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Acupuncture

Acupuncture

Common Names

  • Manual acupuncture
  • Electroacupuncture
  • Acustimulation
  • Acupressure

For Patients & Caregivers

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

Acupuncture is a component of Traditional Chinese Medicine and involves the use of needles, heat, pressure, or electricity to stimulate one or more points on the body to promote the flow of internal energy. There is evidence that acupuncture can reduce 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 treatments are generally safe and well tolerated by most patients, including pediatric patients and the elderly. 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 this population. Clinical trials at MSK are underway to evaluate acupuncture for chronic pain in cancer patients and for distress-related insomnia in caregivers.

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  • Cancer treatment-related symptoms
    A number of clinical trials support the use of acupuncture in relieving pain, nausea and vomiting, dry mouth, fatigue, and hot flashes resulting from cancer treatments. It is also being evaluated to stimulate appetite, and reduce general physical wasting and unintended weight loss.
  • Pain
    Several clinical trials showed that acupuncture is effective in alleviating pain, including joint pain associated with some cancer treatments, as well as in patients with lung or head and neck cancers.
  • Anxiety
    Several studies have shown that acupressure and acupuncture can help to relieve procedural anxiety and anxiety associated with some cancer symptoms.
  • Depression
    Acupuncture is as effective as counseling in reducing symptoms of depression, although results were mixed for major depressive disorder. It may help to relieve depression associated with some cancer symptoms.
  • Nausea and vomiting
    A number of studies support the use of acupuncture for this purpose, including postoperative or chemotherapy-induced nausea and vomiting (PONV or CINV), as well as in pediatric cancer populations.
  • Constipation
    Some evidence suggests acupuncture may be helpful for constipation.
  • Fatigue
    Several clinical trials showed that acupuncture reduces fatigue, including fatigue associated with some cancer symptoms.
  • Headache
    This use is supported by clinical trials.
  • Fibromyalgia
    A clinical study finds acupuncture can reduce symptoms of fibromyalgia.
  • Infertility
    Although studies have mixed results, several large trials have not found acupuncture helpful for infertility.
  • Allergy
    A few studies have shown that acupuncture is useful in treating allergic rhinitis when used along with standard care. It may also be helpful on its own in pediatric populations.
  • Smoking
    Studies on whether acupuncture may help in smoking cessation are mixed. Additional studies are needed.
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  • You have low white blood cell count, low platelet count or heart murmur (symptom of endocarditis): Acupuncture may increase risk of infection and bleeding.
  • You are pregnant: Some acupuncture points can cause strong uterine contractions. Pregnant women should inform practitioners before seeking acupuncture treatment.
  • You wear a pacemaker: Electrical stimulation is not advised for patients wearing electronic medical devices.
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Acupuncture is generally safe when performed by trained practitioners. Failure to remove needles, bleeding, hematoma, dizziness, and pain have been reported. Rare instances of collapsed lung, local infections, or burns caused by moxibustion have occurred.

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For Healthcare Professionals

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Acupuncture is an integral component of Traditional Chinese Medicine (TCM) that 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 (electroacupuncture, EA) for therapeutic effect.

Acupuncture is beneficial for osteoarthritis of the knee (1) (2) (3), chronic neck pain (4), Bell’s palsy (72), and fibromyalgia symptoms (5). Acupressure (6) and acupuncture (7) (8) (9) were superior to physical therapy and/or usual care in treating patients with low back pain. Acupuncture reduced high blood pressure (10) and hot flash severity (11) in postmenopausal women. It was as effective as counseling for depression symptoms (77), but had mixed results for treating major depressive disorder (12) (13). Acupuncture reduced stroke risk in patients with traumatic brain injury (78). Data from clinical trials also support its use for chronic headache (20) (21) (22), and although there was no difference between true and sham acupuncture, both treatments were more effective compared with a no-acupuncture control (23).

