Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
References:
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
References:
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
References:
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
References:
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
References:
Helen Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
CKD
A systematic review (Melo et al, 2020) examined acupuncture’s effect in CKD over 9 RCT’s, finding positive effects on improving quality of life, fatigue, and sleep in patients with chronic kidney disease, but not on the clinical variables of the disease, such as serum creatinine and glomerular filtration rate.
According to Lui et al’s (2022) narrative overview of preclinical studies and clinical trials published in Frontiers in Nephrology, acupuncture has been shown to improve symptoms and delay the progress of chronic kidney disease (CKD). The review suggests that acupuncture may be effective in reducing albuminuria, improving glomerular filtration rate, relieving symptoms, and improving the quality of life of patients with CKD.
Specifically, in diabetic patients with CKD, a prospective RCT (Wang et al, 2014; n=59) found that auricular (ear) acupuncture may have positive effects on improving the quality of life in these patients. The auricular acupressure group had significantly higher SF-36 (Short Form-36 Health Survey) scores and lower PSQI (Pittsburgh Sleep Quality Index) scores compared to the control group, indicating improvements in quality of life and sleep quality.
A preliminary small study (Yu et al, 2017; n=53) found acupuncture at points LI4, St36, and Kid3 for 12 weeks reduced creatinine levels and increased eGFR levels in patients with CKD.
Possible mechanisms of action of acupuncture in CKD include, per Lui et al, 2022, include “oxidative stress inhibition, reducing inflammatory effects, improving haemodynamics, maintaining podocyte structure, and increasing energy metabolism” [sic], leading the researchers to conclude that acupuncture could potentially present a safe, inexpensive treatment modality toward CKD, to improve patient symptoms and slow the progress of renal dysfunction.
Fatigue in End Stage Renal Disease (ESRD)
Hadadian et al (2016) found positive effects from Transcutaneous Electrical Acupoint Stimulation (TEAS) on fatigue among ESRD patients receiving haemodialysis treatment.
Shariati et al’s RCT (2012; n=48) found acupressure beneficial for end-stage renal disease patients on haemodialysis, with Ht7, Li4 and SP6 points used, significant differences in the PSQI (Pittsburgh Sleep Quality Index) and other sleep measures of duration, and daytime function were seen between the acupressure group and the control group after intervention.
Haemodialysis side effects
An RCT (Hmwe et al. 2015; n=108), examined the effects of acupressure on depression, anxiety, and general psychological distress in patients with haemodialysis, finding it could have positive effects on improving the psychological wellbeing of patients. The acupressure group had significantly lower DASS-21 (Depression, Anxiety Stress Scales) scores and GHQ-28 (General Health Questionnaire) scores compared to the control group, indicating improvements in depression, anxiety, stress, and general psychological distress.
Studies by both Sabouhi et al (2013; n=96) and Eglence et al (2013; n=118).found acupressure to reduce fatigue in haemodialysis patients.
Renal Calculi – Kidney Stones, renal colic
Acupuncture has also been used for the management of renal colic caused by urinary calculi (kidney stones), as one of the main issues involved pain management, and the mechanisms of action of acupuncture in pain are well-understood. See our page, for example on Chronic Pain.
Acupuncture at Neiguan (PC 6) and Zusanli (ST 36) points was shown in a Chinese RCT (n=240) to have a good analgesic (painkilling) effect in renal colic pain with a low incidence of adverse reactions, this was compared to two groups who each received pharmaceutical treatments.
Wu et al (2023; n=82) also found acupuncture beneficial for acute pain in patients with urinary calculi, as did Zhang et al, 2021 (n=80), in comparison with drug treatment.
A later RCT study (Tu et al, 2022, n=80) combined acupuncture with diclofenac drug treatment in the emergency department for patients with acute renal colic due to urolithiasis (stones); they concluded that acupuncture combined with diclofenac injection to be safe, providing fast, effective pain relief.
Qu et al (2022) conducted a systematic review and meta-analysis of acupuncture in renal colic caused by urinary calculi; over 15 studies they found acupuncture an effective and safe adjuvant therapy for kidney stone pain.
