Health Care Professional Information

Clinical Summary

Acupuncture, an important component of Traditional Chinese Medicine (TCM), originated more than 2,000 years ago. Treatment involves stimulation of one or more predetermined points on the body with needles, heat (moxibustion), pressure (acupressure), or electricity for therapeutic effect.

Acupuncture is beneficial for osteoarthritis of the knee (1) (2) (3), chronic mechanical neck pain (4), Bell palsy (72), and symptoms associated with fibromyalgia (5). It was also superior to physical therapy (6) in treating patients with low back pain compared with usual care (7) (8) and was cost effective (9). Acupuncture also reduced high blood pressure (10)and the severity of hot flashes in postmenopausal women (11) . Acupuncture is as effective as counseling in reducing symptoms of depression (77), but had mixed results for treating major depressive disorder (12) (13). In addition, studies show benefits of acupuncture for peripheral neuropathy (14), including that associated with diabetes (15), AIDS (16) (17), and chemotherapy (18) (19). It also reduced the risk of stroke in patients with traumatic brain injury (78). Data from clinical trials support use of acupuncture for chronic headache (20) (21) (22), but there was no difference between true and sham acupuncture. However, the treatments were more effective compared with a no acupuncture control (23). Conclusions from a meta-analysis show that acupuncture is an effective treatment for chronic pain (67).
Acupuncture may help in smoking cessation (61). It is a useful adjunct to standard treatment for dyspnea on exertion (DOE), a symptom associated with chronic obstructive pulmonary disorder (COPD) (62).

Acupuncture also improved reproductive outcomes in women following in vitro fertilization, but clinical studies yielded conflicting results (24) (25) (26) (27) (28). Acupuncture increased ovulation frequency, but reduced sex steroids levels, in women with polycystic ovary syndrome (75). Acupuncture did not have an analgesic effect in women undergoing induced labor (29). Acupuncture treatments reduced symptoms of chronic prostatitis/chronic pelvic pain (30), and decreased procedural anxiety in patients undergoing lithotripsy (31). Data from a study done in children undergoing endoscopic procedures indicate benefits of acupressure in reducing preprocedural anxiety (32). Acupuncture may also benefit patients with allergic rhinitis when used in conjunction with standard care, and was cost effective (33) (34).

Acupuncture is being used in the palliative care of cancer to alleviate pain (35) (36), dysfunction (36), fatigue (37) (71), to reduce post-operative (38) and chemotherapy-induced (39) (41) (42) nausea and vomiting, and to ameliorate xerostomia or dry mouth, commonly experienced by cancer patients following radiotherapy of the head and neck regions (36) (43) (44) (63) (70). Findings from a randomized trial suggest that it is as effective as standard care for the management of hot flashes in breast cancer patients (45). Acupuncture also alleviated aromatase inhibitor-induced joint pain and stiffness, improving physical well-being in patients with breast cancer (46) (74). Early phase studies also suggest that acupuncture can help relieve hot flashes in prostate cancer patients (64) (65) (66),and can improve pain and well-being in lung cancer patients (76). Acupuncture does not reduce postoperative ileus from standard surgery (40) (56). However, electroacupuncture does reduce postoperative ileus and analgesic use after laparoscopic surgery for colorectal cancer (73).

Acupuncture is generally safe and well tolerated by patients (68) (69) including children (47) (48) (49). Some conditions require continuous treatments in order to achieve long-term effect. Pregnant women, patients with lymphedema, those wearing pacemakers, and those with low platelet count should inform their practitioners before receiving treatment. Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with cancer patients.

Purported Uses
  • Chemotherapy side effects
  • Radiation therapy side effects
  • Nausea and vomiting
  • Pain
  • Constipation
  • Depression
  • Fatigue
  • Allergy
  • Smoking cessation
Mechanism of Action

