What does the research show about acupuncture?

Acupuncture

Pooled data on about 20,800 people with chronic pain found acupuncture eased pain about 0.5 standard deviations more than no acupuncture and 0.2 more than sham needling. For knee osteoarthritis and low back pain, reviewers judged the edge over sham too small to matter clinically. About 9% of patients report minor effects. Serious events occurred about once per 10,000 patients.

Checked 2026-11-13

Status: Most US states license acupuncturists, and licensing requirements vary from state to state. The FDA regulates acupuncture needles as medical devices and requires them to be sterile and labeled for single use only [1].
Also called: acupuncture, electroacupuncture, EA, manual acupuncture, needling, traditional Chinese acupuncture, medical acupuncture, auricular acupuncture, ear acupuncture, acupressure, PC6, P6 wristband
Used for: back pain, neck pain, knee osteoarthritis, arthritis, migraine, headache, tension headache, chronic pain, nausea, morning sickness, vomiting after surgery, quitting smoking, fertility, IVF, insomnia, depression, anxiety, hot flashes, menopause, bladder leakage, constipation, hay fever, allergies, fibroids, period pain, endometriosis pain, PCOS

Strong several reviews agree · Moderate one review or consistent trials · Limited one or a few small studies · Untested no study in people, listed with what it rests on

Shown to help13

StrongShown to ease chronic pain about 0.5 standard deviations more than no acupuncture and about 0.2 more than sham acupuncture, with effects lasting a year.
StrongShown to ease osteoarthritis pain 14.5 points on a 100-point scale more than a waiting list in the short term. One later trial found no gain at 1 year.
ModerateShown to ease chronic low back pain by about 20 points on a 100-point scale against no treatment. Against usual care the pain difference was smaller, about 10 points.
ModerateShown to ease neck pain slightly more than sham acupuncture in the short term, and more than a waiting list. The effect did not appear to last.
ModerateShown to halve migraine frequency in 41% against 17% with no acupuncture. Against sham acupuncture the difference was small, 50% against 41%.
ModerateShown to halve headache frequency more often than routine care, 48% against 19% in the largest trial. Against sham acupuncture the difference was smaller, 51% against 43%.
ModerateShown to cut nausea after surgery by about a third compared with sham, with stimulation of one wrist point. It did not differ from antinausea drugs.
ModerateShown to lower nasal symptom scores in pooled trials. The largest trial found small gains over sham acupuncture that its authors said may not be clinically meaningful.
ModerateShown in low-quality trials to ease period pain more than no treatment or NSAIDs, comparisons in which no one could be blinded.
LimitedLimited evidence: low-quality trials found a small drop in depression scores, 1.69 points on the Hamilton scale, against sham acupuncture, and a moderate drop against no treatment.
LimitedOne trial of 504 women found electroacupuncture cut urine leakage by 9.9 g against 2.6 g with sham after 6 weeks.
LimitedOne trial of 1,075 people found electroacupuncture added about one complete bowel movement a week more than sham, through 12 weeks after treatment.
LimitedLimited evidence: unblinded trials found acupuncture shrank fibroids more than Chinese medicines or mifepristone in women with fibroids. A Cochrane review found no double-blind trials to include.

Reported risks3

ModerateShown in about 9% of patients over a course of acupuncture, most often bleeding, bruising or pain at the needle site.Common
ModerateShown in about 1 per 10,000 patients. Two collapsed lungs were recorded among 229,230 patients.Rare
LimitedCase reports: infections were the most common complication in 294 published acupuncture adverse event cases from 2000 to 2011, mostly bacterial.How often is not known

What it is used for, and what was found

Shown to help13

Strong

Chronic pain across conditions

Shown to ease chronic pain about 0.5 standard deviations more than no acupuncture and about 0.2 more than sham acupuncture, with effects lasting a year.

