Acupuncture

Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.

It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or 'life force', flows through the body in channels called meridians. This life force is known as Qi (pronounced 'chee'). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners - called acupuncturists - use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain. The availability of acupuncture on the NHS is limited.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. But there is little or no scientific evidence that acupuncture works for many of the conditions on which it is often used. More scientific research is needed to discover whether acupuncture is effective against these and other conditions.

There is no scientific evidence for the existence of Qi, or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture's method of action is fully understood.

For more information, see the Evidence section of this article. If you choose to have acupuncture, you should make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option for one condition: lower back pain. Read the NICE 2009 guidelines on low back pain

What happens

Typically, an initial acupuncture session will involve an assessment of general health, a medical history and a physical examination, followed by insertion of the acupuncture needles. Most acupuncture sessions last between 20 and 30 minutes.

Assessment and examination

The acupuncturist will ask you about your general health and your medical history. If your visit is due to a specific health condition, they will ask about the symptoms of this condition, and about any other treatment you have received for it. After this, the acupuncturist may do a physical examination.

Insertion of the needles

Once the acupuncturist feels they have a clear picture of your health, they will move to the insertion of the acupuncture needles.

These needles are inserted into specific places on the body, which practitioners call 'acupuncture points'.

During the session, you will usually be asked to sit or lie down. You may also be asked to remove some clothes, so that the acupuncturist can access the relevant places on your body.

The needles used are fine, and usually around 30mm long. They should be single-use, pre-sterilised needles, which are disposed of immediately after use.

Acupuncturists believe that there are over 500 acupuncture points on the body. In a session, typically between one and 12 points will be used. The needles may be inserted just under the skin, or deeper so that they reach muscle tissue. Once the needles are in place, they may be left in position for up to 30 minutes.

When the needles are inserted, you may feel a tingling or a dull ache. You should not experience any significant pain. If you do, let your acupuncturist know straight away.

Assessment and examination

The acupuncturist will ask you about your general health and your medical history. If your visit is due to a specific health condition, they will ask about the symptoms of this condition, and about any other treatment you have received for it.

After this, the acupuncturist may do a physical examination.

Safety and regulation

In England, the practice of acupuncture is not regulated by the government. This means that anyone can call themselves an acupuncturist, even if they have no training or experience. For this reason, it is important to ensure that if you want to visit an acupuncturist, you check that they carry out the treatment in a way that is safe, hygienic and acceptable to you.

When it is carried out by a qualified practitioner, acupuncture is a safe. Serious side effects or complications arising from treatment are extremely rare.

Risks and side effects

When conducted by a qualified practitioner, acupuncture is safe.

Mild, short-lasting side effects occur in around 7-11% of patients. These include:

  • pain where the needles puncture the skin
  • bleeding or bruising where the needles puncture the skin
  • drowsiness
  • worsening of pre-existing symptoms

Serious complications from treatment, such as infections or damage to tissue, are extremely rare. They usually occur only as a result of bad practice, carried out by an acupuncturist who has not been properly trained.

Who may not be able to have it?

Due to the slight risk of bleeding, people with bleeding disorders, such as haemophilia (where blood is unable to clot) may not be able to have acupuncture. People who take medicines that prevent the blood clotting, called anticoagulants, also may not be able to have acupuncture. If you have a blood disorder, or you are taking medicine that prevents blood clots, talk to your GP before you have acupuncture.

It is generally safe to have acupuncture when you are pregnant, but you should let your acupuncturist know beforehand. This is because certain acupuncture points cannot be used safely during pregnancy.

Evidence

There is some scientific evidence that acupuncture is effective for a small number of health conditions. But for the majority of conditions against which acupuncture is used, the scientific evidence is inconclusive, or there has been no attempt to collect good quality evidence. For a small number of conditions, there is evidence showing that acupuncture does not work.

More research is needed into the effectiveness of acupuncture on a wide range of conditions.

It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect, and not because of the treatment itself.

When scientists gather evidence on the effectiveness of a treatment, they take the placebo effect into account.

There is reasonably good evidence that acupuncture is an effective treatment for

  • chronic back pain
  • dental pain
  • pain and discomfort during gastrointestinal endoscopy
  • headache
  • nausea and vomiting after an operation
  • pain and discomfort during oocyte retrieval (a procedure used during IVF)
  • osteoarthritis of the knee

This means that scientific trials conducted to investigate the effect of acupuncture on these conditions found that acupuncture did have a beneficial effect.