Acupuncture is a treatment derived from ancient Chinese medicine in which fine needles are inserted at certain sites in the body for therapeutic or preventative purposes.
It is often seen as a form of complementary or alternative medicine (CAM), although it is used in many NHS general practices, as well as the majority of pain clinics and hospices in the UK.
Western medical acupuncture is the use of acupuncture after a proper medical diagnosis. It is based on scientific evidence that shows the treatment can stimulate nerves under the skin and in muscle tissue.
This results in the body producing pain-relieving substances, such as endorphins. It is likely these substances are responsible for any beneficial effects seen with this form of acupuncture.
Traditional acupuncture is based on the belief that an energy, or "life force", flows through the body in channels called meridians. This life force is known as Qi (pronounced "chee").
Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi does not flow freely through the body, this can cause illness. They also believe acupuncture can restore the flow of Qi, and so restore health.
What is it used for?
Acupuncture practitioners – sometimes called acupuncturists – use acupuncture to treat a wide range of health conditions.
It is often used to treat pain conditions such as headache, lower back pain and osteoarthritis, but is also sometimes used in an attempt to help people with conditions ranging from infertility to anxietyand asthma.
Acupuncture is occasionally available on the NHS, although access is limited. Most acupuncture patients pay for private treatment.
Does it work?
Currently, the National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headachesand migraines. NICE makes these recommendations on the basis of scientific evidence.
There is also some evidence that acupuncture works for a small number of other problems, including neck pain and post-chemotherapynausea and vomiting.
Acupuncture is sometimes used for a variety of other conditions as well, but the evidence is not conclusive for many of these uses.
When it is carried out by a qualified practitioner, acupuncture is generally very safe. Some people experience side effects such as feeling drowsy or dizzy, but these are usually mild and short-lived.
If you choose to have acupuncture, make sure your acupuncture practitioner is either a regulated healthcare professional or a member of a recognised national acupuncture organisation.
Acupuncture on the
Acupuncture is sometimes available on the NHS, most often from GPs or physiotherapists, although access is limited.
Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners. Initial sessions usually cost between £35 and £60, and further sessions between £30 and £50.
Back pain guide
Explore this guide for information about different types of back pain, ways of preventing it and advice on treatment
How acupuncture is performed
Typically, an initial acupuncture session will involve an assessment of general health, a medical history and a physical examination, followed by insertion of the acupuncture needles.
Most acupuncture sessions last between 20 and 40 minutes.
Courses of treatment often involve up to 10 separate sessions, but this can vary.
Assessment and examination
The acupuncture practitioner will first ask you about your general health and your medical history.
If your visit is because of a specific health condition, they will ask about the symptoms of this condition and about any other treatment you have received for it.
After this, the acupuncture practitioner may carry out a physical examination.
Insertion of the needles
After taking an appropriate medical history, the acupuncture practitioner will begin the insertion of the acupuncture needles. These needles are inserted into specific places on the body, which practitioners call acupuncture points.
During the session, you will usually be asked to sit or lie down. You may also be asked to remove some clothes so the practitioner can access the relevant parts of your body.
The needles used are fine and are usually a few centimetres long. They should be single-use, pre-sterilised needles that are disposed of immediately after use.
Acupuncture practitioners choose specific points to place the needles based on your condition. From 1 to 12 points will typically be used during a session, and sometimes more depending on the number of symptoms you have.
The needles may be inserted just under the skin, or deeper so they reach muscle tissue. Once the needles are in place, they may be left in position for a length of time lasting from a few minutes up to around 30 minutes.
You may feel a tingling or a dull ache when the needles are inserted. You should not experience any significant pain. If you do, let your practitioner know straight away.
In some cases, your practitioner may rotate the needles or stimulate them with a mild electric current (known as electroacupuncture)
Common uses of acupuncture
Acupuncture practitioners use the treatment for a wide range of health problems.