According to TCM, acupuncture points are thought to be located at specific areas along channels or meridians. Qi (energy) is believed to flow in this network of channels which connect different parts of the body and organs into a unified system. Pain and symptoms of disease are thought to arise when the flow of Qi is stagnated and acupuncture is intended to promote the flow of Qi to relieve symptoms. Acupuncture is known to stimulate release of endogenous opioids. Scientific studies have demonstrated that acupuncture can induce analgesia, but that effect was blocked by naloxone, an opioid antagonist (50) (51). Further, mice lacking opiate receptors showed low analgesic effect following electroacupuncture (EA) (52). Recent research shows that EA inhibits pain through different opioid receptors under varying conditions, but the mechanisms warrant further investigation (53). EA was shown to increase ovarian blood flow via ovarian sympathetic nerves in rats (54). In women with polycystic ovary syndrome, acupuncture treatments increase ovulation frequency through the local peripheral effect on ovaries and not by stimulating the sex steroids (75). Acupuncture protects against cerebral ischemia by increasing blood flow to the ischemic brain region via neural regulation (55). The systemic antiinflammatory activities of EA are thought to be modulated by dopamine (79).
Studies using functional magnetic resonance imaging (fMRI) have shown that acupuncture elicits changes in the brain that appear to correlate with neurological effects produced (57). Needling of LI-2, one of several acupoints used to treat xerostomia, is associated with neuroimaging changes correlated to saliva production (58). Results from a study done in patients with peripheral neuropathy indicate that acupuncture improves nerve conduction (14).
Acupuncture also increases neuropeptite Y in animals suggesting it has benefits in reducing stress and depression (59) (60).

Contraindications
  • Neutropenia, thrombocytopenia, or history of endocarditis
    Acupuncture may increase risk of infection and bleeding. Use with caution.
  • Pregnancy
    Pregnant women should inform practitioners before seeking acupuncture treatment.
  • Pacemakers
    Electrical stimulation is contraindicated for patients wearing electronic medical devices.
Adverse Reactions

Acupuncture is generally safe when performed by trained practitioners. Studies show that less than 0.2% of all individuals treated with acupuncture experienced adverse effects. Failure to remove needles, bleeding, hematoma, dizziness, and pain are the commonly reported adverse events. Pneumothorax, local infections, and burns caused by moxibustion are rare (49) (68) (69).

Literature Summary and Critique

Meng Z, Garcia MK, Hu C, et al. Randomized controlled trial of acupuncture for prevention of radiation-induced xerostomia among patients with nasopharyngeal carcinoma. Cancer. 2011 Nov 9. doi: 10.1002/cncr.26550. [Epub ahead of print]
A total of 86 patients with nasopharyngeal carcinoma were randomized to receive acupuncture (AC) or standard of care to prevent xerostomia. Patients were treated 3 times per week before radiotherapy, and both subjective measures (a xerostomia questionnaire [XQ] and MD Anderson Symptom Inventory–Head and Neck [MDASI-HN]) and objective measures (salivary flow rates) were obtained for up to 6 months of followup. XQ was significantly lower for AC than controls starting week 3 through 6 months with clinically significant differences at week 11; findings for MDASI-HN scores were similar. Group differences emerged as early as 3 weeks into treatment for saliva with greater saliva flow in the AC group at weeks 7 and 11 and at 6 months. AC given concurrently with radiotherapy significantly reduced xerostomia and improved quality of life. Other trials are ongoing.

Andreescu C, Glick RM, Emeremni CA, et al. Acupuncture for the treatment of major depressive disorder: a randomized controlled trial. J Clin Psychiatry. 2011;72:1129-35.
Fifty-three patients with mild or moderate major depressive disorder were randomized to acupuncture or sham control for a total of twelve 30-minute sessions (twice per week) over 6 to 8 weeks and evaluated using the Hamilton Depression Rating Scale (HDRS) as the primary outcome measure. Both treatments resulted in similar absolute and relative improvements using HDRS and significant decreases in HDRS sleep and anxiety subscale scores from baseline to end of intervention. No adverse effects were reported with either intervention. More studies in MDD populations are needed.

Walker EM, Rodriguez AI, Kohn B, et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: A randomized controlled trial. J Clin Oncol. 2010 Feb 1;28(4):634-40.
In this study, 50 breast cancer patients were randomly assigned to receive 12 weeks of acupuncture or venlafaxine, the standard drug therapy used to address hot flashes. Following the study period, both groups reported significant reduction in hot flashes, depressive symptoms, and improvement in energy levels, clarity of thought and a sense of well-being. But two weeks after treatment, patients in the venlafaxine group experienced significant increases in hot flashes compared with those in the acupuncture group. The venlafaxine group also reported 18 incidences of adverse effects such as nausea, dry mouth, dizziness, and anxiety. No such effects were seen in the acupuncture group. Acupuncture may be a safe and effective alternative to drug therapy for reducing hot flashes in breast cancer patients.

Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial. Ann Allergy Asthma Immunol. 2008;101:535-543.
This study involved patients with allergic rhinitis, 487 of whom were assigned to receive up to 15 acupuncture treatments over 3 months, 494 patients to a control group, and 4,256 patients to a nonrandomized acupuncture group. All patients were being treated with standard care for rhinitis. Researchers found that at 3 months, those receiving acupuncture had greater improvement in quality of life compared with patients in the control group as assessed by the Rhinitis Quality of Life Questionnaire. The 6-month improvements in the acupuncture groups were smaller compared with the 3-month assessment. These data indicate that acupuncture resulted in clinically relevant and persistent benefits, and can be a useful adjunct with routine care in the management of allergic rhinitis.

Vickers AJ, et al. Acupuncture for postchemotherapy fatigue: A phase II study. J Clin Oncol. 2004;22:1731-1735.
In this study involving cancer patients who had completed chemotherapy but experienced persistent fatigue, 25 patients received acupuncture twice a week for 4 weeks and 12 patients received acupuncture once a week for 6 weeks. Patients reported an improvement of 31% in fatigue level measured at 2 weeks after the final treatment compared with baseline. There was no significant difference in weekly and bi-weekly treatments. The result suggests that acupuncture has benefit in treating post-chemotherapy fatigue. However, this is only a preliminary study on a small number of patients and was not randomized. Further studies involving large number of patients are warranted.

Vickers AJ, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial. BMJ. 2004;328:744-749.
In this study, 401 patients with chronic headache were randomly assigned to receive up to 12 acupuncture treatments over a period of 3 months or conventional treatment. Patients in the acupuncture group reported fewer headaches, less use of medication, fewer visits to doctors, and improved quality of life compared with those who received conventional care. Researchers concluded that acupuncture offers persistent clinical benefits for patients with chronic headache, particularly migraine.