Compared with sham acupuncture [2][3]; no acupuncture [2][3]

The numbers and sources

Effect: In individual patient data from 39 trials, acupuncture was superior to both sham and no acupuncture for each pain condition (all P < .001). The difference was close to 0.5 standard deviations against no acupuncture and close to 0.2 against sham, and about 15% of the effect was lost at 1 year. Effects were smaller in trials whose sham used a penetrating needle [2]. The earlier analysis of 29 trials found pain scores lower than sham by 0.23 SD for back and neck pain, 0.16 SD for osteoarthritis and 0.15 SD for chronic headache, and lower than no acupuncture by 0.55, 0.57 and 0.42 SD [3].
Population: 20,827 patients with nonspecific musculoskeletal pain, osteoarthritis, chronic headache or shoulder pain in 39 trials [2]. 17,922 patients in 29 trials [3].
Sources: [2], [3]
Caveats: The two analyses come from the same collaboration and the later one contains the earlier trials. Patients and acupuncturists cannot be blinded when the comparison is no acupuncture, so the larger effect includes expectation. The authors say factors beyond needling contribute to the effect [3].

Moderate

Chronic low back pain, compared with no treatment or usual care

Shown to ease chronic low back pain by about 20 points on a 100-point scale against no treatment. Against usual care the pain difference was smaller, about 10 points.

Compared with no treatment [4]; usual care [4]

The numbers and sources

Effect: Against no treatment, pain fell 20.32 points more on a 0 to 100 scale (95% CI -24.50 to -16.14, 4 trials, 366 participants) and back function improved (SMD -0.53, 95% CI -0.73 to -0.34, 5 trials, 2,960 participants), at moderate certainty. Against usual care, pain fell 10.26 points more (95% CI -17.11 to -3.40, 5 trials, 1,054 participants), which the reviewers did not count as clinically important, and function improved (SMD -0.47) [4].
Population: Adults with chronic nonspecific low back pain in 33 trials [4].
Sources: [4]
Caveats: Neither patients nor acupuncturists were blinded in these comparisons, so expectation is part of the effect. The effect was measured right after treatment [4].

Moderate

Neck pain

Shown to ease neck pain slightly more than sham acupuncture in the short term, and more than a waiting list. The effect did not appear to last.

Compared with sham acupuncture [5]; inactive treatment [5]; waiting list [5]

The numbers and sources

Effect: For mechanical neck pain, pooled sham-controlled trials favored acupuncture in the short term (SMD -0.23, P = 0.0006). Acupuncture also eased pain more than inactive treatment, and pain and disability more than a waiting list, at short-term follow-up. The reviewers write that the effect does not seem sustainable over the long term [5].
Population: 27 trials of adults with whiplash, myofascial, arthritic, nonspecific, radicular or mechanical neck pain [5].
Sources: [5]
Caveats: Evidence was rated moderate in quality. Few trials were large, and repeated courses were not studied [5].

Moderate

Migraine prevention

Shown to halve migraine frequency in 41% against 17% with no acupuncture. Against sham acupuncture the difference was small, 50% against 41%.

Compared with no acupuncture or routine care [6]; sham acupuncture [6]; preventive migraine drugs [6]

The numbers and sources

Effect: After treatment, headache frequency at least halved in 41% with acupuncture and 17% with no acupuncture (RR 2.40, 95% CI 2.08 to 2.76, 4 trials, 2,519 participants, number needed to treat 4). Against sham, it halved in 50% and 41% (RR 1.23, 95% CI 1.11 to 1.36, 14 trials, 1,825 participants, number needed to treat 11), and frequency fell slightly more (SMD -0.18). Against preventive drugs, frequency at least halved in 57% and 46% at 3 months (RR 1.24) and in 59% and 54% at 6 months, a difference that was no longer significant [6].
Population: 22 trials with 4,985 adults with episodic migraine, lasting at least 8 weeks [6].
Sources: [6]
Caveats: Evidence was rated moderate. The no-acupuncture and drug comparisons could not be blinded. Only one trial followed people past treatment against no acupuncture [6].

