Description
Acupuncture involves the insertion of very thin needles into specific points on the skin. According to Traditional Chinese Medicine philosophy, acupuncture balances the flow of energy, or "qi", through pathways in the body. Western medical acupuncture is based on neurophysiological concepts; acupuncture points are needled to stimulate nerves, muscles and connective tissue thus influencing various bodily functions.
Efficacy
Breathlessness
- Four RCTs found no clear effect of acupuncture on breathlessness. One trial suggested it might reduce morphine needs and anxiety, but confirmation is needed.
Chemotherapy-associated nausea and vomiting
- Stimulation of Acupoints: Reviews indicate that acupoint stimulation (mainly P6) can reduce nausea/vomiting with standard antiemetics, but limitations in study designs prevent firm conclusions. RCTs show mixed results, especially against sham treatments.
- Moxibustion: Two systematic reviews report mixed results.
- Children: Few studies exist, and findings are conflicting or insufficient.
Pain
- Acupuncture: No firm conclusions on effectiveness for cancer pain. Newer systematic reviews are more positive but included trials have methodological limitations and are at risk of bias.
- Acupressure: Mixed results from three trials, with limited evidence for self-acupressure in managing pain short-term. Recent trials in Chinese are unclear or at high risk of bias.
Fatigue
- Acupuncture/Acupressure: Evidence is contradictory or methodologically weak, preventing firm conclusions. Differences between true acupuncture and sham are less convincing than between acupuncture and usual care.
- Transcutaneous electrical acupoint stimulation, moxibustion: only very preliminary evidence.
Hot flushes
- Severity and Frequency: A Cochrane review found no difference in frequency but a small effect on severity, with very low-quality evidence. Subsequent reviews are conflicting due to difference in intervention and risk of bias.
- Prostate Cancer: Insufficient evidence from one small RCT.
Treatment-induced leukopenia
- Limited evidence for acupuncture. Reviews and trials, mostly in Chinese, are of low quality.
- Moxibustion: Two systematic reviews, including a Cochrane review, found small trials with positive effects but high risk of bias.
- Acupuncture and moxibustion: A systematic review of 17 studies found no conclusive evidence of effectiveness.
Safety
Mild adverse effects, e.g. pain or bleeding at the site of acupuncture can be expected in about 10% of all cases, and serious complications, such as pneumothorax and hepatitis, seem to be very rare.
Description
Acupuncture is a therapeutic modality originating from traditional Chinese medicine, involving the insertion of fine, sterile needles into specific points on the body, known as acupoints. The term ‘acupuncture’ is derived from Latin and means ‘piercing with a sharp instrument’ from acus, ‘needle’ (noun), and pungere, ‘to prick or puncture’ (verb). (BAcC 2025; NCCIH 2025)
Acupuncture is often part of a complex intervention that includes use of herbal mixtures, moxibustion (burning of herbs), and dietary and lifestyle advice.
Background
The origins of acupuncture trace back over 2,000 years in China. Acupuncture is based on the concept of Qi (vital energy) and its flow through meridians in the body. Disease is believed to result from imbalances or blockages in this flow and acupuncture is claimed to restore balance and promote healing. (BAcC 2025; Birch 1999)
Since the 1970s, acupuncture has become increasingly popular in Western medical practice, particularly in pain management and palliative care. (NCCIH 2025)
Application and providers
Acupuncture is usually performed with fine, solid needles but many variations exist. ‘Acupoints’ might, for instance, be stimulated by electrical currents with or without needles (electro-acupuncture), by pressure (acupressure involving use of ‘press’ needles, studs or manual pressure), by heat (moxibustion) or laser light (laser-acupuncture). Techniques that do not involve the insertion of needles are not always classed as acupuncture. (BAcC 2025; Filshie 1999, White 2009).
Treatment typically involves individualized protocols tailored to the patient’s needs. Sessions usually last between 20–60 minutes and may be offered weekly or biweekly during or following active cancer treatment. (BAcC 2025; BMAS)
Providers include licensed acupuncturists, physicians with acupuncture certification, and sometimes nurses or physiotherapists with specialized training (see legal issues below).
