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). TCM uses acupuncture, diet, herbal therapy, meditation, exercise, and massage to restore health.

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 condition.

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 patients feel during acupuncture?

Patients 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, tumor samples are used to test a new treatment and find out if it is likely to have any anticancer effects. In animal studies, tests are done to see if a drug, procedure, or treatment is safe and effective in animals. Laboratory and animal studies are done before a treatment is tested in people.

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

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 fewer chemotherapy patients in the acupuncture groups had acute vomiting compared to the control group.
  • A comparison of studies suggests that the specific acupuncture point used may make a difference in how well acupuncture works to relieve nausea caused by chemotherapy.
  • Patients who received either true acupuncture or sham acupuncture were compared to patients who received only standard care to prevent nausea and vomiting from radiation therapy. The study found that patients 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 in 48 breast cancer patients treated with chemotherapy, patients 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 since the study had a small number of patients and no placebo group.
• Pain

  Acupuncture has been studied to help relieve pain in cancer patients. 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, acupuncture reduced cancer pain in some patients with various cancers, although the studies were small. 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 the pain, but sample sizes were small and additional treatments were unknown. Some studies reported that when acupuncture was used with standard care, pain relief was better.

    In two randomized clinical trials in patients having 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. In two of the studies, patients receiving real acupuncture had more pain relief than a control group of patients who were waiting to receive treatment later.
    • Observational studies have also reported both real acupuncture and sham acupuncture may relieve pain more than standard care.
    • A review of 17,922 patients reported that real acupuncture relieved pain better than sham acupuncture.
  • 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 patient 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 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 patients may benefit most from acupuncture. See the Acupuncture to treat persistent CIPN from taxane or platinum-based chemotherapy section of the health professional version of Acupuncture for more information about these studies.

• 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 patients' quality of life.
  • A 2016 review of 12 randomized trials in breast cancer survivors with hot flashes included 6 studies that compared real acupuncture with sham acupuncture. Of these, only 2 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 prostate cancer patients on androgen-deprivation therapy.
• Fatigue

  Fatigue is a common symptom in patients 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 in cancer patients. Patients who received infrared laser acupuncture 3 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 xerostomia (dry mouth) caused by radiation therapy in patients with nasopharyngeal carcinoma and head and neck cancer.

  • In studies that compared acupuncture with standard care for preventing dry mouth in patients being treated with radiation therapy, patients treated with acupuncture during radiation therapy had fewer 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 patients had better saliva flow at 6 months compared to before treatment. Patients who received additional acupuncture had more saliva flow at 3 years compared to patients who did not continue acupuncture treatment.

  One phase III clinical trial with sites in the United States and China studied 339 patients 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 head and neck cancer patients.

  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 patients with lymphedema in the arms and legs.

  • In one randomized clinical trial, acupuncture was found to keep lymphedema from getting worse but did not decrease swelling or symptoms.
  • In a 2016 study, 23 breast and head and neck cancer patients with lymphedema who had acupuncture and moxibustion treatments reported improved levels of energy and decreased pain.
  • In a 2016 randomized clinical trial of 30 breast cancer patients with lymphedema, about half of those treated with warm acupuncture (acupuncture and moxibustion) had improved symptoms of lymphedema. About one-fourth of the control group (drug therapy) had improved symptoms. The acupuncture and moxibustion group also had improved shoulder joint range of motion and quality of life compared with the control group.
  • A randomized clinical trial of 82 breast cancer patients with lymphedema found no significant difference in symptoms in patients treated with acupuncture compared with the control group.
• Ileus

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

• 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 cancer patients have studied the effects of acupuncture on cancer symptoms and side effects caused by cancer treatment, including weight loss, cough, coughing up blood, fever, anxiety, depression, proctitis, speech problems, blocked esophagus, chemotherapy-related cognitive problems, and hiccups. Studies have shown that treatment with acupuncture either relieves symptoms or keeps them from getting worse.

Have any side effects or risks been reported from acupuncture?

There have been few complications reported. Problems are caused by using needles that are not sterile and from placing the needle in the wrong place, movement of the patient, or a defect in the needle.

Problems include the following:

• Feeling 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 cancer patients, 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.