Electroacupuncture was found to be as helpful for stress urinary incontinence as behavioral treatments such as pelvic floor muscle training, with patients expressing similar satisfaction with results (100). Acupuncture is used to improve reproductive outcomes in women following in vitro fertilization (IVF), but clinical studies yielded conflicting results (24) (25) (26) (27) (28). More recently, large trials did not find acupuncture helpful to improve birth rates for women undergoing IVF (104) or for polycystic ovary syndrome (PCOS) infertility (101). Acupuncture did not reduce pain in women undergoing induced labor (29), but reduced symptoms of chronic prostatitis/chronic pelvic pain (30), and decreased procedural anxiety in patients undergoing lithotripsy (31). In children, acupressure also appeared to reduce preprocedural anxiety (32), while EA reduced postoperative nausea and vomiting (PONV) (83). Acupuncture may benefit patients with allergic rhinitis (33) (34), including pediatric patients (47). Preliminary evidence also suggests it may be helpful for constipation (48) (105).

Studies on whether acupuncture may help in smoking cessation are mixed (61) (84) (85). As an adjunct to standard treatment, acupuncture helped treat dyspnea on exertion in patients with chronic obstructive pulmonary disorder (COPD) (62), and improved health-related quality of life for those with allergic asthma (99).

Various analyses suggest acupuncture may be helpful in cancer pain management (106) (107) and for reducing chemotherapy-induced nausea and vomiting (108). In patients undergoing autologous hematopoietic stem cell transplantation, acupuncture prevented escalation of nausea, lack of appetite, and drowsiness, and reduced pain medication use (103). In lung cancer patients, preliminary evidence suggests acupuncture may improve fatigue (109), pain and well-being (76). In breast cancer patients, acupuncture alleviated aromatase inhibitor-induced joint pain (110) and stiffness, and improved physical well-being (46) (74) and quality of life (96). EA significantly improved fatigue, anxiety, and depression as well as arthralgia compared with usual care (86) (87). Benefits with acupuncture have also been observed for peripheral neuropathy (14), including that associated with diabetes (15), AIDS (16) (17), and chemotherapy (18) (19) (80).

For hot flashes in breast cancer patients, acupuncture was as effective as standard care (45). In addition, EA was more effective than gabapentin with fewer side effects (82), and comparable to gabapentin for improving sleep quality (98). In prostate cancer patients, early phase studies also suggest that acupuncture may relieve hot flashes (64) (65) (66), but effects in non-cancer menopausal patients are mixed (95) (97).

Acupuncture did not reduce postoperative ileus from standard surgery (40) (56), but EA did reduce postoperative ileus and analgesic use after laparoscopic surgery for colorectal cancer (73). Other studies in cancer patients (111) and perimenopausal women (112) suggest acupuncture may be useful for insomnia. Studies on whether acupuncture can reduce lymphedema are mixed (113) (114).

In palliative cancer care, acupuncture is being evaluated as an intervention to reduce cachexia and unintentional weight loss (88) (89). Its use has also been associated with increased appetite (90). Various forms of acupuncture have been found to alleviate pain (35) (36) (67), xerostomia following head and neck radiotherapy (36) (43) (44) (63) (70), fatigue (37) (71), PONV (38) (91), and chemotherapy-induced nausea and vomiting (CINV) (39) (41) (81) (92) (93).

Acupuncture is generally safe, well tolerated (47) (48) (49) (68) (69), and cost-effective (9) (33) (34). Some conditions require continuous treatments in order to achieve long-term effect. Animal studies suggest caffeine can inhibit the pain relieving effect of acupuncture (102). 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. Clinical trials at MSK are underway to evaluate acupuncture for chronic pain in cancer patients and for distress-related insomnia in caregivers.

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  • Cancer treatment-related symptoms
  • Pain
  • Anxiety
  • Depression
  • Nausea and vomiting
  • Constipation
  • Fatigue
  • Headache
  • Infertility
  • Allergy
  • Smoking cessation
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According to TCM, acupuncture points are thought to be located at specific areas along channels or meridians. Qi (pronounced chee, meaning 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. Acupuncture treatments are used to promote the flow of Qi to relieve symptoms. It is also 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). Acupuncture also increases neuropeptide Y in animals suggesting it may help to reduce stress and depression (59) (60). 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).

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).