Moderate

Tension-type headache

Shown to halve headache frequency more often than routine care, 48% against 19% in the largest trial. Against sham acupuncture the difference was smaller, 51% against 43%.

Compared with routine care or treatment of acute headaches only [7]; sham acupuncture [7]

The numbers and sources

Effect: In the largest trial against routine care, headache frequency at least halved in 302 of 629 (48%) with acupuncture and 121 of 636 (19%) without (RR 2.5, 95% CI 2.1 to 3.0). Against sham, it halved in 205 of 391 (51%) and 133 of 312 (43%) (RR 1.3, 95% CI 1.09 to 1.5, 4 trials). One of 420 people receiving acupuncture dropped out for adverse effects [7].
Population: 12 trials with 2,349 adults with episodic or chronic tension-type headache [7].
Sources: [7]
Caveats: Evidence was rated moderate. The two trials against routine care were unblinded and differed in baseline headache frequency. Effects beyond 4 months were not studied against routine care [7].

Strong

Knee osteoarthritis, compared with no acupuncture or a waiting list

Shown to ease osteoarthritis pain 14.5 points on a 100-point scale more than a waiting list in the short term. One later trial found no gain at 1 year.

Compared with waiting list [8]; no acupuncture [3][9]

The numbers and sources

Effect: Against a waiting list, pain improved by 14.5 points more on a 100-point scale (SMD -0.96, 95% CI -1.19 to -0.72, 4 trials, 884 participants) and function by 13.0 points (SMD -0.89) [8]. Individual patient data put the difference from no acupuncture at 0.57 SD for osteoarthritis [3]. Against no acupuncture, needle acupuncture lowered knee pain by 1.1 units on a 0 to 10 scale at 12 weeks (95% CI -1.8 to -0.4), and not at 1 year [9].
Population: People with knee or hip osteoarthritis in 4 waiting-list trials [8]. 282 adults aged 50 or older [9].
Sources: [8], [3], [9]
Caveats: None of these comparisons could blind participants, so expectation and attention are part of the effect. The 1-point change at 12 weeks was below that trial's 1.8-unit threshold for clinical importance [9].

Moderate

Nausea and vomiting after surgery

Shown to cut nausea after surgery by about a third compared with sham, with stimulation of one wrist point. It did not differ from antinausea drugs.

Compared with sham treatment [11]; antinausea drugs [11]

The numbers and sources

Effect: Stimulating the PC6 wrist point lowered nausea (RR 0.68, 95% CI 0.60 to 0.77, 40 trials, 4,742 participants), vomiting (RR 0.60, 95% CI 0.51 to 0.71) and the need for rescue drugs (RR 0.64) against sham. It did not differ from six antinausea drugs, including ondansetron and dexamethasone, for nausea (RR 0.91, 95% CI 0.75 to 1.10) or vomiting (RR 0.93). Added to a drug, it lowered vomiting (RR 0.56) and not nausea [11].
Population: 59 trials with 7,667 surgical patients [11].
Sources: [11]
Caveats: The review pooled needles, electrical stimulation, acupressure and wristbands. Heterogeneity was substantial and the sham evidence was rated low in quality [11].

Moderate

Allergic rhinitis

Shown to lower nasal symptom scores in pooled trials. The largest trial found small gains over sham acupuncture that its authors said may not be clinically meaningful.

Compared with control groups the source abstract does not describe [13]; sham acupuncture [14]; rescue antihistamine alone [14]

The numbers and sources

Effect: Across 13 trials, nasal symptom scores fell more with acupuncture than with control (weighted mean difference -4.42, 95% CI -8.42 to -0.43) and medication scores fell too [13]. In 422 people with seasonal allergic rhinitis, 12 sessions improved rhinitis quality of life by 0.5 points more than sham acupuncture and 0.7 points more than antihistamine alone after 8 weeks. The differences were gone by week 16 [14].
Population: 2,365 participants in 13 trials [13]. 422 adults sensitized to birch and grass pollen in Germany [14].
Sources: [13], [14]
Caveats: The meta-analysis abstract does not say what its control groups received [13]. Baseline scores in the largest trial were low [14].

