- Manual acupuncture
For Patients & Caregivers
What Is It
Acupuncture is a therapeutic component of Traditional Chinese Medicine. It involves the use of very thin needles along with heat, pressure, or electricity to stimulate points on the body, promoting the flow and balance of internal energy.
Acupuncture is effective in treating chronic pain and some symptoms associated with cancer treatment. Studies have shown benefit with acupuncture for postoperative pain, sleep, nausea and vomiting, hot flashes, peripheral neuropathy, and other side effects caused by radiotherapy and/or chemotherapy. It may also reduce symptoms such as depression, headache, lower back or neck pain, shortness of breath, and chronic fatigue.
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.
How It Works
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 and balance of Qi to relieve symptoms. It is also known to release pain-relieving or feel-good chemicals in the brain.
Studies in animals and humans have shown that acupuncture can stimulate pain relief, and reduce stress, anxiety, and depression. Other studies have shown it can improve sleep, increases blood flow, and may help reduce inflammation, which may also explain pain-relieving effects.
MRI studies show that acupuncture causes changes in the brain that reflect changes in the body. Neuroimaging studies have shown that certain acupoints for dry mouth correlate to saliva production. Studies in patients with peripheral neuropathy show that acupuncture improves nerve signaling.
Researchers are continuing to examine the mechanisms by which acupuncture exerts these effects. Additional findings may help to optimize treatment regimens in the future.
Cancer treatment-related symptoms
A number of clinical trials support the use of acupuncture in relieving pain, nausea and vomiting, dry mouth, fatigue, hot flashes, and peripheral neuropathy resulting from cancer treatments. In some studies, benefits have been noted to last well after treatment.
Several clinical trials showed that acupuncture is effective in alleviating pain, including joint or nerve pain associated with some cancer treatments.
Several clinical trials in cancer patients and other populations suggest that acupuncture improves sleep.
Several clinical trials show that acupuncture reduces fatigue, including cancer-related fatigue.
Several studies have shown that acupressure and acupuncture can help to relieve anxiety related to tests and procedures. It may also help with anxiety in general.
Acupuncture may reduce depressive symptoms, although results were mixed for major depressive disorder.
Nausea and vomiting
Current oncology guidelines recommend acupuncture and acupressure for chemotherapy-induced nausea and vomiting (CINV). A number of studies also support its use for postoperative nausea and vomiting (PONV), and in pediatric cancer populations.
Some evidence suggests acupuncture may be helpful for constipation.
This use is supported by clinical trials.
A clinical study finds acupuncture can reduce symptoms of fibromyalgia.
Although studies have mixed results, several large trials have not found acupuncture helpful for infertility.
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.
Studies on whether acupuncture may help in smoking cessation are mixed. Additional studies are needed.
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.
Acupuncture should be avoided or additional precautions taken 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.
- You wear a pacemaker: Electrical stimulation is not advised for patients wearing electronic medical devices.
- You have lymphedema: Patients with lymphedema should inform their practitioners before receiving treatment.
- You are pregnant: Some acupuncture points can cause strong uterine contractions. Pregnant women should inform practitioners before seeking acupuncture treatment.
Who Can Provide this Service
Where Can I Get Treatment
A majority of National Cancer Institute (NCI)-designated cancer centers offer acupuncture as part of supportive care. Clinical trials at MSK are underway to evaluate acupuncture in patients with advanced cancers and for chronic pain.
For Healthcare Professionals
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 along 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). In patients with rheumatoid arthritis, acupuncture reduced pain, joint swelling, and tenderness and improved strength and quality of life (117). Acupressure (6) and acupuncture (7) (8) (9) were superior to physical therapy and/or usual care in treating patients with low back pain. In a meta-analysis of chronic pain patients, long-term benefits were found to persist post-treatment (118).
Acupuncture reduced high blood pressure (10) and hot flash severity (11) in postmenopausal women, but effects in menopausal patients are mixed (95) (97). 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).
Studies have found electroacupuncture helpful for urinary incontinence (100) (119). Clinical studies on outcomes following in vitro fertilization have yielded conflicting results (24) (25) (26) (27) (28). More recently in large trials, acupuncture did not improve birth rates with IVF (104) or polycystic ovary syndrome 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).
