Recent large scale research says the evidence for acupuncture is growing

“So....does acupuncture actually work?”

​Believe it or not, as an acupuncturist I do get asked this question a fair bit. Having devoted the last 13 years to the study and practice of acupuncture, it might prompt a bit of existential angst in me if I had any doubt over the amazing capabilities of my chosen profession! If I didn't think it worked, I certainly would not still be in practice. ​Needless to say, I have no doubt in the ability of acupuncture to 'work' and that is why I continue to study, practice and admire it's effects in all their glory.

​However, of course I understand the need for people to have scientific evidence of acupuncture's claims, and I also enjoy reading all the current research in the area. So I was very excited to read about “The Acupuncture Evidence Project” (2017), an extensive systematic review of acupuncture research which examined over 1000 clinical trials worldwide, and I would like to summarise it for you in this post.  

“The Acupuncture Evidence Project” (AEP) set out to examine the current state of evidence relating to acupuncture. Acupuncture research is a blossoming field, and our understanding of this modality is expanding by the day, but it is fraught with methodological difficulties and bias (just like most scientific research). The aim of the AEP was to expand on previous large scale reviews to encompass the largest number of high quality research papers relating to acupuncture worldwide to date. It took into account risk of bias, quality of evidence, quality of methodology, and the issue of 'sham'/'placebo' acupuncture to enable the most reliable assessment of the research as possible. Conducted over three and a half years (2013 – 2016) the AEP was an immense undertaking, with impressive results.

​According to the AEP, the number of conditions for which acupuncture has been shown to have “evidence of positive effect”, the highest level of evidence, has risen from four (4) in 2010, to eight (8) in 2016. This means that there is no doubt that acupuncture has a positive effect for:

​- Allergic rhinitis (perennial & seasonal)
- Chemotherapy-induced nausea and vomiting (CINV) (with anti-emetics)
- Chronic low back pain
- Headache (tension-type and chronic)
- Knee osteoarthritis
- Migraine prophylaxis
- Postoperative nausea & vomiting; and
- Postoperative pain.
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Even more promising, the number of conditions for which acupuncture has been shown to have “Evidence of potential positive effect”, the second highest level of evidence, has risen from twenty (20) in 2013, to thirty eight (38) in 2016. The clinical trials for conditions listed in this category indicated that acupuncture has a positive effect, and were of moderate or high quality, but concluded that there is not yet sufficient evidence to draw firm conclusions. This may simply be because there hasn't been enough research done yet, but if the direction of acupuncture research continues in this direction (as you can see the evidence is mounting even in just the last few years), it won't be long until many of the conditions in this category are promoted to the highest level of evidence. In the meantime, it is likely that these conditions may have a positive effect from acupuncture treatment:

- Acute low back pain
- Modulating sensory perception thresholds
- Acute stroke
- Neck pain
- Ambulatory anaesthesia
- Obesity
- Anxiety
- Perimenopausal & postmenopausal insomnia
- Aromatase-inhibitor-induced arthralgia
- Plantar heel pain
- Asthma in adults
- Post-stroke insomnia
- Back or pelvic pain during pregnancy
- Post-stroke shoulder pain
- Cancer pain
- Post-stroke spasticity
- Cancer-related fatigue
- Post-traumatic stress disorder
- Constipation
- Prostatitis pain/chronic pelvic pain syndrome
- Craniotomy anaesthesia
- Recovery after colorectal cancer resection
- Depression (with antidepressants)
- Restless leg syndrome
- Dry eye
- Schizophrenia (with antipsychotics)
- Hypertension (with medication)
- Sciatica
- Insomnia
- Shoulder impingement syndrome (early stage) (with exercise)
- Irritable bowel syndrome
- Shoulder pain
- Labour pain
- Smoking cessation (up to 3 months)
- Lateral elbow pain
- Stroke rehabilitation
- Menopausal hot flushes
- Temporomandibular pain

There is also a third category, of “Conditions with weak positive/unclear evidence supporting the effectiveness of acupuncture”. This section listed seventy-one (71) conditions for which reviews found positive results, but the trials were of low quality, or there were conflicting levels of evidence within or between reviews. As with the second category of evidence, this simply means the research is not conclusive yet, but it will be a case of 'watch this space'. As the level of evidence has increased for 24 conditions over the span of this research project, it is anticipated that this pattern will continue, and this is not a reason to infer that acupuncture is ineffective for these conditions.

In addition to these three categories, the AEP found that there were eleven (11) conditions reviewed that showed “evidence of cost-effectiveness” – that is – it produced good results without costing a lot of money, or significantly less than the relevant conventional medical treatment. Conditions where acupuncture has been shown to be cost-effective are:

- Allergic Rhinitis
- Low back pain
- Ambulatory Anaesthesia
- Migraine
- Chronic Pain
- Neck Pain (plus usual medical care)
- Depression
- Osteoarthritis
- Dysmenorrhoea
- Post-operative nausea and vomiting
- Headache

Overall, you can see that there are some really great results here. To summarise, here is “the bottom line” as quoted from the plain english summary of the Acupuncture Evidence Project:

“Our study found evidence for the effectiveness of acupuncture for 117 conditions, with stronger evidence for acupuncture’s effectiveness for some conditions than others. Acupuncture is considered safe in the hands of a well-trained practitioner and has been found to be cost effective for some conditions. The quality and quantity of research into acupuncture’s effectiveness is increasing.”

Considering the fact that research funding for acupuncture worldwide is relatively quite low (compared to other areas of medical research that receive an infinitely greater amount of funding), I find these results extremely reassuring. The body of evidence showing that acupuncture can be helpful for an ever-increasing number of conditions is rapidly growing . Our knowledge of just how well it 'works' will only continue to improve as more research is conducted. I look forward to a future where acupuncture is truly recognised for the wonderfully versatile and holistic modality that it is, and the question that opened this blog post will be one that no longer needs to be asked.

You can access both the full text and the plain english summary of “The Acupuncture Evidence Project – A comparative literature review 2017” at this link: https://www.acupuncture.org.au/resources/publications/the-acupuncture-evidence-project-a-comparative-literature-review-2017/
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