Acupuncture (PDQ®): Integrative, alternative, and complementary therapies - Patient Information [NCI]

What is acupuncture?

Acupuncture applies needles, heat, pressure, and other treatments to places on the skin, called acupuncture points (or acupoints), to control symptoms such as pain or nausea and vomiting. Acupuncture is part of traditional Chinese medicine (TCM).

Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Qi is said to affect a person's spiritual, emotional, mental, and physical health.

How is acupuncture given?

Most acupuncture methods use needles. Disposable, stainless steel needles that are slightly thicker than a human hair are inserted into the skin at acupoints. The acupuncture practitioner chooses the correct acupoints for the problem being treated. The inserted needles may be twirled, moved up and down at different speeds and depths, heated, or charged with a weak electric current.

Acupuncture methods include the following:

• Auricular acupuncture: Acupuncture needles are placed at acupoints on the outer ear that match up with certain parts of the body. Other parts of the body used in acupuncture include scalp, face, nose, hand, wrist-ankle, and foot.
• Electroacupuncture.
• Trigger point acupuncture.
• Laser acupuncture.
• Acupuncture point injection.
• Microwave acupuncture.
• Acupressure.
• Moxibustion.
• Cupping.

What do people feel during acupuncture?

People may have a needling feeling during acupuncture, known as de qi sensation, making them feel heaviness, numbness, or tingling.

Have any laboratory or animal studies been done using acupuncture?

In laboratory studies, a treatment is tested in tumor samples to find out if it has any anticancer effects. In animal studies, a drug, procedure, or treatment is tested in mice or other animals to see if it is safe and effective. Laboratory and animal studies are done before a treatment is tested in people.

Laboratory and animal studies have tested the effects of acupuncture. For information on laboratory and animal studies, see the Laboratory/Animal/Preclinical Studies section of the health professional version of Acupuncture.

Have any studies been done in people?

In 1997, the National Institutes of Health (NIH) began looking at how well acupuncture worked as a complementary therapy for cancer -related symptoms and side effects of cancer treatments. Studies of acupuncture in cancer care also have been done in China and other countries.

• Nausea and vomiting caused by chemotherapy, surgery, and radiation therapy

  The strongest evidence for acupuncture has come from clinical trials on the use of acupuncture to relieve nausea and vomiting.

  • A 2013 review that included 41 randomized controlled trials found that acupuncture helped treat nausea and vomiting caused by chemotherapy.
  • Another review from 11 randomized clinical trials found that people receiving chemotherapy who also received acupuncture were less likely to experience acute vomiting compared to people who did not receive acupuncture.
  • A comparison of studies suggests that using specific acupuncture points may make a difference in how well acupuncture works to relieve nausea caused by chemotherapy.
  • People who received either true acupuncture or sham acupuncture were compared to people who received only standard care to prevent nausea and vomiting from radiation therapy. The study found that people in both the true and sham acupuncture groups had less nausea and vomiting than those in the standard care group.
  • In a 2016 randomized clinical trial of auricular acupressure that included 48 people with breast cancer treated with chemotherapy, people who received auricular acupressure had less intense and less frequent nausea and vomiting compared with those who did not have auricular acupressure. These findings are limited because the study had a small number of participants and no placebo group.
• Pain

  Acupuncture has been studied to help relieve pain in people with cancer. The results are mixed due to small sample sizes and design problems.

  • Cancer pain

    Most clinical trials of acupuncture for cancer pain use conventional acupuncture methods with needles in different parts of the body.

    In one review of several small studies, acupuncture reduced cancer pain in some people with various cancers. Another review concluded acupuncture with pain medicine worked better than the pain medicine alone. This review was limited by poor quality of clinical trials.

    A 2020 clinical trial to treat cancer pain showed that the combination of wrist-ankle acupuncture and auricular acupuncture was effective in reducing pain and use of pain medication. The study was limited by small size, lack of a placebo group, and short follow up.

  • Postoperative pain

    In several randomized clinical trials on pain after surgery, acupuncture reduced pain, but sample sizes were small and additional treatments were unknown. Some studies reported that pain decreased even more when acupuncture was used with standard care.

    In two randomized clinical trials in people who had a bone marrow aspiration and biopsy, acupressure was found to relieve pain and anxiety compared to sham acupressure.

  • Muscle and joint pain from aromatase inhibitors

    Aromatase inhibitors, a type of hormone therapy for postmenopausal women who have hormone-dependent breast cancer, may cause muscle and joint pain.

    • Five randomized controlled trials compared the effects of real and sham acupuncture in reducing pain. All five trials showed no side effects from either real acupuncture or sham acupuncture. Two trials showed real acupuncture was better than sham acupuncture in relieving joint and muscle pain, but the other three trials did not.
    • Observational studies have also reported both real acupuncture and sham acupuncture may relieve pain more than standard care.
    • A review of 17,922 people with cancer reported that real acupuncture relieved pain better than sham acupuncture.
  • Muscle and joint pain in cancer survivors

    In a 2021 randomized clinical trial that included 360 cancer survivors with muscle and joint pain, people reported better pain relief from acupuncture compared to standard care.