The long-term post-treatment benefits seen with EA, and to a lesser extent with sham-EA, but not with gabapentin for the treatment of hot flashes among breast cancer survivors suggest that both types of acupuncture produce underlying physiologic changes not induced by pharmacologic intervention (82). That sham-EA demonstrated greater placebo effects with reduced nocebo effects than pill-placebo (82) also may explain why some acupuncture trials find similar efficacy between active and sham interventions. Other data indicate that a higher baseline expectancy of response predicts treatment response with sham-EA but not EA, suggesting there are divergent mechanisms and that patients who have a low expectancy may do better with EA than sham-EA (94).

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  • 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.
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Acupuncture is generally safe when performed by trained practitioners. Failure to remove needles, bleeding, hematoma, dizziness, and pain have been reported. Pneumothorax, local infections, and burns caused by moxibustion are rare (49) (68) (69).

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  1. Berman BM, Lao L, Langenberg P, et al. Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med. Dec 21 2004;141(12):901-910.

  2. Scharf HP, Mansmann U, Streitberger K, et al. Acupuncture and knee osteoarthritis: a three-armed randomized trial. Ann Intern Med. Jul 4 2006;145(1):12-20.

  3. White P, Lewith G, Prescott P, et al. Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. Ann Intern Med. Dec 21 2004;141(12):911-919.

  4. Vas J, Santos-Rey K, Navarro-Pablo R, et al. Acupuncture for fibromyalgia in primary care: a randomised controlled trial. Acupunct Med. 2016 Aug;34(4):257-66.

  5. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ. Mar 25 2006;332(7543):696-700.

  6. Haake M, Muller HH, Schade-Brittinger C, et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. Sep 24 2007;167(17):1892-1898.

  7. Ratcliffe J, Thomas KJ, MacPherson H, et al. A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ. Sep 23 2006;333(7569):626.

  8. Flachskampf FA, Gallasch J, Gefeller O, et al. Randomized trial of acupuncture to lower blood pressure. Circulation. Jun 19 2007;115(24):3121-3129.

  9. Allen JJ, Schnyer RN, Chambers AS, et al. Acupuncture for depression: a randomized controlled trial. J Clin Psychiatry. Nov 2006;67(11):1665-1673.

  10. Andreescu C, Glick RM, Emeremni CA, et al. Acupuncture for the treatment of major depressive disorder: a randomized controlled trial. J Clin Psychiatry. Aug 2011;72(8):1129-1135.

  11. Schroder S, Liepert J, Remppis A, et al. Acupuncture treatment improves nerve conduction in peripheral neuropathy. Eur J Neurol. Mar 2007;14(3):276-281.

  12. Ahn AC, Bennani T, Freeman R, et al. Two styles of acupuncture for treating painful diabetic neuropathy—a pilot randomised control trial. Acupunct Med. Jun 2007;25(1-2):11-17.

  13. Donald GK, Tobin I, Stringer J. Evaluation of acupuncture in the management of chemotherapy-induced peripheral neuropathy. Acupunct Med. Sep 2011;29(3):230-233.

  14. Vickers AJ, Rees RW, Zollman CE, et al. Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial. BMJ. Mar 27 2004;328(7442):744.

  15. Coeytaux RR, Kaufman JS, Kaptchuk TJ, et al. A randomized, controlled trial of acupuncture for chronic daily headache. Headache. Oct 2005;45(9):1113-1123.

  16. Linde K, Streng A, Jurgens S, et al. Acupuncture for patients with migraine: a randomized controlled trial. JAMA. May 4 2005;293(17):2118-2125.

  17. Smith C, Coyle M, Norman RJ. Influence of acupuncture stimulation on pregnancy rates for women undergoing embryo transfer. Fertil Steril. May 2006;85(5):1352-1358.

  18. 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.

  19. Lee SW, Liong ML, Yuen KH, et al. Acupuncture versus sham acupuncture for chronic prostatitis/chronic pelvic pain. Am J Med. Jan 2008;121(1):79 e71-77.

  20. Wang SM, Punjala M, Weiss D, et al. Acupuncture as an adjunct for sedation during lithotripsy. J Altern Complement Med. Mar 2007;13(2):241-246.

