Acupuncture - Evidence 

Evidence for and against acupuncuture 

The placebo effect

Ben Goldacre explains what the placebo effect is and describes its role in medical research and in the pharmaceutical industry.

Media last reviewed: 02/10/2013

Next review due: 02/10/2015

There is some scientific evidence acupuncture has a beneficial effect for a number of health conditions.

However, there is less clear scientific evidence about the benefits of acupuncture in the majority of conditions it is often used for.

The National Institute for Health and Care Excellence (NICE) only recommends considering acupuncture as a treatment option for chronic lower back pain, chronic tension-type headaches and migraine.

Assessing the evidence

One of the best ways researchers can assess the evidence behind a particular treatment is by carrying out a systematic review. This is a "study of studies" that combines findings from separate but similar studies to come up with an overall conclusion.

Systematic reviews are an important part of health research because they can identify findings that might otherwise be missed in individual studies. They can also help distinguish the effects of treatment from the effects of chance.

It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect and not because of the treatment itself. Systematic reviews can help reduce the potential influence of the placebo effect.

While systematic reviews cannot always determine conclusively whether a treatment does or does not work, they can be useful in assessing how a particular treatment (such as acupuncture) compares to another (such as "sham" acupuncture or medication).

However, even this can be challenging – both acupuncture and placebo treatments can stimulate the release of natural painkilling substances called endorphins, which can make it difficult to distinguish between them.

What evidence is there for acupuncture?

One of the largest and most respected organisations that carries out and publishes systematic reviews into the effectiveness of medical treatments is The Cochrane Collaboration.

A number of systematic reviews into the effectiveness of acupuncture have been published by The Cochrane Collaboration, and the basic results are summarised below.

Some positive evidence

Systematic reviews carried out by The Cochrane Collaboration have found there is some evidence acupuncture may have a beneficial effect on the following conditions:

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, the existence of some positive evidence does not mean acupuncture definitely works for these conditions.

In many cases, the evidence appears contradictory. For example, some high-quality studies may suggest acupuncture is no better than "sham" acupuncture, whereas some lower-quality studies may suggest acupuncture is better than an established medical treatment.

The issue is sometimes also further complicated by the fact some "sham interventions" include active needling and are therefore not true placebos.

In addition, it can be difficult to make sure the patients involved in acupuncture studies are unaware of the specific treatment they are receiving (known as "blinding").

This is because it is obvious whether you are receiving a conventional medical treatment such as medication or if you are receiving acupuncture, for example. This is a problem as it means the preconceptions of the person being treated may influence the result.

Some systematic reviews, however, have demonstrated the effects of acupuncture over sham treatment in studies where patients are unaware whether they are having real acupuncture or sham treatment.

For example, one large meta-analysis (a type of systematic review) not carried out by The Cochrane Collaboration included data from more than 17,000 patients. It compared acupuncture to sham acupuncture or no acupuncture without patients being aware of whether they had received real or sham treatment.

This review found acupuncture to be superior to both sham and no treatment for headaches, osteoarthritis, back pain and neck pain. 

Little or no evidence

In many conditions where acupuncture is used, there is not enough good quality evidence to draw any clear conclusions over its relative effectiveness compared with other treatments.

For example, systematic reviews published by The Cochrane Collaboration have suggested more research is needed to assess whether acupuncture is effective for:

More research is needed to establish whether acupuncture is better or worse than best standard treatments for these conditions.

More information and research

If you want to find out more about studies into acupuncture, you can search for high-quality research using the NHS Evidence and Cochrane Library websites.

Page last reviewed: 15/07/2014

Next review due: 15/07/2016

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