Medical Acupuncture: What Does the Evidence Actually Tell Us?

Medical acupuncture has become increasingly common within musculoskeletal and sports therapy.

But what exactly is it, and what can someone realistically expect from it?

The first thing to understand is that acupuncture isn't a single, standardised treatment.

Different practitioners may use different techniques, points, treatment durations and approaches. "Medical acupuncture" is often used to describe acupuncture delivered within a Western healthcare setting, sometimes alongside other rehabilitation techniques.

How might acupuncture help?

The precise mechanisms are still being researched.

Needling may influence local tissues and the nervous system, and research suggests that acupuncture can affect pain-processing mechanisms.

However, it is important not to oversell the treatment.

Acupuncture isn't a magic solution for every injury or pain condition.

Its potential usefulness depends on the condition being treated, the individual and what other treatment is being provided.

What does NICE say?

NICE's guidance on chronic primary pain recommends that a single course of acupuncture or dry needling may be considered in appropriate circumstances. The recommendation is specifically for chronic primary pain and includes conditions such as chronic primary musculoskeletal pain. 

NICE's evidence review found that a number of studies reported reductions in pain and improvements in quality of life in the short term, although the evidence for longer-term benefits was insufficient. 

That's an important distinction.

The evidence doesn't mean:

"Acupuncture cures chronic pain."

It means there is evidence that it may provide a useful short-term reduction in pain for some people.

What about back pain?

The evidence is evolving.

The World Health Organization's 2023 guideline on chronic primary low back pain states that needling therapies, including acupuncture and other forms of dry needling, may be offered to adults, including older adults, with chronic primary low back pain.

However, the recommendation is conditional and the certainty of evidence is low. 

This is a good example of how evidence-based healthcare should be communicated.

A treatment can be reasonable to consider without being presented as universally effective.

Acupuncture should not replace rehabilitation

For someone who wants to return to hiking, running, cycling or adventure challenges, reducing pain is only one part of the process.

You also need to rebuild:

• Strength

• Mobility

• Balance

• Cardiovascular fitness

• Confidence

• Load tolerance

• Activity-specific capacity

Acupuncture may potentially be one tool within that process.

It shouldn't necessarily be the entire process.

What about osteoarthritis?

This is where guidelines are particularly useful.

NICE specifically recommends against offering acupuncture or dry needling to manage osteoarthritis. NICE instead identifies therapeutic exercise and, where appropriate, weight management as core treatments. 

So the message isn't simply "acupuncture works" or "acupuncture doesn't work".

The better question is:

What condition are we treating, what does the evidence show, and where does acupuncture fit within the overall rehabilitation plan?

That's the approach we should take with every treatment.

References

1. National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment and management of chronic primary pain (NG193). 2021. NICE NG193

2. NICE. Rationale and impact: Acupuncture for chronic primary pain. 

3. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. 2023. WHO low back pain guideline

4. WHO/NCBI Bookshelf. Evidence and recommendations — needling therapies. 

5. NICE. Osteoarthritis in over 16s: diagnosis and management (NG226).