Acupuncture for pain relief: How it works and what to expect

Adapted from Pain Relief Without Drugs or Surgery , Medical Editor: Melissa L. Colbert, MD, Instructor in Physical Medicine and Rehabilitation, Harvard Medical School; Interim Medical Director, Spaulding Rehabilitation Outpatient Center.

Acupuncture has been used to treat many pain conditions, including low back pain, shingles and other nerve pain, hand and knee pain, headaches, fibromyalgia, and menstrual pain.

How acupuncture works

According to traditional Chinese beliefs, acupuncture works by affecting the flow of energy (called qi) through 12 channels, or meridians, that run lengthwise through the body.

Acupuncture involves the insertion of extremely fine needles into the skin at specific “acupoints” along the meridians. This action, some scientific evidence has shown, may result in pain relief by releasing endorphins, the body’s natural painkilling chemicals, and may affect the part of the brain that governs levels of serotonin, a neurotransmitter involved with mood.

A related technique called acupressure does not involve the insertion of needles at all, but substitutes deep pressure, usually with a finger or thumb, at acupressure points.

How is acupuncture administered?

Acupuncture technique can vary with the practitioner:

• During Chinese acupuncture, the acupuncturist may turn or twirl the needles slightly, or apply heat or electrical stimulation to enhance the effects. In some cases, an herb called mugwort is burned near the needle tips or over specific areas of the body to stimulate the acupoints; this is called moxibustion.
• While traditional moxibustion may involve placing mugwort directly on the needle or skin, more commonly in the U.S. indirect methods are used, where the mugwort is burned near the skin without making contact.
• A Japanese form of acupuncture involves more shallow needle insertion than Chinese acupuncture, and needles usually are not manipulated.
• Korean acupuncture focuses on needling points just in the hands and feet.

Generally, the acupuncturist will start by asking you about your pain and other symptoms and your medical and family history. They may also do a physical exam, take your pulse, and press on various parts of your body to identify swelling or sensitivity.

Acupuncturists use a holistic approach. Therefore, the treatment will likely address general whole-body imbalances as well as your specific complaint. The acupuncturist typically inserts four to 10 needles and leaves them in place for 10 to 30 minutes while you rest. A usual course of treatment includes six to 12 sessions over a three-month period.

Minor side effects can include pain, bruising, or bleeding at the site of the needle insertion. The complication rate for acupuncture appears to be quite low. Skin infections have also been reported. Single-use, sealed needle packages have all but eliminated the risk of blood-borne infection such as hepatitis B or HIV.

A study published in The Journal of Pain pooled results of 39 studies involving nearly 21,000 people who received either acupuncture, simulated acupuncture, or no acupuncture for osteoarthritis, headaches, or chronic pain in the back, neck, or shoulders. True acupuncture provided the greatest pain relief, and the benefits persisted for at least a year. A 2021 study in Advances in Therapy found that acupuncture can help with low back pain up to two years after treatment.

If you decide to try acupuncture, it is crucial to seek out an experienced acupuncturist. Licensing requirements vary from state to state. In states with no licensing requirements, the safest way to find a qualified acupuncturist is to seek one with certification from the National Certification Commission for Acupuncture and Oriental Medicine. Some physicians also practice acupuncture, so ask your doctor for a referral. Increasingly, insurers cover acupuncture for conditions such as low back pain.