Limited

Depression

Limited evidence: low-quality trials found a small drop in depression scores, 1.69 points on the Hamilton scale, against sham acupuncture, and a moderate drop against no treatment.

Compared with no treatment, waiting list or treatment as usual [16]; sham acupuncture [16]; antidepressant medication [16]

The numbers and sources

Effect: Against no treatment, waiting list or usual care, depression severity fell (SMD -0.66, 95% CI -1.06 to -0.25, 5 trials, 488 participants). Against sham, it fell by 1.69 points on the Hamilton Depression Rating Scale (95% CI -3.33 to -0.05, 14 trials, 841 participants). Against medication, the difference was small (SMD -0.23, 31 trials, 3,127 participants), at very low quality [16].
Population: 64 trials with 7,104 people with depression [16].
Sources: [16]
Caveats: Most trials were at high risk of performance bias, and evidence was rated low to very low in quality [16].

LimitedStudied in women

Stress urinary incontinence, electroacupuncture

One trial of 504 women found electroacupuncture cut urine leakage by 9.9 g against 2.6 g with sham after 6 weeks.

Compared with sham electroacupuncture without skin penetration [19]

The numbers and sources

Effect: At week 6, urine leakage on a 1-hour pad test fell 9.9 g with electroacupuncture and 2.6 g with sham (difference 7.4 g, 95% CI 4.8 to 10.0). Incontinence episodes fell by 1.0 more in weeks 1 to 6 and by 2.1 more in weeks 27 to 30. Treatment-related adverse events occurred in 1.6% and 2.0%, all mild [19].
Population: 504 women with stress urinary incontinence, mean age 55, at 12 hospitals in China [19].
Sources: [19]
Caveats: One trial. The authors call for more research on long-term effects [19].

Limited

Chronic constipation, electroacupuncture

One trial of 1,075 people found electroacupuncture added about one complete bowel movement a week more than sham, through 12 weeks after treatment.

Compared with sham electroacupuncture at non-acupoints [20]

The numbers and sources

Effect: Weekly complete spontaneous bowel movements rose by 1.76 with electroacupuncture and 0.87 with sham over weeks 1 to 8 (difference 0.90, 95% CI 0.74 to 1.10), and by 1.96 and 0.89 over weeks 9 to 20. Three or more a week were reached by 31.3% and 12.1% during treatment [20].
Population: 1,075 people with chronic severe functional constipation at 15 hospitals in China [20].
Sources: [20]
Caveats: Acupuncturists could not be blinded and longer-term follow-up was not assessed [20].
Why limited: This rests on one trial, of 1,075 people. Strength counts independent studies that agree, so one trial is limited at any size.

LimitedStudied in women

Uterine fibroids

Limited evidence: unblinded trials found acupuncture shrank fibroids more than Chinese medicines or mifepristone in women with fibroids. A Cochrane review found no double-blind trials to include.

Compared with traditional Chinese medicine, and mifepristone in one trial [25]; Chinese herbal medicine alone, with acupuncture added to it [26]

The numbers and sources

Effect: Across 11 randomized trials (735 women), acupuncture reduced fibroid volume (MD -3.89, 95% CI -5.23 to -2.56) and uterine volume (MD -16.22, 95% CI -19.89 to -12.55) and lowered fibroid symptom scores (MD -3.03, 95% CI -3.45 to -2.60) more than the comparison treatments. Estrogen levels did not differ, and no serious adverse reactions were reported [25]. Across 9 randomized trials (640 women), acupuncture added to Chinese herbs raised the overall response rate (RR 1.20, 95% CI 1.12 to 1.30) and reduced fibroid size (SMD -0.82, 95% CI -1.36 to -0.27, I² 90%) more than herbs alone [26]. A Cochrane review searching to May 2009 found no randomized double-blind trials that met its criteria [27].
Population: 735 women with fibroids, mean age 34 to 48, in 11 trials, most treated for 3 months [25]; 640 women with fibroids in 9 trials [26].
Sources: [25], [26], [27]
Caveats: Every trial in [25] compared acupuncture with medicines taken by mouth, so no one was blinded and none used sham acupuncture, and heterogeneity was high. The authors of [26] call the trials few and of limited quality. Neither review abstract reports measured menstrual blood loss.

