Acupuncture

Acupuncture

Acupuncture

For Patients & Caregivers

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.

  • 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.

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)

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.

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For Healthcare Professionals

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)(80). 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)(81) 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.

  • Chemotherapy side effects
  • Radiation therapy side effects
  • Nausea and vomiting
  • Pain
  • Constipation
  • Depression
  • Fatigue
  • Allergy
  • Smoking cessation

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).

  • 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.

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).


  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. Martin DP, Sletten CD, Williams BA, et al. Improvement in fibromyalgia symptoms with acupuncture: results of a randomized controlled trial. Mayo Clin Proc. Jun 2006;81(6):749-757.

  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. Nov 21 2011.

  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. doi: 10.1245/s10434-012-2759-7. Epub 2012 Nov 28.

  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 Apr 11.

  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. Published online September 10, 2012. doi:10.1001/archinternmed.2012.3654.

  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. Simcock R, Fallowfield L., Monson K. et al. A randomised trial of acupuncture v oral care sessions in patients with chronic xerostomia following treatment of head and neck cancer. Ann Oncol 2013 Mar;24(3):776-83. doi: 10.1093/annonc/mds515. Epub 2012 Oct 25.

  48. 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.

  49. 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.

  50. 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.

  51. 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.

  52. Shih C-C, Hsu Y-T, Wang H-H, Chen T-L, Tsai C-C, et al. (2014) Decreased Risk of Stroke in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study. PLoS ONE 9(2): e89208. doi:10.1371/journal.pone.0089208

  53. 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.

  54. 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.

  55. 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.

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