Alleged indications
According to TCM concepts, acupuncture is a therapy for most symptoms and diseases.
In oncology, acupuncture is used as a supportive therapy aimed at managing symptoms and adverse effects associated with cancer and its conventional treatments. These include chemotherapy-induced nausea and vomiting, pain, cancer-related fatigue, and hot flashes.
The American Society of Clinical Oncology (ASCO) and other professional bodies acknowledge the use of acupuncture for certain symptoms, particularly CINV and pain, based on moderate-quality evidence. (Garcia 2013; Greenlee 2017).
Mechanisms of action
Considerable research effort has been focused on finding physiological or histological evidence of the existence of concepts postulated within TCM acupuncture such as Qi, meridians and specific acupuncture points but conclusive proof has not been obtained (Ahn 2008).
From a biomedical perspective, proposed effects include stimulation of endogenous opioids (e.g., endorphins), modulation of neurotransmitters such as serotonin and dopamine, and regulation of the hypothalamic-pituitary-adrenal (HPA) axis. Neuroimaging studies have shown that acupuncture can alter brain activity associated with pain and emotion regulation. Additionally, acupuncture may modulate immune function and inflammatory pathways (Zhou 2020; Zhao 2008).
Legal issues
The regulation of acupuncture varies significantly by country and region. In many European countries, medical acupuncture must be practiced by licensed physicians and other statutorily-regulated health professionals (e.g. physiotherapists, nurses, midwives). In other countries such as the UK, acupuncture is largely unregulated but practitioners are often registered with voluntary bodies. (WHO 2010; BAcC 2025).
Information on the regulation of acupuncture in European countries can be found on websites such as that of the European Traditional Chinese Medicine Association (ETCMA 2025).
Regulatory frameworks aim to ensure safety and competency, particularly when used alongside oncology treatments. (WHO 2010).
Acupuncture is generally considered safe when performed by trained professionals according to established safety guidelines using sterile needles. Most side effects are mild and transient and serious adverse events are rare. (Bäumler 2021; Xu 2103; Chan 2017; Huang 2024)
Adverse Events
Common mild AEs:
- Bruising, bleeding, soreness at needle sites
- Dizziness or fainting (vasovagal response)
- Temporary fatigue or drowsiness
These occur in about 10% of treatments and usually resolve quickly. (Bäumler 2021; Xu 2103; Chan 2017; Huang 2024)
Rare but serious AEs:
- Infection: if non-sterile needles are used; failure to maintain aseptic technique can result in localized or systemic infections, including hepatitis and endocarditis.
- Pneumothorax: collapsed lung, typically due to poor technique around the chest
- Nerve injury, organ puncture
- Seizures: very rare; usually in those with a seizure history
- Allergic reactions to needle coatings or topical substances
Serious AE rate are rare and frequently associated with poor hygiene or technique (Chan 2017; Huang 2024; Bäumler 2021; Xu 2103).
Contraindications
Acupuncture is generally contraindicated in the following situations (drugs.com; Kwon 2018; NCCIH 2025):
- Patients with bleeding disorders: e.g., haemophilia
- Pregnancy: Certain acupuncture points are contraindicated as their stimulation may induce labour.
- Pacemakers: Electroacupuncture should be avoided as electrical currents can interfere with device function.
- Severe psychiatric disorders: Risk of unpredictable responses.
- Epilepsy: Heightened risk of seizure under certain stimuli.
Interactions
- Anticoagulants: Increased bleeding risk, e.g., warfarin, heparin. (Kwon 2018; drugs.com; NCCIH 2025.
Warnings
- Syncope risk: Patients with a history of syncope or needle sensitivity should be treated in a supine position to minimize injury risk from falls.
Oncology-specific considerations:
As outlined by the U.S. National Cancer Institute, "oncology acupuncture" is considered a specialty practice requiring specific clinical caution (Zia, 2017):
- Immunocompromised state (e.g., neutropenia) increases infection risk
- Thrombocytopenia raises the risk of bruising and haemorrhage.