  21. Wang SM, Escalera S, Lin EC, et al. Extra-1 acupressure for children undergoing anesthesia. Anesth Analg. Sep 2008;107(3):811-816.

  22. Brinkhaus B, Ortiz M, Witt CM, et al. Acupuncture in patients with seasonal allergic rhinitis: a randomized trial. Ann Intern Med. 2013 Feb 19;158(4):225-34.

  23. Witt CM, Reinhold T, Jena S, et al. Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care. Am J Epidemiol. Mar 1 2009;169(5):562-571.

  24. 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.

  25. 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.

  26. 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.

  27. 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.

  28. 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.

  29. Ezzo J, Vickers A, Richardson MA, et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol. Oct 1 2005;23(28):7188-7198.

  30. Molassiotis A, Helin AM, Dabbour R, et al. The effects of P6 acupressure in the prophylaxis of chemotherapy-related nausea and vomiting in breast cancer patients. Complement Th r Med. Mar 2007;15(1):3-12.

  31. 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.

  32. 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.

  33. Adams D, Cheng F, Jou H, et al. The Safety of Pediatric Acupuncture: A Systematic Review. Pediatrics. 2011 Dec;128(6):e1575-87

  34. Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. Dec 1 1976;19(11):1757-1762.

  35. Peets JM, Pomeranz B. CXBK mice deficient in opiate receptors show poor electroacupuncture analgesia. Nature. Jun 22 1978;273(5664):675-676.

  36. 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. 

  37. 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.

  38. 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.

  39. 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.

  40. Tahiri M, Mottillo S, Joseph L et al. Alternative Smoking Cessation Aids: A Meta-analysis of Randomized Controlled Trials. Am J Med. 2012 Jun;125(6):576-84.

  41. 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.

  42. Beer TM, Benavides M, Emmons SL, et al. Acupuncture for hot flashes in patients with prostate cancer. Urology. Nov 2010;76(5):1182-1188.

  43. 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.

  44. Vickers A, Cronin A, Maschino A, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22;172(19):1444-53. 

  45. Melchart D, Weidenhammer W, Streng A, et al. Prospective investigation of adverse effects of acupuncture in 97 733 patients. Arch Intern Med. 2004 Jan 12;164(1):104-5.

  46. He W, Zhao X, Li Y, Xi Q, Guo Y. Adverse events following acupuncture: a systematic review of the chinese literature for the years 1956-2010. J Altern Complement Med. 2012 Oct;18(10):892-901.

  47. 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.

  48. Ng SS, Leung WW, Mak TW, et al. Electroacupuncture reduces duration of postoperative ileus after laparoscopic surgery for colorectal cancer. Gastroenterology. 2013 Feb;144(2):307-313.

  49. Johansson J, Redman L, Veldhuis PP, et al. Acupuncture for ovulation induction in polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2013 May 1;304(9):E934-43.

  50. MacPherson H, Richmond S, Bland M, et al. Acupuncture and counselling for depression in primary care: a randomised controlled trial. PLoS Med. 2013;10(9):e1001518. doi: 10.1371/journal.pmed.1001518

  51. Torres-Rosas R, Yehia G, Peña G, et al. Dopamine mediates vagal modulation of the immune system by electroacupuncture. Nat Med. 2014 Mar;20(3):291-5. doi: 10.1038/nm.3479.

  52. Bao T, Goloubeva O, Pelser C, et al. A Pilot Study of Acupuncture in Treating Bortezomib-Induced Peripheral Neuropathy in Patients With Multiple Myeloma. Integr Cancer Ther. 2014 Sep;13(5):396-404.

  53. Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecol Oncol. 2015 Jan;136(1):82-6.

  54. Di YM, May BH, Zhang AL, et al. A meta-analysis of ear-acupuncture, ear-acupressure and auriculotherapy for cigarette smoking cessation. Drug Alcohol Depend. Sep 1 2014;142:14-23.

  55. White AR, Rampes H, Liu JP, et al. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2014;1:Cd000009.

  56. Mao JJ, Xie SX, Farrar JT, et al. A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use. Eur J Cancer. Jan 2014;50(2):267-276.