There is an increasing number of clinical trials assessing acupuncture and comparing it with a placebo treatment or best standard treatment.
However, the use of acupuncture is not always based on rigorous scientific evidence.
This means practitioners may use acupuncture to treat a certain health condition, even though there have not been scientific trials proving acupuncture works for that condition.
For more information about the evidence on acupuncture and specific health conditions, see evidence for acupuncture.
Sometimes patients combine acupuncture with conventional treatments that have been prescribed by a GP or hospital consultant.
If you are being treated by an acupuncture practitioner for a health condition or are considering having acupuncture, it is advisable to discuss this with your GP.
NICE recommended uses
The National Institute for Health and Care Excellence (NICE) provides guidelines for the NHS on the use of treatments and care of patients.
Currently, NICE only recommends considering acupuncture as a treatment option for:
persistent lower back pain
chronic tension-type headaches
Other common uses
Acupuncture is also often used to treat other musculoskeletal conditions (of the bones and muscles) and pain conditions, including:
chronic pain, such as neck pain
Some acupuncture practitioners use acupuncture to treat a far wider range of conditions, including:
postoperative nausea and vomiting
allergies, including hay fever
fatigue, including fatigue in cancer patients after chemotherapy
depression and anxiety
digestive disorders, including irritable bowel syndrome (IBS)
infertility and menstrual disorders
a dry mouth (xerostomia)
However, the evidence is not conclusive regarding the effectiveness of acupuncture for many of these conditions.
Safety and regulation of acupuncture
There is no statutory regulation of acupuncture in England, but many non-medical acupuncture practitioners are required to register with their local authority.
This is because of the risk of blood-borne infections from piercing the skin with acupuncture needles. The same rules also cover tattooing and body piercing.
Practitioners of conventional medicine, such as GPs, physiotherapists and nurses, are subject to statutory regulation. This means there are special laws to ensure they are properly qualified and adhere to certain standards or codes of practice.
The local authority must also ensure it has bylaws that govern the cleanliness of the acupuncture premises, practitioners, instruments, materials and equipment.
There are a number of acupuncture organisations in the UK practitioners can join if they hold certain qualifications and agree to work according to certain codes of practice.
If you decide to have acupuncture, you can visit the websites of these organisations to find a qualified acupuncturist near you. The qualifications and codes of practice they require of their members are also available on their websites.
These organisations include:
The British Medical Acupuncture Society (BMAS)
Acupuncture Association of Chartered Physiotherapists (AACP)
British Acupuncture Council (BacC)
British Academy of Western Medical Acupuncture (BAWMA)
British Register of Complementary Practitioners (BRCP)
The Acupuncture-Acutherapy Council (AcuC)
Risks and side effects
Acupuncture is safe when it is conducted by a qualified practitioner.
Mild, short-lasting side effects do occur in some cases, however. These include:
pain where the needles puncture the skin
bleeding or bruising where the needles puncture the skin
feeling dizzy or faint
worsening of pre-existing symptoms
Serious complications from treatment, such as infections or damage to tissue, are extremely rare. They usually only occur as the result of bad practice, carried out by an acupuncture practitioner who has not been properly trained.
Who may not be able to have acupuncture?
Because of the slight risk of bleeding, people with bleeding disorders such as haemophilia, or people taking medication to prevent blood clotting (anticoagulants), may not be able to have acupuncture.
If you have a blood disorder or are taking anticoagulants, talk to your GP before you have acupuncture.
Acupuncture is also not usually advised if you have a metal allergy or an infection in the area where needles may be inserted.
Before treatment, your acupuncture practitioner should ask you about any underlying conditions you have or medication you are taking, as some of these may affect the treatment you can have.
It is generally safe to have acupuncture when you are pregnant. However, you should let your acupuncture practitioner know if you are pregnant because certain acupuncture points cannot be used safely during pregnancy.
See are complementary therapies safe in pregnancy? for more information.
