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Acupuncture for Chronic Pain

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Acupuncture for Chronic Tension-Type Headache, Migraine, and Cluster Headaches

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Acupuncture for Chronic Pain; Osteoarthritis, Headache, Back, Neck or Shoulder Chronic Pain

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Acupuncture for Lower Back Pain

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Acupuncture for Sciatica due to Herniated Disc

 

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Acupuncture for Chronic Pain

 

Let’s begin with the NICE guidelines, which recommend acupuncture for the treatment of chronic pain in people age 16 and up. “Who are NICE ?” I hear you ask, they are the National Institute of Clinical Excellence, and they are a large UK body who make recommendations for best healthcare practices (the NHS draws best practice guidance from them for example). For NICE to make recommendations, the evidence of success base has to be very high.

 

These are the guidelines: Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, NICE guideline, Reference number:NG193, Published: 07 April 2021. And here’s a great pdf they’ve made to view the guidelines in a basic one-page flow chart Chronic pain (primary and secondary) – using NICE guidelines for assessment and management.

 

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Let me briefly talk you through the NICE guide for pain:

 

They recommend four things for managing chronic pain:

• Exercise programmes and physical activity

• Psychological therapy

• Acupuncture

• Pharmacological management.

This means: movement, talking and mind-work, acupuncture, and medication. It’s obviously great for me to see that acupuncture is recommended by such a top-level health authority. And, I’m really pleased to see the psychological therapy is in there too.

 

These are the chronic pain conditions they specifically advise using acupuncture (and the other modalities) to help:

• Fibromyalgia

• Chronic primary headache and orofacial pain

• Chronic primary musculoskeletal pain

• Chronic primary visceral pain (ie abdominal or pelvic pain)

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NICE clarifies the type of pain to be chronic primary pain that has no clear underlying condition, or symptoms may seem to be out of proportion to any observable injury or disease. Do take note, that in accordance with the guidelines and in accordance with general sensible practice, you’ve got to check for other potential causes for pain and address these- I always recommend/require that you see your GP for their input and testing and diagnostic work first or alongside holistic support.

 

To be open with you, due to the cost of acupuncture, they suggest only 5 sessions are offered as otherwise they feel it’s not cost effective. Take note- it’s not that they feel more sessions won’t help, it’s that they feel it’s too expensive on the NHS to offer more.

 

Being honest, they recommend that the acupuncture is delivered by someone in the NHS of band 7 or above. Now, most Traditional Acupuncturists are not also nurses working in the NHS, although we are degree trained. It’s fair that I point it out to you. Why this is, I’m honestly not sure. If you look out for BAcC membership in the letters next to people’s names, or the BAcC logo or the professional standards agency logo on an acupuncturist’s website, you can be sure you’re in well-trained hands- but please do check they have proper acupuncture training and haven’t done a short course, and that they feel confident doing muscular-skeletal pain work, like I do.

 

 

 

Acupuncture for Chronic Tension-Type Headache, Migraine, and Cluster Headaches

 

In the specific headache guidelines, NICE recommends up to 10 sessions of acupuncture for chronic tension type headache and migraines in people age 12 and up and.

 

Here are the full guidelines to read https://www.nice.org.uk/guidance/cg150, and here’s a NICE simple PDF diagram https://www.nice.org.uk/guidance/cg150/resources/visual-summary-on-prophylaxis-of-migraine-with-or-without-aura-pdf-15363542125 .

 

They advise that if the usual medications haven’t worked, then up to 10 sessions of acupuncture are recommended. My understanding again is that after this amount of treatment they consider it’s no longer cost effective- it’s NOT saying that more acupuncture doesn’t continue to help.

 

My personal comment to this is that with chronic pain, you generally might choose to continue having top-up acupuncture treatments at a much reduced frequency to maintain the effects, and not stop once you get the benefit! When you come for acupuncture with me, we’ll discuss the benefit you’re getting and whether you feel it’s worth you continuing treatment or not. Before we get to this point- if you haven’t found it useful- I will have referred you on to a different holistic treatment practitioner.

 

Remember to also always see your GP for proper NHS investigation for headaches as per the NICE advice before or alongside holistic support.