  57. Yoon SL, Grundmann O, Williams JJ, et al. Novel intervention with acupuncture for anorexia and cachexia in patients with gastrointestinal tract cancers: a feasibility study. Evid Based Complement Alternat Med. Mar 2015;42(2):E102-109.

  58. Lee EJ, Frazier SK. The efficacy of acupressure for symptom management: a systematic review. J Pain Symptom Manage. Oct 2011;42(4):589-603.

  59. Garcia MK, McQuade J, Haddad R, et al. Systematic review of acupuncture in cancer care: a synthesis of the evidence. J Clin Oncol. Mar 1 2013;31(7):952-960.

  60. Bauml J, Xie SX, Farrar JT, et al. Expectancy in real and sham electroacupuncture: does believing make it so? J Natl Cancer Inst Monogr. 2014;50:302-307.

  61. Ee C, Xue C, Chondros P, et al. Acupuncture for menopausal hot flashes: A randomized trial. Ann Intern Med. 2016. Feb 2;164(3):146-54. doi: 10.7326/M15-1380.

  62. Avis NE, Coeytaux RR, Levine B, et al. Trajectories of response to acupuncture for menopausal vasomotor symptoms: the Acupuncture in Menopause study. Menopause. 2017 Feb;24(2):171-179. 

  63. Brinkhaus B, Roll S, Jena S, et al. Acupuncture in Patients with Allergic Asthma: A Randomized Pragmatic Trial. J Altern Complement Med. 2017 Apr;23(4):268-277.

  64. Wu XK, Stener-Victorin E, Kuang HY, et al. Effect of Acupuncture and Clomiphene in Chinese Women With Polycystic Ovary Syndrome: A Randomized Clinical Trial. JAMA. Jun 27 2017;317(24):2502-2514.

  65. Fujita T, Feng C, Takano T. Presence of caffeine reversibly interferes with efficacy of acupuncture-induced analgesia. Sci Rep. Jun 13 2017;7(1):3397.

  66. Smith CA, de Lacey S, Chapman M, et al. Effect of Acupuncture vs Sham Acupuncture on Live Births Among Women Undergoing In Vitro Fertilization: A Randomized Clinical Trial. JAMA. May 15 2018;319(19):1990-1998. doi: 10.1001/jama.2018.5336

  67. Lee HY, Kwon OJ, Kim JE, et al. Efficacy and safety of acupuncture for functional constipation: a randomised, sham-controlled pilot trial. BMC Complement Altern Med. Jun 15 2018;18(1):186. 

  68. Hu C, Zhang H, Wu W, et al. Acupuncture for Pain Management in Cancer: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2016;2016:1720239. doi: 10.1155/2016/1720239

  69. Paice JA, Portenoy R, Lacchetti C, et al. Management of Chronic Pain in Survivors of Adult Cancers: American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol. Sep 20 2016;34(27):3325-3345. 

  70. Lyman GH, Greenlee H, Bohlke K, et al. Integrative Therapies During and After Breast Cancer Treatment: ASCO Endorsement of the SIO Clinical Practice Guideline. J Clin Oncol. Jun 11 2018:Jco2018792721. doi: 10.1200/jco.2018.79.2721

  71. Cheng CS, Chen LY, Ning ZY, et al. Acupuncture for cancer-related fatigue in lung cancer patients: a randomized, double blind, placebo-controlled pilot trial. Support Care Cancer. Dec 2017;25(12):3807-3814. 

  72. Fu C, Zhao N, Liu Z, et al. Acupuncture Improves Peri-menopausal Insomnia: A Randomized Controlled Trial. Sleep. Nov 1 2017;40(11). 

  73. Bao T, Iris Zhi W, Vertosick EA, et al. Acupuncture for breast cancer-related lymphedema: a randomized controlled trial. Breast Cancer Res Treat. Jul 2018;170(1):77-87. 

  74. Cassileth BR, Van Zee KJ, Yeung KS, et al. Acupuncture in the treatment of upper-limb lymphedema: results of a pilot study. Cancer. Jul 1 2013;119(13):2455-2461. 

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