ModerateStudied in women

Period pain, compared with no treatment or NSAIDs

Shown in low-quality trials to ease period pain more than no treatment or NSAIDs, comparisons in which no one could be blinded.

Compared with no treatment [28][29]; NSAIDs [28][29]

The numbers and sources

Effect: Against NSAIDs, more women had pain relief with acupuncture (OR 4.99, 95% CI 2.82 to 8.82, 4 RCTs, 352 women), and adverse events were less common (OR 0.10, 95% CI 0.02 to 0.44, 4 RCTs, 239 women). Against no treatment, pain scores were lower with acupuncture in all 6 trials that reported them [28]. At 3 cycles after treatment, pain on a visual analogue scale was 47.80 points lower than with no intervention and 29.89 points lower than with NSAIDs [29].
Population: Women with primary dysmenorrhea in 42 RCTs [28]; 14 RCTs with 970 women [29].
Sources: [28], [29]
Caveats: Evidence was low quality, and 7 trials against NSAIDs were too heterogeneous to pool (I² 94%) [28]. The later review rated the evidence low certainty with high risk of bias [29]. Against sham, no difference was found (see above).

Mixed results5

Moderate

Chronic low back pain, compared with sham acupuncture

Mixed results: pain eased slightly more than with sham acupuncture right after treatment, a difference below the clinically important threshold, and back function did not differ.

Compared with sham acupuncture [4]

The numbers and sources

Effect: Against sham, acupuncture lowered pain by 9.22 points on a 0 to 100 scale in the immediate term (95% CI -13.82 to -4.61, 7 trials, 1,403 participants), short of the 15-point threshold the reviewers set as clinically important. Back-specific function did not differ from sham (SMD -0.16, 95% CI -0.38 to 0.06, 5 trials, 1,481 participants), and short-term quality of life did not differ by a clinically meaningful amount (SMD 0.24) [4].
Population: 33 trials with 8,270 adults with chronic nonspecific low back pain, two thirds of them in 7 German trials [4].
Sources: [4]
Caveats: Certainty was rated low to very low for these comparisons, mostly because acupuncturists could not be blinded [4].

Strong

Knee osteoarthritis, compared with sham acupuncture

Mixed results: pooled trials found a small edge over sham acupuncture that reviewers judged below clinical relevance, and a 282-person trial found no difference from sham.

Compared with sham acupuncture [3][8][9][10]; sham laser [9]

The numbers and sources

Effect: Against sham, pain improved by 0.9 points more on a 20-point scale (SMD -0.28, 95% CI -0.45 to -0.11, 9 trials, 1,835 participants), below the reviewers' 1.3-point threshold for clinical relevance. With the shams most likely to blind participants, the benefit was smaller and not significant, and at 6 months it was borderline (SMD -0.10) [8]. Individual patient data put the edge over sham at 0.16 SD for osteoarthritis [3]. In people over 50 with chronic knee pain, needle acupuncture did not differ from sham for pain (-0.4 units on a 0 to 10 scale, 95% CI -1.2 to 0.4) or function at 12 weeks [9]. In a 480-person trial, 60.3% responded to electroacupuncture, 58.6% to manual acupuncture and 47.3% to sham at 8 weeks. Electroacupuncture differed from sham (P = 0.0234) and manual acupuncture narrowly did not (P = 0.0507) [10].
Population: 16 trials with 3,498 people with knee or hip osteoarthritis [8]. 282 adults aged 50 or older in Australia [9]. 480 adults in China [10].
Sources: [8], [3], [9], [10]
Caveats: Heterogeneity was substantial across sham-controlled trials [8]. The trials used different shams, from non-penetrating needles to inactive lasers.

