Acupuncture is an ancient form of Chinese medicine which practitioners believe can help with pain, anxiety, and many other health conditions. Which benefits are supported by science, and what are the potential side effects? Read on to learn more.
Health Benefits of Acupuncture
There are many potential health benefits and positive side effects of acupuncture. Practitioners believe that acupuncture can produce:
- Alertness 
- Anti-inflammation 
- Relaxation 
- Calmness 
- Improved sleep 
- Pleasant feeling of fatigue 
- Euphoria 
- Feeling of warmth 
But does it really work? What does the science say?
Note that the FDA has approved acupuncture needles as therapeutic devices with special controls (namely that they must be sterilized before use), but it has not approved any specific health claims made about acupuncture as a therapy. Talk to your doctor before undergoing acupuncture.
Possibly Effective For
Chronic pain affects about 20% of adults globally . In the US, the use of addictive opiate painkillers is becoming very problematic . Acupuncture appears to be more effective at pain management without the side effects and may even help patients wean off from opiate drugs [5, 6].
Perhaps the most common use of acupuncture is to manage chronic pain .
Stimulation of acupoints is believed to release endorphins and natural opioids in the body, thus reducing the perception of pain . In addition, it also reduces stress and tension .
However, the role of acupuncture in pain management is controversial. Some researchers have hypothesized that a combination of neural signaling, opioids, glutamate, and adenosine are involved .
Chronic lower back pain is a common, disabling condition with an annual incidence of 10 – 15%. 15 – 30% of people experience lower back pain at some point in their life .
A meta-analysis of 22 randomized clinical trials found that acupuncture is an effective treatment for chronic lower back pain but it was inconclusive for acute low back pain. However, despite these results, the study found that other active therapies were just as effective for treating chronic low back pain as acupuncture .
In several clinical studies, patients in both the acupuncture and the sham (minimal fake acupuncture control) acupuncture groups experienced more benefit to their lower back pain than patients with no acupuncture treatment or conventional therapies. However, there was no significant difference between the acupuncture group and the sham control group [11, 12].
Potentially, acupuncture treatment may have psychological placebo effects without having physical effects on the body. The acupuncture treatment outperformed other groups (conventional treatments and no treatments) but did not outperform the sham control group.
However, brain imaging studies have shown that acupuncture and sham acupuncture had different effects on the brain (limbic structures), despite similar levels of pain relief .
According to a meta-analysis, some studies demonstrated low to moderate evidence of acupuncture’s effectiveness for chronic lower back pain. These benefits were short-term (less than 3 months) .
Osteoarthritis is the most common joint disorder throughout the world, affecting more than 80% of people over the age of 75. Osteoarthritis is the loss of bone cartilage, affecting the flexible tissues around the bone and causing pain .
A 2014 meta-analysis found that acupuncture was associated with :
- a reduction of pain intensities
- functional mobility improvements
- improved quality of life
The study supports acupuncture as an alternative form of medicine to traditional painkillers (including opiates) in osteoarthritis patients .
Clinical studies have shown mixed results .
Other randomized controlled studies have shown that acupuncture has functional improvements of joints and pain relief for osteoarthritis compared with both controls .
However, the improvement differences between acupuncture and sham acupuncture decrease over time (after 26 and 52 weeks) .
Pain Associated with Cancer and Chemotherapy
Cancer-related pain, prevalent in 40 – 85% of patients , can be caused directly by the cancer lesions, or indirectly by surgeries and chemotherapies .
Acupuncture is used to treat cancer-related pain, as well as nausea and vomiting .
Acupuncture works by helping to release serotonin, opioids, and endorphins in the brain .
Serotonin release from the brain (upper brain stem region and hypothalamus) stimulates the release of other hormones (β-endorphin, enkephalin, endomorphin, and dynorphin) that reduce and alleviate the pain .
Acupuncture can also be used to treat weakness and pain from nerve damage (peripheral neuropathy) associated with chemotherapy. Although further studies are still needed to validate using acupuncture to treat chemotherapy pain, utilizing acupuncture in this area seems promising .
Pain During Pregnancy
When compared to physical therapy, acupuncture was more effective at relieving pain and decreasing disability from lower back pain during pregnancy [26, 27, 28].
In a blind controlled study, ear acupuncture reduced posterior pelvic pain during pregnancy after one week of therapy .
However, certain acupoint sites in the abdominal region and those that stimulate the cervix and uterus (stimulation of these points can potentially induce labor) should be avoided during pregnancy [30, 31, 27].
Although acupuncture and acupressure have been effective at reducing pain during pregnancy, further studies are needed to validate the results .
Headaches and Migraines
People sometimes use acupuncture to help with headaches and migraines .
