-2016-011306. Epub 2017 Nov 8. PMID: 29117967.

Zhang Y, Wang C. Acupuncture and Chronic Musculoskeletal Pain. Curr Rheumatol Rep. 2020 Sep 25;22(11):80. doi: 10.1007/s11926-020-00954-z. PMID: 32978666; PMCID: PMC8719359

Menstrual pain (dysmenorrhea)

In a trial involving 60 patients, Shetty et al (2018) found that acupuncture led a significant reduction in menstrual cramps, as well as dizziness and mood changes compared to controls. This has been found in other clinical trials, such as Witt et al (2008).

Cao et al (2023) performed a systematic review and meta-analysis of the use of auricular therapy for menstrual pain. On the basis of 793 patients in 11 RCTs, they concluded that auricular acupuncture was more effective than either placebo or NSAIDs.

Chen et al (2024) looked at 70 studies involving 5772 patients suffering from primary dysmenorrhea, and involving many different kinds of acupuncture. They concluded that acupuncture had a greater clinical efficacy than oral analgesics.

Cao M, Ye F, Xie W, Yan X, Ho MH, Cheung DST, Lee JJ. Effectiveness of auricular acupoint therapy targeting menstrual pain for primary dysmenorrhea: A systematic review and meta-analysis of randomized controlled trials. Worldviews Evid Based Nurs. 2023 Dec;20(6):621-633. doi: 10.1111/wvn.12636. Epub 2023 Mar 29. PMID: 36991541.

Chen B, Liu S, Jin F, Li T, Yang N, Xu Y, Hu J, Jiang T, Huang Y. Efficacy of acupuncture-related therapy in the treatment of primary dysmenorrhea: A network meta-analysis of randomized controlled trials. Heliyon. 2024 May 9;10(10):e30912. doi: 10.1016/j.heliyon.2024.e30912. PMID: 38770299; PMCID: PMC11103538.

Shetty GB, Shetty B, Mooventhan A. Efficacy of Acupuncture in the Management of Primary Dysmenorrhea: A Randomized Controlled Trial. J Acupunct Meridian Stud. 2018 Aug;11(4):153-158. doi: 10.1016/j.jams.2018.04.001. Epub 2018 Apr 12. PMID: 29654840.

Witt CM, Reinhold T, Brinkhaus B, Roll S, Jena S, Willich SN. Acupuncture in patients with dysmenorrhea: a randomized study on clinical effectiveness and cost-effectiveness in usual care. Am J Obstet Gynecol. 2008 Feb;198(2):166.e1-8. doi: 10.1016/j.ajog.2007.07.041. PMID: 18226614.