Evidence regarding the efficacy of acupuncture for chronic pain comes from a meta-analysis of 39 randomized controlled trials including over 20,000 individuals. In summary, findings suggest that there is low to moderate quality evidence suggesting moderate and lasting pain reduction for individuals experiencing chronic lower back pain, osteoarthritis, neck pain, and shoulder pain.

Heterogeneity in trial design, specifically regarding the comparator groups (sham acupuncture versus no treatment), limits generalizability but is taken into account when grading overall evidence quality. Specifically, it is reported that effect sizes are smaller when acupuncture is compared to sham acupuncture versus no acupuncture. This is suggestive that even in sham acupuncture, where needles may not be placed in the same spots or needles do not actually penetrate the skin, there may still be some physiological activation and impact on pain.

Evidence across several study types indicates that the implementation of acupuncture for chronic pain can reduce opioid intake among those who receive acupuncture treatment.

In Rhode Island, a Medicaid demonstration project implemented triage nurses who could refer individuals with high emergency room visit rates and chronic pain to complementary and integrative health services, which included acupuncture. The results from this program showed that total opioid scripts were reduced by 86% in this population, thus acupuncture may be a viable opioid sparing care pathway.

In another study using medical claims data within a population of adults with chronic lower back pain, it was found that acupuncture users were significantly less likely to use opioids relative to non-users. Further studies show that initiation of care with a chiropractor relative to a primary care provider for lower back pain is associated with significantly decreased rates of opioid use, particularly long-term opioid therapy.