Later, Chen et al’s (2023) meta-analysis and trial sequence analysis examined 13 studies (n=1212) comparing conventional medicinal painkillers with acupuncture, finding acupuncture to be able to efficiently relieve renal colic with fewer adverse effects than those seen in pharmaceutical approaches. Both Que et al, and Chen et al (2022; 2023) noted some limitations in the number and quality of studies, warranting further future RCTs in this area.
Forthcoming is a study protocol for a randomized controlled trial published in Trials aims to evaluate the efficacy and safety of acupuncture as an adjunctive treatment to diclofenac for acute renal colic caused by urinary calculi (Cao et al, 2021).
During extracorporeal shock wave lithotripsy (ESWL) for kidney stones
Clinical studies by Tavakoli et al (2014); Rogenhofer et al (2004; n=90); Agah et al (2004; n=100) and Medina et al (2005; ) all found acupuncture effective on pain during ESWL.
A meta-analysis and systematic review of studies into acupuncture during ESWL (Chen et al, 2023b; n=1220), found acupuncture associated with higher pain relief and low side effect profile and supported the efficacy of acupuncture for pain relief during and after ESWL.
References:
Agah M, Falihi A. The efficacy of acupuncture in extracorporeal shock wave lithotripsy. Urol J. 2004 Summer;1(3):195-9.
Cao, Y., Tu, J.F., Shi, G.X., Wang, L.Q., Jia, L.C., Li, B., Liu, B.L., Yao, W.H., Pei, X.L., Qu, Z.C. and Liu, C.Z., 2021. Acupuncture as adjunctive therapy for acute renal colic caused by urinary calculi: study protocol for a randomized controlled trial. Trials, 22(1), pp.1-8.
Chen, H.T., Kuo, C.F., Hsu, C.C., Lai, L.C., Cheng, A.C., Sun, C.K. and Hung, K.C., 2023. Clinical efficacy of acupuncture for pain relief from renal colic: A meta-analysis and trial sequence analysis. Frontiers in Medicine, 9, p.1100014.
Chen, H.T., Hung, K.C., Hsu, Y.C., Kuo, J.R., Chang, Y.J., Chen, I.W. and Sun, C.K., 2023b. Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies. Frontiers in Medicine, 10, p.1114485.
Eglence, R., Karatas, N. and Tasci, S., 2013. The effect of acupressure on the level of fatigue in hemodialysis patients. Alternative Therapies in Health and Medicine, 19(6), p.23.
Hmwe, N.T.T., Subramanian, P., Tan, L.P. and Chong, W.K., 2015. The effects of acupressure on depression, anxiety and stress in patients with hemodialysis: A randomized controlled trial. International journal of nursing studies, 52(2), pp.509-518.
Hadadian, F., Sohrabi, N., Farokhpayam, M., Farokhpayam, H., Towhidi, F., Fayazi, S., Soroush, A. and Abdi, A., 2016. The effects of transcutaneous electrical acupoint stimulation (TEAS) on fatigue in haemodialysis patients. Journal of Clinical and Diagnostic Research: JCDR, 10(9), p.YC01.
Ju, B.J. and Niu, L.L., 2012. Analysis of therapeutic effect of acupuncture at neiguan (PC 6) and zusanli (ST 36) on acute renal colic. Zhongguo Zhen jiu= Chinese Acupuncture & Moxibustion, 32(11), pp.975-978.
Liu, X., Wang, X., Ma, H. and Zhang, W., 2022. Mechanisms underlying acupuncture therapy in chronic kidney disease: A narrative overview of preclinical studies and clinical trials. Frontiers in Nephrology, 2, p.1006506.
Melo, G.A.A., Aguiar, L.L., Silva, R.A., Pereira, F.G.F., Silva, F.L.B.D. and Caetano, J.Á., 2020. Effects of acupuncture in patients with chronic kidney disease: a systematic review. Revista Brasileira de Enfermagem, 73, p.e20180784.
