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 refers to the insertion of fine needles at specific points (acupuncture points or acupoints) on the body for the prevention or treatment of disease or the maintenance of health. 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).
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.
Acupuncture is often part of a complex intervention that includes use of herbal mixtures, moxibustion (burning of herbs), and dietary and lifestyle advice.
Background and prevalence
The history of acupuncture can be traced to ancient China and its Taoist philosophy (White 1999). It has been practised in China for more than 2000 years and in other East Asian countries, including Japan, Korea and Vietnam, for between 1000 to 2000 years arriving in Europe several hundred years ago (Birch 1999). In traditional Chinese medicine (TCM), the life energy ‘Qi’ flowing through the body in meridians and the balance of ‘yin’ and ‘yang’ are thought to determine human health. Illness is seen as an imbalance of these energies and acupuncture is perceived to be one method for re-balancing the imbalance.
Traditionally, acupuncture was not used primarily for specific problems such as pain control but to treat a wide range of symptoms or problems based on the pattern of diagnosis (Birch 1999). Yet, in recent years, pain-control seems to have become its main purpose in many clinical settings. Most modern pain clinics and many oncology centres across the world routinely offer acupuncture as one of several therapeutic options. In integrative oncology centres across Europe, acupuncture was the therapy most frequently provided by being provided by 55% of 47 centres (Rossi 2015).
Application and providers
Acupuncture is applied to the body surface including the ears and scalp. The dosage (number of points stimulated, depth of needle insertion, duration of stimulation and frequency and duration of treatment sessions) depends on the condition treated. Sometimes only one acupoint is stimulated; more commonly several needles are applied.
A specific area of the body (for example, ear-acupuncture) may be treated but, more commonly, several areas are needled. Needles are usually removed after a 30-minute treatment session but press needles and studs may be left for several days or, in some cases, weeks. Needles may be stimulated by manual manipulation or left unstimulated. Treatments may be repeated at regular intervals, for example once or twice weekly, or treatment can comprise of a single session.
The placement of needles is determined by the condition being treated and, to some extent, by the type of acupuncture being applied. In traditional Chinese or East Asian forms of acupuncture, acupoints are considered to be located along channels or ‘meridians’ through which a vital force or energy (‘Qi’) flows (BAcC 2021).
Diagnosis is carried out using a number of methods including peripheral pulses, the appearance of the tongue, speech, history and overall impressions of the patient. The ‘symptom pattern’ and underlying ‘imbalances’ guide selection of points. In ‘Western medical’ acupuncture, points are selected according to contemporary neurophysiology and are considered to be sites where external stimuli result in a greater sensory stimulus, so-called ‘trigger points’ (Filshie 1999, White 2009).
Alleged indications
According to TCM concepts, acupuncture is a therapy for most symptoms and diseases. Modern Western concepts are centred around conditions likely to be influenced through effects on neurotransmitters, such as musculoskeletal pain and nausea and vomiting (White 2009, Zhao 2008).
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). Neurophysiological theories to explain acupuncture’s modes of action in pain have been developed, e.g. gate-control mechanism, and effects on neurotransmitters like endorphins (Zhao 2008).
Legal issues
In most countries, acupuncture can be administered by both medically-trained and statutorily-regulated health professionals (e.g. doctors, physiotherapists, nurses, midwives) and by non-medically-trained acupuncturists. The regulation of acupuncture varies from one country to another. 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).
Adverse events
In about 8-10% of all patients, acupuncture causes mild, transient adverse effects such as pain, haematoma or bleeding at the site of needling (Coyle 2014, White 1997, Witt 2009). Most commonly reported problems are local pain (3.3%), bruising (3.2%), minor bleeding (1.4%), and orthostatic problems (0.5%) (Melchart 2004). In addition, in rare cases complications due to tissue trauma, pneumothorax, cardiac tamponade or infection are on record (White 2004).
Risk of cross-infection of blood borne disease, particularly hepatitis B, is minimised by the use of sterile disposable needles, and immunisation of acupuncturists. Rare cases of fatalities after acupuncture treatment have been reported although causality was not confirmed in many of these reports (Ernst 2010).
Safety incidents have been assessed that were linked to acupuncture treatments received in a healthcare setting (UK National Health Service) (Wheway 2012). The 325 incidents over a 3 year period included retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), bruising or soreness at needle site (2%), pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm.
A systematic review that specifically assessed adverse effects of non-hormonal pharmacological interventions in breast cancer survivors, suffering from hot flashes included two trials of non-hormonal medication versus acupuncture (Hervik 2016). In the comparison based on these two trials (108 participants), a significant difference was found between the groups in favour of acupuncture, with OR of 1.75, 95 % CI of 01.09–2.75 and I2 of 0 % (P = 0.02).
Contraindications
Professional bodies for acupuncture vary somewhat in defining contraindications, particularly in relation to pregnancy (BAcC 2019, BMAS 2019, Hervic 2016). Bleeding abnormalities and anticoagulant treatment, oedema, epilepsy, pregnancy and needle phobia are among those conditions that have been suggested as relative, or in some cases absolute, contra-indications. Some points are considered ‘forbidden’ or not to be used for acupuncture needling.
Interactions
None known, except for electro-acupuncture where the electrical current might interfere with pacemakers and is used with caution in epilepsy (Filshie 1999).
Warnings
Strict asepsis and use of sterile disposable needles are mandatory to avoid infections. Some patients faint during acupuncture and should thus be treated lying down.
Recommendations from the US National Cancer Institute's Conference on Acupuncture for Symptom Management in Oncology in 2017 indicate that “oncology acupuncture” is a specialty area of practice (Zia 2017). Specific concerns include higher risks of infection and bleeding due to neutropenia and thrombocytopenia and possibility for hemodynamic instability due to dehydration and malnutrition. It was proposed that clinical practice guidelines are followed that take into account lab values such as absolute neutrophil and platelet counts.
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Citation
Karen Pilkington, CAM Cancer Collaboration. Acupuncture. [online document], May 20, 2025
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 December 2024.
The most recent updates 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, all authored by Edzard Ernst. The summary for “chemotherapy-induced nausea and vomiting” was first published in 2005 authored by Vinjar Fønnebø.
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