 

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Acupuncture for Chronic Pain; Osteoarthritis, Headache, Back, Neck or Shoulder Chronic Pain

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An excellent high quality gold-standard piece of research which demonstrates that acupuncture is good for pain conditions is: Acupuncture for chronic pain: individual patient data meta-analysis by Vickers et al 2018. It analysed results of 20,000 adults with osteoarthritis, chronic headache or musculoskeletal pain (back, neck or shoulder), and it concluded:

 

• Acupuncture was more effective than control for all pain conditions (acupuncture worked for all types of pain conditions studied)

• Acupuncture does not work by placebo for treatment of chronic pain (this study shows that acupuncture isn’t a placebo effect, which is brilliant to see in print)

• The positive pain-relief effects persisted over time (this was a great finding- that even after a whole year, people were still getting pain reduction benefit after a course of treatment, only dropping it’s pain reducing effect by 15% a year after the treatment finished.)

 

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You can read more about research and evidence of acupuncture for neck pain, osteoarthritis of the knee pain, and headaches in factsheets by the British Acupuncture Council:

Acupuncture for neck pain

Acupuncture for osteoarthritis of the knee

Acupuncture for headaches and migraines

 

 

 

Acupuncture for Lower Back Pain

 

This is a nitty gritty discussion topic. Read on as I try my best to pick it apart for you, as you’ll see that the research has been interpreted differently by different countries.

 

The official UK recommendations for acupuncture for chronic non-specific lower back pain (pain lasting more than 3 months, and not having a known cause to it) are mixed. There’s an incredibly interesting discussion about the nuances in the way data is interpreted and decided by the different organisations reviewing it and the biases they use when comparing – for  example acupuncture versus psychological therapy or exercise on the British Acupuncture Council website’s Back Pain Fact Sheet commentary here.

 

The lower back pain NICE guidelines don’t recommend acupuncture – but they DO recommend massage when combined with exercise and potentially psychological work. So for my clinic, this is a win, as I generally always combine acupuncture with massage for back pain (and usually any kind of muscular pain). (As you’ll have read above, for other types of pain, the NICE guidelines favour acupuncture). But let’s dig deeper…

 

I’d like to look into the studies that NICE used to make their decisions in the back pain guidelines Low back pain and sciatica in over 16s: assessment and management NG59

 

Of real interest is to pick out the two large studies which the NICE guidelines referred to as their evidence and pick them apart a bit to help you understand them. When I read them I see where they are so flawed in their interpretation by NICE and show that acupuncture for back pain does work really well! And, that Germany decided to approve acupuncture off the back of one of these studies- whereas the UK didn’t. Here are the two large studies:

 

 

A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain, Cherkin et al, 2010. This large American study with 638 participants found that both acupuncture and sham acupuncture were superior to ‘usual care’ alone (usual care means medication/ primary care/ physiotherapy). And results were still superior after a year.

 

However, because both the ‘sham’ acupuncture and the real types of acupuncture were not that much different in their results, this is where NICE therefore takes a look and says that acupuncture can’t be recommended because real acupuncture isn’t as good as ‘sham’ acupuncture. Even though the sham acupuncture was better than medication/physiotherapy/primary care!

 

It’s really important to note in this study that the sham they used in this study was actually acupressure on the same actual acupuncture points as used in the acupuncture group. I would debate that this study therefore proved that both acupuncture and acupressure works better for low back pain than usual care. Which is amazing, and shows how well both acupuncture and acupressure work.

 

 

German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups, Haake et al, 2006.

 

This large German trial of 1162 patients is amongst the largest acupuncture studies ever conducted. The findings of these studies helped shift German health authority policies to approve acupuncture reimbursement to patients for chronic low back pain and knee osteoarthritis- that’s how effective they deemed acupuncture to be!

 

Findings demonstrated that true acupuncture was almost twice as effective than conventional care (‘conventional care included medication, physiotherapy, and exercise), even six months after the treatment stopped! Also, the sham acupuncture was more effective than the conventional care!

 

In this trial again, I see it that the findings are discussing which form of acupuncture is better-  sham or true. In this study, both sham and true used proper inserted acupuncture needles- the same type of needles, it wasn’t acupressure. The true acupuncture needles were inserted only 1-2mm deeper than the sham acupuncture points which were still properly inserted. And the true acupuncture also received rotation to the needle.