- Patients with dehydration, cachexia, or malnutrition may be at higher risk for hemodynamic instability (e.g., hypotension or orthostasis).
Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008 29(4):245-56.
BAcC, British Acupuncture Council. About Acupuncture - BAcC, accessed 28th May 2025.
Bäumler P, Zhang W, Stübinger T, Irnich D. Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies. BMJ Open. 2021 Sep 6;11(9):e045961. doi: 10.1136/bmjopen-2020-045961. PMID: 34489268; PMCID: PMC8422480.
Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 11-30.
Chan MWC, Wu XY, Wu JCY, Wong SYS, Chung VCH. Safety of Acupuncture: Overview of Systematic Reviews. Sci Rep. 2017 Jun 13;7(1):3369. doi: 10.1038/s41598-017-03272-0.
Drugs.com. Acupuncture. [website], accessed 28th May 2025
Filshie, J., Cummings, M. Western medical acupuncture. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 31-59.
Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, et al. Systematic review of acupuncture in cancer care: A synthesis of the evidence. J Clin Oncol. 2013;31(7):952–60.
Greenlee H, DuPont-Reyes MJ, Balneaves LG, Carlson LE, Cohen MR, Deng G, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2017;2017(52).
Huang CC, Kotha P, Tu CH, Huang MC, Chen YH, Lin JG. Acupuncture: A Review of the Safety and Adverse Events and the Strategy of Potential Risk Prevention. Am J Chin Med. 2024;52(6):1555-1587. doi: 10.1142/S0192415X24500617.
Kwon S, Jung WS, Yang S, Jin C, Cho SY, Park SU, Moon SK, Park JM, Ko CN, Cho KH, Park MJ. Safety of Acupuncture in Patients Taking Newer Oral Anticoagulants: A Retrospective Chart Review Study. Evid Based Complement Alternat Med. 2018 Oct 10;2018:8042198. doi: 10.1155/2018/8042198. PMID: 30405744; PMCID: PMC6199863.
Lu W, Lu Y. Acupuncture for cancer pain and related symptoms. Curr Pain Headache Rep. 2013;17(3):321.
NCCIH; National Institute of Complementary and Integrative Health. Acupuncture: Effectiveness and Safety | NCCIH, [website], accessed 28th May 2025.
White A, Ernst E. Introduction. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp1-10.
WHO, World Health Organization. Benchmarks for training in traditional / complementary and alternative medicine: Benchmarks for training in acupuncture. Geneva: World Health Organization; 2010.
Xu S, Wang L, Cooper E, Zhang M, Manheimer E, Berman B, Shen X, Lao L. Adverse events of acupuncture: a systematic review of case reports. Evid Based Complement Alternat Med. 2013;2013:581203. doi: 10.1155/2013/581203.
Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008; 84(4):355-375.
Zhou W, Benharash P. Significance of acupoint selection: Exploring mechanisms of acupuncture analgesia. Pain Manag. 2020;10(4):211–20.
Zia FZ, Olaku O, Bao T, et al. The National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology: State of the Science, Evidence, and Research Gaps. J Natl Cancer Inst Monogr. 2017;2017(52).
Document history
The current summary on “Acupuncture” is based on six previously separate CAM Cancer summaries. The original summaries on different symptoms related to cancer or cancer treatment were merged into one summary in May 2025.
The “Is it safe” information was updated in May 2025. The most recent updates of the “Does it work” sections were performed in 2021 by Karen Pilkington: Pain (September), Fatigue (July), Hot flushes (June), Leukopenia (February), Nausea and vomiting (January).
Between 2015 and 2021 all summaries were regularly updated by Karen Pilkington.
The original summaries for “breathlessness”, “fatigue”, “hot flushes” and “leukopenia” were originally published in 2013, and the summary for “pain” in 2011, authored by Edzard Ernst. The summary for “chemotherapy-induced nausea and vomiting” was first published in 2005 authored by Vinjar Fønnebø.
Photo: Mostphotos.com
