Acupuncture for Chronic Pain

Acupuncture is used to treat various types of chronic pain conditions among adults, including headache, migraines, neck pain, lower back pain, and osteoarthritis.

Acupuncture for Chronic Pain — Evidence Rating: Low to Moderate Quality

The overall quality of evidence supporting acupuncture for chronic pain is low to moderate, depending on the condition. Systematic reviews and meta-analyses demonstrate that acupuncture provides modest but clinically meaningful improvements in pain and function compared with usual care or no treatment, with smaller but statistically significant benefits compared with sham acupuncture. Sham acupuncture refers to a comparison control used in clinical trials that can include shallow or non-penetrating needles or regular needling on non-acupuncture point areas. Studies involving sham acupuncture typically demonstrate mild therapeutic effects in the sham group, which can contribute to the apparent lesser improvements observed with real acupuncture. However, variability in trial quality, particularly heterogeneity in comparator groups and condition definitions, limits the quality of the evidence base. The American College of Physicians recommends acupuncture as a nonpharmacologic option for the management of chronic lower back pain. Evidence suggests that, in addition to lower back pain, acupuncture can achieve modest pain improvements for neck pain, osteoarthritis, and headache disorders. Acupuncture is also safe and generally well accepted by patients, making it a viable adjunct in multimodal pain care. For insurance-based acupuncture care, the most frequent conditions submitted between 2010 and 2015 were joint-related conditions (e.g., rheumatoid arthritis, osteoarthritis), back pain, connective tissue disorders, anxiety disorders, and headaches or migraines. Future research on implementing acupuncture care for chronic pain may help scale its utilization further.

Evidence-based Scale

A 2017 clinical guideline from the American College of Physicians recommends acupuncture as a first-line nonpharmacological intervention for the treatment of chronic lower back pain. There is substantial evidence supporting minor and sustained pain improvements from acupuncture among individuals with chronic lower back pain when compared to a placebo. Additional studies demonstrate benefits for several types of chronic pain, including headache, migraine, neck pain, and osteoarthritis. The evidence of efficacy varies by pain site and condition, with the greatest effect observed in neck pain reduction, though this effect was not as long-lasting as those in other pain sites. This evidence is drawn from a meta-analysis of randomized controlled trials that includes over 20,000 adults with chronic pain lasting four or more weeks. It is important to note that there are no disqualifying conditions for the use of acupuncture, even among pregnant individuals, persons with bleeding disorders, or those on anticoagulant therapies.