Adding acupuncture to the standard of care reduced the frequency of migraine attacks in multiple clinical studies [34, 35].
However, in clinical studies, acupuncture treatment for headaches and migraines have conflicting results.
In a randomized control study of 270 patients, those in both the acupuncture and sham acupuncture groups experienced greater relief for tension headaches than patients with no acupuncture treatment. However, there was no significant difference between the acupuncture group and the sham control group .
In 2 different studies, acupuncture was more effective than placebo, reducing both the number of headache attacks and the duration of the headaches [37, 38].
A 2016 meta-analysis found that acupuncture is effective at treating frequent episodic or chronic tension-type headaches .
For episodic migraines, true acupuncture was more effective than sham acupuncture and traditional painkillers .
2) Sleep Quality & Duration
Some people use acupuncture to improve the quality and duration of sleep .
Acupuncture led to brain and hormonal changes associated with better sleep. It decreased metabolic activities and heart rate (increased parasympathetic system, decreased sympathetic system) .
Analyses of randomized, controlled studies have shown that acupuncture is more effective at treating insomnia than other controls [40, 41, 42].
In a randomized, single-blind study, acupuncture was more effective at reducing respiratory conditions in obstructive sleep apnea syndrome than sham acupuncture .
Menopause-Related Sleep Disturbances
A 2016 meta-analysis found that acupuncture treatment was associated with decreased sleep disturbances in perimenopausal or menopausal women [44, 45].
Acupuncture has also been associated with subjective improvements of individual symptoms of Parkinson’s disease. These symptoms include tremors, walking, handwriting, slowness, pain, sleep, depression, and anxiety. However, clinical tests have demonstrated that acupuncture failed to show physical improvements besides improved sleep and rest .
3) Nausea & Vomiting
A meta-analysis of 1247 patients across 11 trials found that acupuncture reduced acute vomiting during chemotherapy by 14% .
Another meta-analysis of 19 studies found that acupuncture significantly reduced nausea and vomiting after surgery .
Insufficient Evidence For
The following purported benefits are only supported by limited, low-quality clinical studies. There is insufficient evidence to support the use of acupuncture for any of the below-listed uses. Remember to speak with a doctor before getting acupuncture, and never use it in place of something a doctor recommends or prescribes.
4) Mood & Stress
Acupuncture may induce the release of the neurotransmitters serotonin and endorphins in the brain, elevating mood. Early clinical results indicate the potential usefulness of acupuncture in anxiety and depression .
In animal studies, acupuncture can improve mood-related disorders (by increasing NPY in the hippocampus) .
Acupuncture has been shown to signiﬁcantly reduce anxiety in both human and animal subjects, despite poor methodological reporting and reproducibility in repeat studies .
In two case reports of male patients, scalp acupuncture has demonstrated to be effective in treating anxiety. Acupuncture stimulation at specific points of the brain (Governing Vessel and local acupoints) helped with anxiety – both in the short and long terms .
Also, acupuncture can treat anxiety and depression during pregnancy. A systematic review of 6 studies showed that acupuncture reduces both depression and anxiety during pregnancy .
Despite promising results in multiple studies for the treatment of anxiety, there is still not enough research evidence to validate these results [54, 55].
Psychological stress can elevate inflammatory responses. These inflammatory responses can cause depressive symptoms such as poor mood, inability to feel pleasure (anhedonia), fatigue, and social problems .
Inflammation and stress are interconnected and interactive in the (sympathetic) nervous system .
Acupuncture inhibits inflammation in specific parts of the brain and in (peripheral) blood, indirectly reducing stress hormones. Some researchers point to this effect and conclude that it has potential against depression .
Electrical stimulation of the vagus nerve with electroacupuncture has also been observed to inhibit these inflammatory responses (TNF, IL-1beta, IL-6, and IL-18) .
Stress-Associated Blood Pressure
Stress increases blood pressure .
In a controlled experiment, acupuncture at both acupoints and non-acupoints greatly decreased blood pressure in response to mild mental stress (mental arithmetic and the Stroop test) in humans .
Researchers proposed one explanation for the reduction in blood pressure: that acupuncture stimulates the sensory neurons in the muscles. This stimulation of the nervous system could induce the release of endogenous opioids, which have effects on the heart (cardiovascular system) [60, 61].
Acupuncture involves introducing a foreign object in the form of a metallic needle into the body. The introduction of foreign material into the body triggers an immune response .
Acupuncture treatment stimulated the immune system in a study of elderly adults, possibly by increasing the production of white blood cells (lymphocytes) .
Immune functions such as mobility of cells (chemotaxis), phagocytosis, lymphocyte proliferation, and activities of natural killer (NK) cells were significantly improved in anxious women after acupuncture treatment in women with anxiety .