ModerateStudied in women

Hot flashes in menopause

Mixed results: hot flash frequency did not differ from sham acupuncture, fell compared with no treatment, and was higher than with hormone therapy.

Compared with sham acupuncture [15]; waiting list or no intervention [15]; hormone therapy [15]; relaxation [15]

The numbers and sources

Effect: Against sham, hot flash frequency did not differ (-1.13 flushes a day, 95% CI -2.55 to 0.29, 8 trials, 414 women) and severity was slightly lower (SMD -0.45, 95% CI -0.84 to -0.05), a difference that disappeared once trials in women with breast cancer were removed. Against no treatment, frequency fell (SMD -0.50, 95% CI -0.69 to -0.31, 3 trials, 463 women). Women on hormone therapy had 3.18 fewer flushes a day than women given acupuncture [15].
Population: 16 trials with 1,155 perimenopausal or postmenopausal women [15].
Sources: [15]
Caveats: Evidence was low or very low in quality, and adverse effect data were lacking [15].

Limited

Insomnia

Limited evidence: small, biased trials found more people sleeping better with acupressure or added acupuncture, and the effect became uncertain when dropouts were counted as failures.

Compared with no treatment [17]; sham or placebo [17]; other treatment alone [17]

The numbers and sources

Effect: Acupressure improved sleep quality in more people than no treatment (OR 13.08, 95% CI 1.79 to 95.59, 2 trials) or sham (OR 6.62, 95% CI 1.78 to 24.55, 2 trials). Acupuncture added to other treatment raised the share with better sleep (OR 3.08, 95% CI 1.93 to 4.90, 13 trials, 883 participants), with needle acupuncture and not electroacupuncture showing a benefit. When dropouts were assumed to do worse, the benefit was inconclusive [17].
Population: 33 trials with 2,293 people aged 15 to 98 with insomnia [17].
Sources: [17]
Caveats: All trials were at high risk of bias, and publication bias was likely. The reviewers wrote that the evidence could neither support nor refute acupuncture for insomnia [17].

ModerateStudied in women

Endometriosis pain

Mixed results: reviews of mostly unblinded trials found less endometriosis pain with acupuncture, while a sham-controlled trial found period pain eased during treatment but not 12 weeks later.

Compared with placebo, traditional Chinese medicine and Western medicine [30]; medications and herbs, and placebo in one pilot trial [31]; sham acupuncture [32]; a comparison the source abstract does not describe [33]

The numbers and sources

Effect: Across 14 studies (793 patients), pain severity fell more with acupuncture than with control treatments (SMD -1.10, 95% CI -1.45 to -0.75) [30]. Across 10 studies, pain fell 1.36 points more on a 0 to 10 scale (95% CI 1.01 to 1.72) [31]. In a sham-controlled trial of 12 weeks of treatment, period pain fell more with acupuncture by the end of treatment but not by week 24, pain lasted fewer days, and pelvic pain outside periods and pain with sex did not differ. Adverse events did not differ [32]. A Cochrane review found one trial (67 women) meeting its criteria, with lower period pain scores in the acupuncture group (MD -4.81 points) [33].
Population: 793 patients in 14 studies [30]; 10 studies of 8 to 36 patients per arm [31]; 106 women aged 20 to 40 with endometriosis pain at 4 hospitals in China [32]; 67 women [33].
Sources: [30], [31], [32], [33]
Caveats: Only one pilot trial in [31] used a placebo control, and the rest could not be blinded. The authors of [30] point to design and quality flaws in the trials.

Not shown to help4

Moderate

Quitting smoking

Not shown to raise long-term quitting. Quit rates were slightly higher than with sham acupuncture in the short term, and lower than with nicotine replacement.

