Acupuncture for Chronic Pain

Acupuncture involves the placement of small needles into the skin at strategic points throughout the body. The duration, intensity, and frequency of treatment are typically guided by the pain site and its quality.

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

In most contexts, acupuncture treatment consists of a practitioner inserting thin, short, and solid needles into the body in different areas determined by the provider, referred to as “acupuncture points.” Quick insertion of the needles to break the skin can help minimize discomfort. Individuals report a minor radiating numbness at the site of the needles, while some practitioners may manually manipulate (twisting or pistoning) needles to gain such a response if not initially reported. Needles usually remain in place for 10-20 minutes before being removed. Typically, acupuncture for chronic pain treatment regimens may involve 8-15 treatments over 10-12 weeks coupled with recommendations for self-care, exercise, and lifestyle changes. However, treatment courses can vary significantly, from a single session to several weeks or months, depending on the individualized treatment. Acupuncture visits sometimes exceed an hour to accommodate examination, multi-modal treatment, and discussion.

Auricular acupuncture is a type of acupuncture that focuses specifically on needle insertion into the ear. Protocols for auricular acupuncture have been developed for the treatment of chronic pain and involve slightly different equipment. Auricular needles are smaller than typical acupuncture needles and can be retained in the ear for several days before removal.

Acupressure is a variation of acupuncture that does not require needles to penetrate the skin. Rather, acupressure involves applying pressure to acupoints with fingers, hands, or other tools, such as beads.