As an adjunct to standard treatment, acupuncture helped treat dyspnea on exertion in patients with chronic obstructive pulmonary disorder (COPD) (62), and improved nutritional status (120). It also improved health-related quality of life for those with allergic asthma (99). Studies on whether acupuncture may help in smoking cessation are mixed (61) (84) (85).
Current oncology guidelines recommend acupuncture and acupressure for chemotherapy-induced nausea and vomiting (CINV) (108). In addition, data suggest acupuncture may be helpful in cancer pain management (106) (107) and a recent meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics (116). 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).
Several studies on acupuncture for sleep disorders have been conducted that demonstrated clinically relevant improvements in insomnia (112) (122) and lasting effects post-therapy (123). Similar improvements were observed in cancer patients (111); and in survivors, in a trial that compared acupuncture with cognitive behavioral therapy for insomnia (CBT-I) (121). Furthermore, secondary analysis of data from this study revealed that in the acupuncture group, participants with clinically meaningful responses with regard to insomnia showed greater improvements in subjective cognitive function compared to those without clinically meaningful insomnia responses (129).
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). In patients receiving neurotoxic chemotherapies, acupuncture improved peripheral neuropathy and other symptoms in addition to pain (18) (19) (80) (115) (124) (130) with long-term improvements observed post treatment (125). Benefits with acupuncture have also been observed for peripheral neuropathy associated with diabetes (15), AIDS (16) (17).
For hot flashes, acupuncture was as effective as standard care in breast cancer patients (45), and early phase studies also suggest it may relieve hot flashes in prostate cancer patients (64) (65) (66). In addition, EA was more effective than gabapentin with fewer side effects (82), and comparable to gabapentin for improving sleep quality (98). Studies on whether acupuncture can reduce lymphedema are mixed (113) (114). 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).
In palliative cancer care, acupuncture is being evaluated as an intervention to reduce cachexia and unintentional weight loss (88) (89). Various forms of acupuncture have been found to alleviate pain (35) (36) (67), and a metanalysis determined this effect is more than just placebo (126). It also improved 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).
In addition, preliminary findings suggest utility of auricular acupuncture for improving appetite in patients with advanced cancer (131). Another trial to determine the comparative effectiveness of electro-acupuncture versus auricular acupuncture against chronic musculoskeletal pain is underway (132).
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. Some oncology physicians may also be board-certified acupuncturists. Clinical trials at MSK are underway to evaluate acupuncture in patients with advanced cancers and for chronic pain.
Mechanism of Action
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.
Animal studies suggest acupuncture induces analgesia through different opioid receptors under varying conditions (53), 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 suggesting it may help to reduce stress and depression (59) (60). Acupuncture protects against cerebral ischemia by increasing blood flow to the ischemic brain region via neural regulation (55). The systemic anti-inflammatory activities of EA are thought to be modulated by dopamine (79).
In patients with fibromyalgia, analgesic effects of acupuncture are attributed to increased mu-Opioid receptor binding potential (127). In patients with peripheral neuropathy, acupuncture improves nerve conduction (14). Needling of LI-2, one of several acupoints used to treat xerostomia, was associated with neuroimaging changes correlated to saliva production (58). Other studies using functional magnetic resonance imaging (fMRI) also show that acupuncture elicits brain changes that correlate with neurological effects produced (57). A meta-analysis of fMRI research confirmed that acupuncture modulates a variety of brain activity including somatosensory, affective, and cognitive processing (127).
Long-term benefits seen with EA and to a lesser extent sham-EA post-treatment for hot flashes among breast cancer survivors suggest that both interventions produce underlying physiologic changes not induced by gabapentin (82). That sham-EA demonstrated greater 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 higher baseline expectancy predicts treatment response with sham-EA but not EA, suggesting divergent mechanisms and that patients with low expectancy may do better with EA than sham (94).
Neutropenia, thrombocytopenia, or history of endocarditis
Acupuncture may increase risk of infection and bleeding. Use with caution.
Pregnant women should inform practitioners before seeking acupuncture treatment.
Electrical stimulation is contraindicated for patients wearing electronic medical devices.