Compared with sham acupuncture [12]; waiting list [12]; nicotine replacement therapy [12]; psychological interventions [12]

The numbers and sources

Effect: Against sham, acupuncture raised short-term abstinence (RR 1.22, 95% CI 1.08 to 1.38) and not long-term abstinence (RR 1.10, 95% CI 0.86 to 1.40). Against a waiting list, long-term abstinence did not differ significantly (RR 1.79, 95% CI 0.98 to 3.28, 3 trials). Abstinence was lower with acupuncture than with nicotine replacement, and did not differ from psychological interventions. Electrostimulation did not differ from sham electrostimulation [12].
Population: 38 studies of adult smokers [12].
Sources: [12]
Caveats: Funnel plot asymmetry suggested that larger studies found smaller effects [12].

LimitedStudied in women

Live birth after IVF

One trial of 848 women found live births did not differ between acupuncture and sham acupuncture during IVF, 18.3% against 17.8%.

Compared with sham acupuncture with a non-penetrating needle [18]

The numbers and sources

Effect: Live births occurred in 74 of 405 women given acupuncture (18.3%) and 72 of 404 given sham (17.8%) (risk difference 0.5%, 95% CI -4.9% to 5.8%, relative risk 1.02) [18].
Population: 848 women having a fresh IVF cycle at 16 centers in Australia and New Zealand [18].
Sources: [18]
Caveats: One trial, with treatment only during ovarian stimulation and around embryo transfer. No no-treatment group was included.

ModerateStudied in women

Period pain, compared with sham acupuncture

Not shown to ease period pain more than sham acupuncture in women with primary dysmenorrhea. The one trial at low risk of bias found no difference.

Compared with sham or placebo acupuncture [28][29]

The numbers and sources

Effect: Against sham or placebo, findings across 6 trials were inconsistent, and the only trial at low risk of bias in every domain found no difference at 3, 6 or 12 months [28]. A 2025 review of 14 trials found acupuncture did not ease pain more than sham at 3 cycles after treatment [29].
Population: 42 RCTs with 4,640 women with moderate to severe primary dysmenorrhea, 6 of them sham-controlled [28]; 14 RCTs with 970 women [29].
Sources: [28], [29]
Caveats: The Cochrane authors rated the evidence low quality, from risk of bias, poor reporting, inconsistency and possible publication bias. No sham-controlled trial reported adverse events [28].

ModerateStudied in women

Ovulation and pregnancy in PCOS

Not shown to raise live births, ovulation or pregnancy over sham acupuncture in women with PCOS. Side effects were slightly more common with true acupuncture.

Compared with sham acupuncture [34]; relaxation, clomiphene, physical exercise or no intervention, and the pill Diane-35 [34]

The numbers and sources

Effect: Against sham, live birth (RR 0.97, 95% CI 0.76 to 1.24, 1 RCT, 926 women), ovulation (SMD 0.02, 95% CI -0.15 to 0.19, 2 RCTs, 1,010 women), clinical pregnancy (RR 1.03, 95% CI 0.82 to 1.29, 3 RCTs, 1,117 women) and miscarriage did not clearly differ. Days between periods may have fallen (1 RCT, 141 women). Adverse events were more common with true acupuncture (RR 1.16, 95% CI 1.02 to 1.31, 3 RCTs, 1,230 women, moderate quality) [34].
Population: 1,546 women with PCOS and infrequent or absent ovulation in 8 RCTs [34].
Sources: [34]
Caveats: Evidence ranged from very low to moderate quality, and 7 of 8 trials had a high risk of bias in at least one domain. Other comparisons did not report live birth [34].

Protocols studied

Trials in the chronic pain analyses gave needle acupuncture against sham or no acupuncture over courses of weeks [2]. Migraine and headache trials ran at least 8 weeks after randomization [6][7]. The knee trials used 12 weeks of treatment by family physician acupuncturists [9] and electroacupuncture or manual acupuncture 3 times a week for 8 weeks [10]. The allergic rhinitis trial gave 12 treatments over 8 weeks [14]. The incontinence trial gave 18 sessions of electroacupuncture over 6 weeks [19], and the constipation trial 28 sessions over 8 weeks [20]. The IVF trial gave one treatment on day 6 to 8 of follicle stimulation and two around embryo transfer [18]. Nausea trials stimulated the PC6 point on the inner wrist with needles, electrical stimulation, acupressure or wristbands [11].