Both sham and true used acupuncture points on the back and legs- the true acupuncture using true acupuncture points, but the sham acupuncture using ‘fake’ points. However, these points still fall within domains of area of influence under theory that us acupuncturists refer to as the Six Divisions in traditional acupuncture- they’re not areas which don’t do anything.

 

For me, this study is another winner- acupuncture (and sham acupuncture) works much better than medication/physio/exercise.

 

Germany said ‘yay’! to acupuncture on the basis of this, but the UK interpreted it as ‘no’. Odd!

 

The Scottish ‘equivalent’ of NICE- Scottish Intercollegiate Guidance Network SIGN-  DOES recommend acupuncture, but only as short term strategy. SIGN recommends that acupuncture should be considered short term for people with chronic low back pain or osteoarthritis [SIGN, 2019], they comment that the evidence is high- This is Grade A recommendation (evidence included at least one meta-analysis, systematic review, or randomized controlled trial rated as 1++, or a body of evidence consisting principally of studies rated as 1+ demonstrating overall consistency of results). This guide is being re-written in 2026, so I’m hoping the updated guidelines continue to make the recommendation.

 

Take note that I always recommend a multi-modal approach to lower back pain- including physio and exercise as well as acupuncture. And remember that you’ve always got to see your GP to have pain investigated for other causes on the NHS- this is so important.

 

 

 

Acupuncture for Sciatica (due to Herniated Disk)

 

There’s a recent piece of research from 2024 worth talking about; Acupuncture vs Sham Acupuncture for Chronic Sciatica From Herniated Disk A Randomized Clinical Trial, Tu et al 2024.

 

So far I’ve discussed back pain research when there’s no ‘cause’ to it. This study looks at pain relief for sciatica due to herniated spinal disk. This is a great study, well designed it seems, and a clever use of sham versus real acupuncture- although again, it’s no surprise to me that both groups benefitted from pain relief as the stimulation of sham acupuncture points via acupressure still will be stimulating zones relating to the nearby actual channels. You’ll read however, that the true acupuncture was superior.

 

In this study, they had just over 200 people with sciatic pain that lasted on average of around 3 years, and split them into two groups. Both groups received 10 sessions of acupuncture or sham acupuncture over four weeks. Both groups saw improvement from early in the treatment right up to a year after! But the true acupuncture was superior.

 

Both groups began scoring their leg pain on average at 60/100 on a pain scale. After 4 weeks the acupuncture group scored about 30/100 (pain halved) and the sham group scored 45/100. After a year, the results continued to get better for both groups, with the acupuncture group coming down to 23/100 versus 34/100 in the sham group. They also reported results on disability scores (the actual function as opposed to the pain) and general lower back pain- both of which reduced in both groups, but again was better in the acupuncture group.

 

For the method, in both groups they stuck little foam pads where the points were and then either needled a true needle through it, or, for sham they stuck a blunt needle into it which only pressed the skin and stayed sticking up (giving the feel and look of a needle being inserted).

 

If you’d like to know which points they used, here’s the info.  In the true acupuncture group the acupuncture points used in this study were Bl 25 and Bl26 for everyone. In addition, if the pain was down the side of the leg, the points added were: GB 30, GB31, GB33, GB34 (which are on the back of the bum but more to the side and side of the leg). If the pain was instead down the back of the leg, the points added were: Bl36, Bl40, Bl54, Bl57, Bl60 (which are on the back of the bum and back of the leg). If there was pain both down the side and back of the leg the practitioner could choose a combination of five from both sets of points.

 

In the ‘sham’ acupuncture group the points were midway between both the GB and Bl channels into non-real points (although as I’ve commented, my personal opinion is that the sham will of course have influence over both these areas, influencing both taiyang and shaoyang acupuncture zones of influence in traditional acupuncture theory). If you’d like to see the actual location, there’s a nice coloured diagram of true and sham points that the authors have published in a supplement here.

 

I feel that this study tests not ‘acupuncture versus fake acupuncture’, but, instead ‘inserted acupuncture in specific meridian points versus acupressure in an areas midway between two zones of meridian influence’.

 

Either way, the true acupuncture works better, and many people benefitted from treatment without needing surgery or prolonged use of intense medication. A winner in my eyes- but being an acupuncturist, my bias will shine through!