Does Acupuncture Really Work? A Look at the Effectiveness and Safety
- Zhifei Zeng
- 15 hours ago
- 4 min read
From Ancient Roots to Modern Practice
Acupuncture is a traditional therapeutic technique that involves inserting fine needles into the skin to address various health conditions. Common forms include manual acupuncture and electroacupuncture, which uses low-level electrical stimulation. With origins in Traditional Chinese Medicine, acupuncture has been practiced for over 2,500 years, historically grounded in concepts such as meridians and the flow of qi (vital energy). Since the 1970s, however, it has increasingly been adopted in Western medicine as a form of complementary therapy.
Today, acupuncture is used far beyond its country of origin. The World Health Organization (WHO) first recommended acupuncture for the treatment of 43 conditions in 1979. As of recent reports, 103 out of 129 countries surveyed by the WHO have incorporated acupuncture into their healthcare practices to varying extents. In the United States, the use of acupuncture has more than doubled over the past two decades: in 2002, just 1.0% of adults reported using acupuncture; by 2022, that number had risen to 2.2%.
This growing popularity reflects a broader shift in public interest toward non-pharmacological treatments, especially for managing chronic pain and other long-term conditions. In Western contexts, acupuncture is most commonly used for pain-related conditions, such as chronic back pain, joint pain, and neck pain. Its appeal lies in its relative simplicity, accessibility, and low cost. When performed by trained professionals, acupuncture is generally considered safe, with few adverse effects.
As for its underlying mechanisms, acupuncture remains a topic of ongoing scientific inquiry. Although a complete explanation has yet to be established, existing studies suggest several pathways through which acupuncture may exert its effects:
Neurological modulation: Acupuncture may influence pain perception and other neural functions by activating specific neural pathways in the brain and spinal cord.
Local tissue response: The physical stimulation of connective tissue may trigger localized physiological changes, including increased blood flow and anti-inflammatory responses.
Non-specific (placebo-related) effects: Factors such as patient expectations, the therapeutic setting, and the clinician–patient relationship can all contribute to symptom relief, even when the needles themselves are not the primary driver.
One particularly striking study found that even watching a video of one’s own past acupuncture session, combined with guided imagery, produced measurable pain relief. This suggests that acupuncture's effects likely involve a complex interplay of biological, psychological, and contextual factors, going well beyond the needles alone.
Conditions Where Acupuncture Helps
Numerous studies have shown that acupuncture may play an active role in pain management for a wide range of conditions. In particular, the efficacy of acupuncture in chronic back pain, neck pain, osteoarthritis, headache, and postoperative pain has been extensively explored in systematic evaluations and randomized controlled trials. A systematic analysis of 6,376 patients noted that the effects of acupuncture in the treatment of chronic pain, such as back pain, osteoarthritis, and headaches, lasted up to one year and were superior to conventional treatment with placebos.
For acute pain management, acupuncture has been shown to have significant benefits in postoperative pain control. Not only does it reduce the amount of opioids, but it also reduces side effects such as nausea, sedation, and itching. In the emergency department, acupuncture provides immediate relief of musculoskeletal pain, renal colic, etc., even better than morphine, and is better tolerated and safer. Acupuncture has also been shown to significantly reduce pain intensity and need for medication in common acute pain types such as acute low back pain, primary dysmenorrhea, labor pain, and tension-type headaches.
In the area of chronic pain, acupuncture has demonstrated long-term efficacy in several conditions. For example, patients with chronic low back pain reported significant improvements in pain intensity and dysfunction when treated with acupuncture, and its efficacy has been recognized in numerous systematic evaluations and guidelines. For chronic headaches and migraines, acupuncture is comparable to or even superior to medication in reducing the frequency of attacks and pain intensity in some indicators. For osteoarthritis-induced knee pain, chronic shoulder and neck pain, acupuncture not only reduces pain but also improves quality of life and mobility.
In addition to pain management, acupuncture has shown potential in the adjunctive treatment of other conditions. For example, studies have shown that acupuncture can alleviate nausea and vomiting associated with cancer treatment, seasonal allergy symptoms, and stress urinary incontinence in women; it can also be helpful for problems such as asthma, depression, menopausal hot flashes, and infertility. Although the evidence for some indications is still not strong enough, the continued accumulation of research data is enriching our knowledge of acupuncture's efficacy.
Is Acupuncture Risk-Free?
Acupuncture is generally safe, with relatively few reports of associated complications. However, improper handling or use of unsterilized needles can lead to serious adverse effects, including infection, organ perforation, and central nervous system damage. To ensure safety, the U.S. Food and Drug Administration (FDA) classifies acupuncture needles as medical devices and strictly requires that the needles be sterile and labeled for single-use only.
In clinical practice, any foreign body that enters the body, even if only superficially, carries some risk of bleeding, localized irritation, or infection. Possible complications of acupuncture include infection, disease transmission, tissue damage, nerve damage, and bleeding. In addition, depending on the site of the acupuncture, there is a rare risk of pneumothorax, pneumoperitoneum, or even organ puncture.
Final Thoughts: Balancing Tradition, Evidence, and Patient Choice
Overall, the safety of acupuncture as a traditional treatment has been widely recognized in most clinical practices. Although a few serious complications have been reported, these are mostly related to improper handling or non-standardized needles. Therefore, ensuring the use of sterilized, single-use needles and selecting professionally qualified and experienced acupuncturists are key to ensuring safe treatment and minimizing risks. Patients should also be fully aware of the potential risks and indications of acupuncture before receiving it, and undergo individualized assessment under professional guidance to achieve the best treatment outcome.
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Assessed and Endorsed by the MedReport Medical Review Board