Qu, Z., Wang, T., Tu, J., Yao, W., Pei, X., Jia, L., Cao, Y. and Liu, C., 2022. Efficacy and safety of acupuncture in renal colic caused by urinary calculi in adults: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2022.
Rogenhofer S, Wimmer K, Blana A, Roessler W, Wieland WF, Filbeck T. Acupuncture for pain in extracorporeal shockwave lithotripsy. J Endourol. 2004 Sep;18(7):634-7.
Sabouhi, F., Kalani, L., Valiani, M., Mortazavi, M. and Bemanian, M., 2013. Effect of acupressure on fatigue in patients on hemodialysis. Iranian journal of nursing and midwifery research, 18(6), p.429.
Shariati, A., Jahani, S., Hooshmand, M. and Khalili, N., 2012. The effect of acupressure on sleep quality in hemodialysis patients. Complementary therapies in medicine, 20(6), pp.417-423.
Tu, J.F., Cao, Y., Wang, L.Q., Shi, G.X., Jia, L.C., Liu, B.L., Yao, W.H., Pei, X.L., Cao, Y., Li, H.W. and Yan, S.Y., 2022. Effect of adjunctive acupuncture on pain relief among emergency department patients with acute renal colic due to urolithiasis: a randomized clinical trial. JAMA Network Open, 5(8), pp.e2225735-e2225735.
Tavakoli K, Taghavi R, Barakati N, Mohammadi SH. The effect of acupuncture on pain during extracorporeal shock wave lithotripsy- a clinical trial. J Shahrekord Univ Med Sci. 2014; 16(5): 84-91.
Wang, S., Chen, Z., Fu, P., Zang, L., Wang, L., Zhai, X., Gao, F., Huang, A. and Zhang, Y., 2014. Use of auricular acupressure to improve the quality of life in diabetic patients with chronic kidney diseases: a prospective randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2014.
Wu, L.M., Liu, Q., Yin, X.H., Yang, L.P., Yuan, J., Zhang, X.Q. and Wang, Y.L., 2023. Wrist-ankle acupuncture combined with pain nursing for the treatment of urinary calculi with acute pain. World Journal of Clinical Cases, 11(18), pp.4287-4294.
Yu, J.S., Ho, C.H., Wang, H.Y., Chen, Y.H. and Hsieh, C.L., 2017. Acupuncture on renal function in patients with chronic kidney disease: a single-blinded, randomized, preliminary controlled study. The Journal of Alternative and Complementary Medicine, 23(8), pp.624-631.
Zhang, X., Liu, X., Ye, Q., Wang, X., Chen, J., Wang, Z., Zhao, P., Tao, B., Xu, G., Xu, W. and Wu, K., 2021. Acupuncture versus lornoxicam in the treatment of acute renal colic: a randomized controlled trial. Journal of Pain Research, pp.3637-3648.
Helen Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
The Joints of the body are part of the MusculoSkeletal System, so you may find our page on this useful. We also have pages on Osteoarthritis, and Rheumatoid Arthritis, both of which may be causes if joint symptoms. If the cause is an injury to the joints, our Sports Injury page may be of assistance.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
Chronic Pain in General
“Acupuncture is effective for the treatment of chronic musculoskeletal, headache, and osteoarthritis pain. Treatment effects of acupuncture persist over time and cannot be explained solely in terms of placebo effects. Referral for a course of acupuncture treatment is a reasonable option for a patient with chronic pain”. (Vickers et al, 2018: large chronic pain review of high quality RCTs updating a previous meta-analysis; 39 trials, n=20827; conditions addressed chronic headache, back/neck pain and osteoarthritis)
Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture as an effective, safe, and cost-effective intervention in chronic low back, neck, shoulder, and knee pain, as well as headaches.
The NHS body in charge of which treatments should be used in particular conditions recommends acupuncture for chronic pain: The NICE Scenario Management guidelines (2021) for chronic pain state: “consider a course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system”
Overall, a large systematic review has found acupuncture a cost effective intervention for several painful conditions (Ambrósio et al, 2012).
Knee
Knee pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827) acupuncture showed a significant clinical superiority over usual care.