  • Chemotherapy-induced peripheral neuropathy

    Peripheral neuropathy is a common side effect of chemotherapy that can cause pain, paresthesia, sensory loss, and muscle weakness. These symptoms can cause a person to delay or end treatment. Chemotherapy-induced peripheral neuropathy (CIPN) can affect quality of life and may last long after chemotherapy has ended.

    The current standard of care for CIPN is symptom management such as narcotics and antidepressants. However, treatment may not relieve all of the pain, and it can cause dizziness, sedation, dry mouth, and constipation.

    Some randomized clinical trials of acupuncture have shown promise in treating CIPN. More evidence is needed to explore how acupuncture may relieve symptoms of CIPN and to find out which people may benefit most from acupuncture. For more information about these studies, see the Acupuncture to treat persistent CIPN from taxane or platinum-based chemotherapy section of the health professional version of Acupuncture.

• Hot flashes

  Hormone therapy may cause hot flashes in women with breast cancer and men with prostate cancer. Studies of the use of acupuncture to relieve hot flashes have shown mixed results.

  • Six randomized clinical trials studied the use of acupuncture to prevent hot flashes in breast cancer survivors. These trials found that acupuncture was safe and decreased hot flashes. It was not clear whether real acupuncture worked better than sham acupuncture.
  • A 2015 randomized trial of electroacupuncture in breast cancer survivors with hot flashes had four groups for treatment: electroacupuncture, sham acupuncture, gabapentin, and placebo. The trial looked at how well sham acupuncture worked compared to the placebo and compared hot flash relief in all groups. The study found that sham acupuncture worked better than gabapentin or the placebo, and both electroacupuncture and sham acupuncture gave better relief than gabapentin.
  • A 2016 randomized trial compared acupuncture plus self-care (as described in an information booklet provided to all patients) to self-care alone in breast cancer survivors. The study found that adding acupuncture reduced hot flashes after 12 weeks of treatment and at the 3- and 6-month follow-up visits. The study also found that acupuncture improved the participants' quality of life.
  • A 2016 review of 12 randomized trials in breast cancer survivors with hot flashes included six studies that compared real acupuncture with sham acupuncture. Of these, only two studies found that real acupuncture had a benefit compared with the sham treatment. The other studies found that acupuncture was no better than hormone therapy, venlafaxine, or relaxation therapy in relieving hot flashes.
  • Some studies have reported that acupuncture may relieve hot flashes in people with prostate cancer who are on androgen-deprivation therapy.
• Fatigue

  Fatigue is a common symptom in people with cancer and a frequent side effect of chemotherapy and radiation therapy.

  • Several randomized clinical trials have studied the use of acupuncture in reducing cancer-related fatigue. These trials found that acupuncture improved fatigue when compared to standard care alone. It is not clear whether real acupuncture works better than sham acupuncture.
  • A 2016 randomized clinical trial of 78 cancer survivors with cancer-related fatigue showed that infrared laser acupuncture used on certain acupoints was safe. People who received infrared laser acupuncture three times per week for 4 weeks had less fatigue than those who received sham treatment.
  • A 2016 randomized clinical trial of 288 breast cancer survivors with fatigue that wouldn't go away showed that two types of acupressure (relaxing and stimulating) significantly reduced cancer-related fatigue.
• Dry mouth (xerostomia)

  Several clinical trials have studied the effect of acupuncture in the treatment and prevention of dry mouth caused by radiation therapy in people with nasopharyngeal carcinoma and head and neck cancer.

  • In studies that compared acupuncture with standard care for preventing dry mouth in people receiving radiation therapy, people receiving acupuncture had fewer dry mouth symptoms and better saliva flow.
  • Two randomized controlled trials compared real and sham acupuncture for the prevention and treatment of dry mouth. These trials found that both real and sham acupuncture increased the flow of saliva.
  • A study on the long-term effects of acupuncture on dry mouth found that people had better saliva flow 6 months after receiving acupuncture treatment than before they began acupuncture treatment. People who received additional acupuncture had more saliva flow at 3 years compared to people who did not continue acupuncture treatment.

  One phase III clinical trial with sites in the United States and China studied 339 people with head and neck cancer who received true acupuncture, sham acupuncture, or standard care while receiving radiation therapy. Acupuncture was given three times per week during a 6- to 7-week course of radiation therapy. The dry mouth score reduction at 1 year was greater in the true acupuncture group than in the standard care group, but only slightly different from the sham acupuncture group. An additional phase III clinical trial is in progress to study the role of acupuncture for the treatment of dry mouth in people with head and neck cancer.