6) Weight Management
Ear acupuncture is widely used in Western countries for weight loss, though the evidence is sparse [64, 65].
In a randomized control study, bilateral auricular acupuncture stimulation in healthy, nonobese subjects led to significant weight loss .
Practitioners believe that the satiety center (ventromedial nuclei of the hypothalamus) of the brain can be stimulated to decrease the feeling of hunger .
For the therapeutic effect of weight loss, stimulation of the vagal nerve raises serotonin levels. This stimulation affects the smooth muscles in the stomach, which could theoretically lead to appetite suppression .
Serotonin can also enhance intestinal motility, decrease anxiety, and mobilize the body’s energy reserves (lipolytic effect), which contribute to weight loss .
Side Effects & Safety
Acupuncture treatment is generally considered safe, and few adverse effects are observed when treatment follows Clean Needle Technique (CNT) and sterile practices .
The risk of adverse events for acupuncture is 0.01 per 10,000 acupuncture sessions and 0.09 per 10,000 individual patients .
From 2000 to 2009, there were 95 cases of serious adverse effects associated with acupuncture use, with many incidents occurring in Asia. 5 cases were fatal .
Many serious complications are not inherent to acupuncture but are caused by the malpractice of acupuncturists .
Improper acupuncture techniques can lead to excessive bleeding, heart problems, lung problems, and different kinds of infections .
Negative side effects inherent to acupuncture includes:
- Bruising [73, 74]
- Sweating 
- An extreme feeling of fatigue 
- Feeling cold 
- Dizziness 
- Pain in acupuncture points 
Before the introduction of disposable needles, hepatitis cross-infections between patients were common. Since then, the majority of infections have been bacterial, caused by skin contact at the acupoints .
Complete sterilization of the skin is not only impractical for acupuncture but also not possible even under surgical conditions .
The most common outbreak are mycobacterial infections, which occur in 96% of cases .
Other infections include pyogenic bacteria (Staphylococcus aureus), bacterial endocarditis, and blood-borne viruses (hepatitis, HIV) [77, 78].
Infection control education and good hygiene practices should be emphasized at acupuncture clinics .
Although bacterial infections are the most commonly encountered complication, these infections are relatively minor and can be treated with antibiotics (Note: antibiotics do not treat viral infections) .
2) Loss of Balance and Consciousness
During acupuncture treatment, loss of balance (vertigo) and loss of consciousness (syncope) is not uncommon. Individuals with abnormally low blood pressure (hypotension) or slow heart rate (bradycardia) are more at risk .
Loss of consciousness due to acupuncture is called “needle fainting.” These symptoms include:
- Cold sweats 
- Stomach discomforts 
- Loss of overall body strength 
- Decreased pulse 
- Loss of balance 
Needle fainting primarily occurs in patients receiving acupuncture treatment for the first time. This reaction is a reflex (caused by vagal excitation and a subsequent drop in blood pressure) .
The vagus nerve controls different systems of the body including the heart, lungs, hormonal (endocrine), and digestive systems, exerting effects on smooth muscles, blood vessels, and sweat glands .
Vagus nerve stimulation affects the nervous system (parasympathetic system) and can lead to voice alteration, cough, difficulty breathing (dyspnea), and diarrhea .
In some circumstances, the stimulation of the vagus nerve can lead to heart problems (bradycardia and arrhythmia). In rare but severe cases, death can occur .
Reduced blood flow to the brain can also lead to loss of balance and consciousness. Caution is needed when delivering acupuncture treatment to older patients. Convulsive loss of consciousness can sometimes occur .
In some cases, reduced blood flow due to chest acupuncture can lead to ineffective pumping by the heart (cardiac tamponade). These effects can also lead to fainting and shock .
In several surveys, fainting (syncope) was the most common adverse effect experienced by patients after acupuncture treatments .
There are some situations and conditions in which acupuncture treatment may be harmful to the individual. These contraindications include:
- Serious spinal disease (cancer or infections) [30, 80]
- Clotting & bleeding disorders (hemophilia & advanced liver disease) 
- Heart conditions (myocardial infarctions, arrhythmias, congenital abnormalities) 
- Warfarin use 
- Severe psychiatric conditions (psychosis) 
- Local skin infections or skin trauma (burns) 
- Low blood pressure conditions (hunger, anxiety, exhaustion) 
Electroacupuncture should be avoided near sites of electrical implanted devices such as pacemakers .
Certain acupoint points should also be avoided during pregnancy [30, 31].
Acupuncture should not be done on an empty stomach. Ideally, consume some food an hour before the treatment.
To avoid adverse effects or unexpected interactions, talk to your doctor before undergoing acupuncture treatment.