Sham acupuncture in these trials took several forms: needles placed at non-acupoints, shallow needling, non-penetrating retractable needles, and inactive lasers [2][9][18]. In the chronic pain data, effects against sham were smaller when the sham needle penetrated the skin [2].

Risks

Reported risks3

ModerateCommon

Bleeding, bruising and pain at the needle site

Shown in about 9% of patients over a course of acupuncture, most often bleeding, bruising or pain at the needle site.

The numbers and sources

How common: Common: between 1 in 100 and 1 in 10 people.
Effect: Across prospective studies, at least one adverse event occurred in 9.31% of patients (95% CI 5.10% to 14.62%) over a course of treatment, and half were bleeding, pain or flare at the needle site [21]. Among 229,230 patients, 8.6% reported at least one adverse effect and 2.2% one needing treatment. Bleeding or hematoma affected 6.1%, pain 1.7% and dizziness, fainting or other vegetative symptoms 0.7% [22]. In sham-controlled migraine trials, the share reporting adverse effects did not differ between acupuncture and sham (OR 1.15) [6].
Population: 21 prospective studies [21]. 229,230 German patients receiving an average of 10 treatments from physicians [22].
Sources: [21], [22], [6]
Caveats: Definitions varied widely between studies. The reviewers note that some needle-site reactions are considered part of treatment [21].

ModerateRare

Serious adverse events, including collapsed lung

Shown in about 1 per 10,000 patients. Two collapsed lungs were recorded among 229,230 patients.

The numbers and sources

How common: Rare: fewer than 1 in 1,000 people.
Effect: Serious adverse events occurred in 1.01 per 10,000 patients (95% CI 0.23 to 2.33) and 7.98 per million treatments [21]. Among 229,230 patients, 2 had a pneumothorax, one treated in hospital, and the longest-lasting side effect was a nerve injury of the leg lasting 180 days [22]. An overview of 17 systematic reviews grouped reported serious events into organ or tissue injuries, with a median of 4 deaths per review, and infections [23].
Population: 21 prospective studies [21]. 229,230 patients [22]. 17 systematic reviews of adverse events [23].
Sources: [21], [22], [23]
Caveats: The overview rated the quality of the reviews as mediocre, and case counts in reviews give no rate [23].

LimitedHow often is not known

Infections

Case reports: infections were the most common complication in 294 published acupuncture adverse event cases from 2000 to 2011, mostly bacterial.

The numbers and sources

How common: How often is not known: the sources give no rate.
Effect: From 2000 to 2011, 117 reports described 294 adverse event cases after acupuncture in 25 countries and regions. Infections, mostly mycobacterial and staphylococcal, were the main complication. An earlier review by the same team had found hepatitis from reusable needles, and none was found in this period [24]. NCCIH notes complications from nonsterile needles and improper delivery, including infections, punctured organs and nervous system injury [1].
Population: 294 published cases [24].
Sources: [24], [1]
Caveats: Case reports give no rate. Only English-language reports were included [24].

Claims tested and not found

That acupuncture raises live birth rates in IVF. In 848 women, live births were 18.3% with acupuncture and 17.8% with sham [18].
That needle acupuncture eases chronic knee pain beyond sham in people over 50. Pain and function did not differ from sham at 12 weeks in 282 adults [9].
That acupuncture helps people stay off cigarettes. Long-term abstinence did not differ from sham (RR 1.10, 95% CI 0.86 to 1.40) [12].
That acupuncture reduces how often hot flashes occur, beyond sham. Frequency did not differ from sham in 8 trials of 414 women [15].

Sources

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