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References
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  29. Mackenzie IZ, Xu J, Cusick C, et al. Acupuncture for pain relief during induced labour in nulliparae: a randomised controlled study. BJOG. Mar 2011;118(4):440-447.
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  32. Wang SM, Escalera S, Lin EC, et al. Extra-1 acupressure for children undergoing anesthesia. Anesth Analg. Sep 2008;107(3):811-816.
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  35. Alimi D, Rubino C, Pichard-Leandri E, et al. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. J Clin Oncol. Nov 15 2003;21(22):4120-4126.
  36. Pfister DG, Cassileth BR, Deng GE, et al. Acupuncture for pain and dysfunction after neck dissection: results of a randomized controlled trial. J Clin Oncol. May 20 2010;28(15):2565-2570.
  37. Vickers AJ, Straus DJ, Fearon B, et al. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol. May 1 2004;22(9):1731-1735.
  38. Gan TJ, Jiao KR, Zenn M, et al. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesth Analg. Oct 2004;99(4):1070-1075.
  39. Shen J, Wenger N, Glaspy J, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA. Dec 6 2000;284(21):2755-2761.
  40. Meng ZQ, Garcia MK, Chiang JS, et al. Electro-acupuncture to prevent prolonged postoperative ileus: a randomized clinical trial. World J Gastroenterol. 2010 Jan 7;16(1):104-11.
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  44. Garcia MK, Chiang JS, Cohen L, et al. Acupuncture for radiation-induced xerostomia in patients with cancer: a pilot study. Head Neck. Oct 2009;31(10):1360-1368.
  45. Walker EM, Rodriguez AI, Kohn B, et al. Acupuncture versus venlafaxine for the management of vasomotor symptoms in patients with hormone receptor-positive breast cancer: a randomized controlled trial. J Clin Oncol. Feb 1 2010;28(4):634-640.
  46. Crew KD, Capodice JL, Greenlee H, et al. Randomized, blinded, sham-controlled trial of acupuncture for the management of aromatase inhibitor-associated joint symptoms in women with early-stage breast cancer. J Clin Oncol. Mar 1 2010;28(7):1154-1160.
  47. Ng DK, Chow PY, Ming SP, et al. A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis. Pediatrics. Nov 2004;114(5):1242-1247.
  48. Broide E, Pintov S, Portnoy S, et al. Effectiveness of acupuncture for treatment of childhood constipation. Dig Dis Sci. Jun 2001;46(6):1270-1275.
  49. Adams D, Cheng F, Jou H, et al. The Safety of Pediatric Acupuncture: A Systematic Review. Pediatrics. Nov 21 2011.
  50. Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. Dec 1 1976;19(11):1757-1762.
  51. Pomeranz B, Warma N. Electroacupuncture suppression of a nociceptive reflex is potentiated by two repeated electroacupuncture treatments: the first opioid effect potentiates a second non-opioid effect. Brain Res. Jun 14 1988;452(1-2):232-236.
  52. Peets JM, Pomeranz B. CXBK mice deficient in opiate receptors show poor electroacupuncture analgesia. Nature. Jun 22 1978;273(5664):675-676.
  53. Meng X, Zhang Y, Li A, et al. The effects of opioid receptor antagonists on electroacupuncture-produced anti-allodynia/hyperalgesia in rats with paclitaxel-evoked peripheral neuropathy. Brain Res. Sep 26 2011;1414:58-65.
  54. Stener-Victorin E, Kobayashi R, Watanabe O, et al. Effect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries. Reprod Biol Endocrinol. Mar 26 2004;2:16.
  55. Zhou F, Guo J, Cheng J, et al. Electroacupuncture increased cerebral blood flow and reduced ischemic brain injury: Dependence on stimulation intensity and frequency. J Appl Physiol. Aug 11 2011.
  56. Deng G, Wong WD, Guillem J, et al. A Phase II, Randomized, Controlled Trial of Acupuncture for Reduction of Postcolectomy Ileus. Ann Surg Oncol. 2013 Apr;20(4):1164-9. doi: 10.1245/s10434-012-2759-7. Epub 2012 Nov 28.
  57. Yoo SS, Teh EK, Blinder RA, et al. Modulation of cerebellar activities by acupuncture stimulation: evidence from fMRI study. Neuroimage. Jun 2004;22(2):932-940.
  58. Deng G, Hou BL, Holodny AI, et al. Functional magnetic resonance imaging (fMRI) changes and saliva production associated with acupuncture at LI-2 acupuncture point: a randomized controlled study. BMC Complement Altern Med. 2008;8:37.
  59. Eshkevari L, Egan R, Phillips D, et al. Acupuncture at ST36 prevents chronic stress-induced increases in neuropeptide Y in rat. Exp Biol Med. 2012 Jan 1;237(1):18-23.
  60. Lim S, Ryu YH, Kim ST, et al. Acupuncture increases neuropeptide Y expression in hippocampus of maternally-separated rats. Neurosci Lett. 2003 May 29;343(1):49-52.
  61. Tahiri M, Mottillo S, Joseph L et al. Alternative Smoking Cessation Aids: A Meta-analysis of Randomized Controlled Trials. Am J Med. 2012 Apr 11.
  62. Suzuki M, Muro S, Ando Y, et al. A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD). The COPD-Acupuncture Trial (CAT). Arch Intern Med. 2012;172(11):878-886.
  63. Wong RK, James JL, Sagar S, et al. Phase 2 results from Radiation Therapy Oncology Group Study 0537: A phase 2/3 study comparing acupuncture-like transcutaneous electrical nerve stimulation versus pilocarpine in treating early radiation-induced xerostomia. Cancer. 2012 Jan 17. doi: 10.1002/cncr.27382.
  64. Ashamalla H, Jiang ML, Guirguis A, et al. Acupuncture for the alleviation of hot flashes in men treated with androgen ablation therapy. Int J Radiat Oncol Biol Phys. Apr 1 2011;79(5):1358-1363.
  65. Beer TM, Benavides M, Emmons SL, et al. Acupuncture for hot flashes in patients with prostate cancer. Urology. Nov 2010;76(5):1182-1188.
  66. Capodice J CP, Benson MC, et al. Acupuncture for the treatment of hot flashes in men with advanced prostate cancer. Int J Clin Med. 2011;2(1):51-55.
  67. Vickers A, Cronin A, Maschino A, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.
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  71. Molassiotis A, Bardy J, Finnegan-John J, Mackereth P, et al. Acupuncture for Cancer-Related Fatigue in Patients With Breast Cancer: A Pragmatic Randomized Controlled Trial. J Clin Oncol. 2012 Dec 20;30(36):4470-6.
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  74. Bao T, Cai L, Giles JT, Gould J, et al. A dual-center randomized controlled double blind trial assessing the effect of acupuncture in reducing musculoskeletal symptoms in breast cancer patients taking aromatase inhibitors. Breast Cancer Res Treat. 2013 Feb;138(1):167-74.
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Consumer Information

How It Works

Bottom Line: Acupuncture is effective in treating chronic pain and some symptoms associated with cancer treatment.