  Other trials are ongoing.

• Lymphedema

  There have been a number of case reports and studies that show acupuncture is safe and may decrease swelling and relieve symptoms in people with lymphedema in the arms and legs.

  • In one randomized clinical trial, acupuncture may have kept lymphedema from getting worse but did not decrease swelling or symptoms.
  • In a 2016 study, acupuncture along with moxibustion treatments were shown to increase energy levels and decrease pain in 23 people with breast or head and neck cancer and lymphedema.
  • In a 2016 randomized clinical trial that included 30 people with breast cancer and lymphedema, warm acupuncture (acupuncture and moxibustion) improved lymphedema symptoms for some participants. However, a small portion of people who did not receive warm acupuncture also had improved symptoms. People who received warm acupuncture also had improved shoulder joint range of motion and quality of life compared to those who did not receive warm acupuncture.
  • A randomized clinical trial that included 82 people with breast cancer and lymphedema found that those who received acupuncture had no change in lymphedema symptoms compared to those who did not receive acupuncture.
• Ileus

  After cancer surgery, some people develop ileus. Randomized clinical trials that studied acupuncture for ileus had mixed results.

  A 2023 randomized clinical trial of 249 patients in China compared electroacupuncture with sham acupuncture in people who underwent laparoscopic surgery for colon cancer. The study reported that the average time to recover bowel function was shorter in the electroacupuncture group compared with the sham acupuncture group. Electroacupuncture after laparoscopic colon cancer surgery was reported to be safe and effective in reducing postoperative ileus.

• Anxiety

  A randomized clinical trial that included 141 people studied the effect of acupuncture on relieving anxiety in people undergoing surgery. Participants received either standard care for relieving anxiety or acupuncture before surgery, during surgery, or both combined. Acupuncture before surgery relieved anxiety for people waiting for their surgery to begin. Acupuncture before and during surgery combined were most effective in improving quality of life after surgery. Because there was no group that received sham acupuncture as a placebo, future studies are needed to find out if acupuncture is useful for anxiety.

  A randomized clinical trial published in 2013 studied cancer-related fatigue in 246 patients. Participants reported that acupuncture reduced fatigue, anxiety, and depression, and improved quality of life when compared with standard care.

  An analysis of a larger study showed that acupressure was linked to decreased anxiety and pain and fewer symptoms of depression when compared with standard care.

• Sleep problems

  Studies have shown that acupuncture may help relieve sleep problems.

  • A 2019 randomized controlled trial of cancer survivors found that acupuncture reduced the severity of insomnia.
  • A 2014 study found that acupuncture improved sleep slightly more than standard care.
  • A 2011 study that compared acupuncture with fluoxetine found that acupuncture worked better in relieving depression and improving sleep.
• The immune system

  Studies that suggest acupuncture may improve the immune system are limited.

• Other symptoms of cancer and side effects of cancer treatment

  Other clinical trials in people with cancer have studied the effects of acupuncture on cancer symptoms and side effects caused by cancer treatment, including weight loss, cough, coughing up blood, fever, depression, proctitis, speech problems, blocked esophagus, chemotherapy-related cognitive problems, and hiccups. A randomized study of acupressure in managing opioid -induced constipation suggested that it helped to improve quality of life and reduce symptoms. Studies have shown that treatment with acupuncture either relieves symptoms or keeps them from getting worse.

• Acupuncture in children with cancer

  Few studies have examined the effects of acupuncture in children with cancer. In a study of 80 participants, the acceptance rate for acupuncture was 82% in children, adolescents, and young adults who were having a hematopoietic stem cell transplant.

  Adverse effects of acupuncture in children appear to be rare and similar to the same effects found in adults. One study in children who received acupuncture showed that there was no higher rate of adverse effects in those with cancer-related thrombocytopenia or neutropenia.

Have any side effects or risks been reported from acupuncture?

There have been few complications reported. Problems may arise from using needles that are not sterile, placing the needle in the wrong place, movement of the person receiving acupuncture, or a defect in the needle.

Side effects include the following:

• Soreness and pain during treatment.
• Feeling tired, lightheaded, or sleepy.
• Getting an infection.

A strict clean needle method must be used when acupuncture treatment is given to people with cancer, because chemotherapy and radiation therapy weaken the body's immune system.

Is acupuncture approved by the US Food and Drug Administration (FDA)?

The FDA approved acupuncture needles for use by licensed practitioners in 1996. The FDA requires that sterile needles be used and labeled for single use by qualified practitioners only.

More than 40 states and the District of Columbia have laws about acupuncture practice. The National Certification Commission for Acupuncture and Oriental Medicine (www.nccaom.org) certifies practitioners of acupuncture and traditional Chinese medicine (TCM). Most states require this certification.