Evidence for and against acupuncuture
There is some scientific evidence acupuncture has a beneficial effect for a number of health conditions.
However, there is less clear scientific evidence about the benefits of acupuncture in the majority of conditions it is often used for.
The National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraine.
Assessing the evidence
One of the best ways researchers can assess the evidence behind a particular treatment is by carrying out a systematic review. This is a "study of studies" that combines findings from separate but similar studies to come up with an overall conclusion.
Systematic reviews are an important part of health research because they can identify findings that might otherwise be missed in individual studies. They can also help distinguish the effects of treatment from the effects of chance.
It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effectand not because of the treatment itself. Systematic reviews can help reduce the potential influence of the placebo effect.
While systematic reviews cannot always determine conclusively whether a treatment does or does not work, they can be useful in assessing how a particular treatment (such as acupuncture) compares to another (such as "sham" acupuncture or medication).
However, even this can be challenging – both acupuncture and placebo treatments can stimulate the release of natural painkilling substances called endorphins, which can make it difficult to distinguish between them.
What evidence is there for acupuncture?
One of the largest and most respected organisations that carries out and publishes systematic reviews into the effectiveness of medical treatments is The Cochrane Collaboration.
A number of systematic reviews into the effectiveness of acupuncture have been published by The Cochrane Collaboration, and the basic results are summarised below.
Some positive evidence
Systematic reviews carried out by The Cochrane Collaboration have found there is some evidence acupuncture may have a beneficial effect on the following conditions:
chronic lower back pain
nausea and vomiting after chemotherapy
nausea and vomiting after surgery
irritable bowel syndrome (IBS)
However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, the existence of some positive evidence does not mean acupuncture definitely works for these conditions.
In many cases, the evidence appears contradictory. For example, some high-quality studies may suggest acupuncture is no better than "sham" acupuncture, whereas some lower-quality studies may suggest acupuncture is better than an established medical treatment.
The issue is sometimes also further complicated by the fact some "sham interventions" include active needling and are therefore not true placebos.
In addition, it can be difficult to make sure the patients involved in acupuncture studies are unaware of the specific treatment they are receiving (known as "blinding").
This is because it is obvious whether you are receiving a conventional medical treatment such as medication or if you are receiving acupuncture, for example. This is a problem as it means the preconceptions of the person being treated may influence the result.
Some systematic reviews, however, have demonstrated the effects of acupuncture over sham treatment in studies where patients are unaware whether they are having real acupuncture or sham treatment.
For example, one large meta-analysis (a type of systematic review) not carried out by The Cochrane Collaboration included data from more than 17,000 patients. It compared acupuncture to sham acupuncture or no acupuncture without patients being aware of whether they had received real or sham treatment.
This review found acupuncture to be superior to both sham and no treatment for headaches, osteoarthritis, back pain and neck pain.
Little or no evidence
In many conditions where acupuncture is used, there is not enough good quality evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.
For example, systematic reviews published by The Cochrane Collaboration have suggested more research is needed to assess whether acupuncture is effective for:
restless legs syndrome
stroke, stroke rehabilitation and swallowing problems caused by stroke
More research is needed to establish whether acupuncture is better or worse than best standard treatments for these conditions.
More information and research
If you want to find out more about studies into acupuncture, you can search for high-quality research using the NHS Evidence andCochrane Library websites.
The placebo effect
Ben Goldacre explains what the placebo effect is and describes its role in medical research and in the pharmaceutical industry.
Media last reviewed: 02/10/2013
Next review due: 02/10/2015
Healthy Evidence forum
Smoking Or A CASE for Industrial Injuries Disablement Benefit ... You Decide Given Healthy Evidence.
This is a letter I have written to Industrial Injuries Disablement Benefit ..…
50 year old male with many problems.
what are the odds of a successful repair of a complete quad tendon rupture…
Henna Tattoo Killer?
Could this be true about Hennah? I dont understand how the tattoo could make…
More from the community
Content provided by HealthUnlocked