Acupuncture is a component of Traditional Chinese Medicine and involves use of needles, heat (moxibustion), pressure (acupressure) or electricity to stimulate one or more points in the body to promote the flow of Qi (internal energy). The World Health Organization supports the use of acupuncture in reducing symptoms, such as depression, facial pain, headache, peripheral neuropathy, lower back pain, nausea and vomiting, neck pain, postoperative pain, shortness of breath, chronic fatigue, hot flashes and side effects caused by radiotherapy and/or chemotherapy. Acupuncture reduced symptoms of sneezing, itching, and runny nose in children with allergies, and may be useful against allergic rhinitis in adults when used along with standard medications. It also improved pregnancy rates in women following in vitro fertilization, but did not provide pain relief in women undergoing induced labor.
Acupuncture treatments are generally safe and well tolerated by most patients. Some conditions may require continuous treatments in order to achieve long-term effect.
Cancer patients considering acupuncture should seek certified or state-licensed practitioners who have training or experience in working with cancer patients.

Purported Uses
  • Pain
    Several clinical trials showed that acupuncture is effective in alleviating pain.
  • In vitro fertilization
    Some studies show acupuncture can improve pregnancy rates in women following in vitro fertilization. But a recent study showed no benefits.
  • Depression
    Acupuncture is as effective as counseling in reducing symptoms of depression.
  • Headache
    This use is supported by clinical trials.
  • Fatigue
    Several clinical trials showed that acupuncture reduces fatigue.
  • Constipation
    This use is supported by scientific evidence.
  • Nausea
    A number of studies support the use of acupuncture in treating nausea.
  • Cancer-related symptoms
    Several clinical trials support the use of acupuncture in relieving pain, nausea and vomiting, fatigue, and hot flashes resulting from cancer treatments.
  • Allergy
    A few studies have shown that acupuncture is useful in treating allergic rhinitis when used along with standard care.
  • Smoking
    Several randomized clinical trials show that acupuncture can help smokers quit the habit.
Research Evidence

Cancer
Fifty breast cancer patients were randomly assigned to receive 12 weeks of acupuncture or venlafaxine, the standard drug therapy used for the treatment of hot flashes. Following the study period, both groups reported significant reduction in hot flashes, depressive symptoms, and improvement in energy levels, clarity of thought and a sense of well-being.
But two weeks after treatment, patients in the venlafaxine group experienced significant increases in hot flashes compared to those in the acupuncture group. The venlafaxine group also reported 18 incidences of adverse effects such as nausea, dry mouth, dizziness, and anxiety. No such effects were seen in the acupuncture group.
Acupuncture may be a safe and effective alternative to drug therapy for reducing hot flashes in breast cancer patients.

In a recent clinical trial, 104 breast cancer patients undergoing chemotherapy received electroacupuncture, at antiemetic acupuncture points, minimal needling at control points, or antiemetic drugs alone. Patients who received electroacupuncture reported fewer episodes of vomiting compared to those in the other groups. However, this effect was short-term and not observed at a follow-up done from days 6-14.

In another study, twenty-five cancer patients who had completed chemotherapy but experienced fatigue received acupuncture treatments twice a week for 4 weeks or once a week for 6 weeks. All patients irrespective of weekly or biweekly treatments reported a 31% improvement in fatigue level after 2 weeks following the final treatment. However, more studies involving large number of patients are needed to establish this use.

Headache
In a study conducted to determine the effects of acupuncture on headache, 401 patients with chronic headache received up to 12 acupuncture treatments over 3 months or conventional treatment. Patients in the acupuncture group had fewer headaches, paid fewer visits to doctors, and their quality of life improved compared to those in the conventional care group. Researchers concluded that acupuncture is beneficial in patients suffering from chronic headache, particularly, migraine.

Do Not Take If

Acupuncture is not recommended
 

  • If you have low white blood cell count, low platelet count or heart murmur (symptom of endocarditis). Acupuncture may increase risk of infection and bleeding.
  • If you are pregnant (some acupuncture points can cause strong uterine contractions. Pregnant women should inform practitioners before seeking acupuncture treatment)
  • If you wear pacemakers (electrical stimulation is contraindicated for patients wearing electronic medical devices)
Side Effects

Acupuncture is generally safe when performed by trained practitioners. Studies show that less than 0.2% of all individuals treated with acupuncture experienced adverse effects. Failure to remove needles, bleeding, hematoma, dizziness, and pain are the commonly reported adverse events. Pneumothorax, local infections, and burns caused by moxibustion are rare.

E-mail your questions and comments to aboutherbs@mskcc.org.