A systematic review and meta-analysis of 17 trials, showed significant benefits whereby in patients in study groups having received acupuncture, this was associated with significantly reduced chronic knee pain 12 weeks (Zhang et al, 2017). Specifically comparing treatments including acupuncture in osteoarthritic knee pain, Corbett et al’s (2013, n=9709) systematic review and network meta-analysis found that acupuncture could be considered as one of the more effective physical treatments for alleviating osteoarthritis knee pain in the short-term: Acupuncture was ranked second out of 21 physical treatments in this study. The team also clarified that further research is also warranted in this area, due to the quality of the research available in some treatment areas across the studies.
Shoulder
The British Acupuncture Council has a Research digest where they examined some recent studies on shoulder pain, as well as an evidence based factsheet (links are below)
Shoulder pain was included in large chronic pain review of RCTs updating a previous meta-analysis (Vickers et al, 2018; 39 trials, n=20827), acupuncture showed a significant clinical superiority over usual care and a smaller advantage over sham.
Another systematic review and meta analysis of acupuncture in shoulder pain post stroke (Lee & Lim, 2016), saw that over 12 RCTs found it more effective that rehabilitation alone finding it a useful for this, with the authors calling for further trials of high quality to corroborate this.
Another recent overview (Yin et al, 2017) confirms that there is increasing evidence for acupuncture as an effective, safe, and cost-effective intervention in chronic shoulder pain.
Elbow
The British Acupuncture Council has a Research digest where they examined some recent studies on lateral elbow pain, as well as an evidence based factsheet (tennis elbow – links are below), finding promising evidence in the field.
Gadau et al, (2014) conducted a systematic review of 19 RCTs of varying quality were examined, and overall the evidence suggested acupuncture was more effective than sham control. Tang et al (2015) looed at a smaller number of RCT and were more tentative about the outcomes due to concern over trial designs and highlighted a need for further research.
Recent small trials include one comparing acupuncture and manipulation (n=35; Hsu et al, 2016) in which both groups experienced improvement in pain and function. Another looked at ultrasound imaging of the affected tendon to evaluate acupuncture’s effect, finding reduction of tendon thickness after 10 sessions as well as improvement in pain scores (Ural et al 2017; n-41). A further trial (Wong et al, 2017; n=34) compared acupuncture and extracorporeal shockwave therapy (ESWT), finding a trend of improvement in pain scores in both groups.
Hip
There is less research in this area, although it is growing, a systematic review (Manheimer et al, 2018; n=413, for 6 trials) found Acupuncture beneficial as an add-on to usual GP care, with a small but significant benefit for physical quality of life in Osteoarthritis of the hip.
Back pain and Neck Pain
We have separate pages for these conditions for you to read more about acupuncture’s use in back pain, and in neck pain.
Resources:
Evidence Based Acupuncture Factsheet on Pain
BAcC Frozen Shoulder Factsheet
BAcC Neck Pain Factsheet
BAcC Osteoarthritis of the Knee Factsheet
References:
General Chronic Pain References
Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.
Birch, S., Lee, M.S., Alraek, T. and Kim, T.H., 2018. Overview of treatment guidelines and clinical practical guidelines that recommend the use of acupuncture: a bibliometric analysis. The Journal of Alternative and Complementary Medicine, 24(8), pp.752-769.
NICE 2021 Chronic pain: Scenario: Management Last revised in April 2021
Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.
Knee
Corbett, M.S., Rice, S.J.C., Madurasinghe, V., Slack, R., Fayter, D.A., Harden, M., Sutton, A.J., Macpherson, H. and Woolacott, N.F., 2013. Acupuncture and other physical treatments for the relief of pain due to osteoarthritis of the knee: network meta-analysis. Osteoarthritis and cartilage, 21(9), pp.1290-1298.
Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.
Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.
Zhang, Q., Yue, J., Golianu, B., Sun, Z. and Lu, Y., 2017. Updated systematic review and meta-analysis of acupuncture for chronic knee pain. Acupuncture in Medicine, 35(6), pp.392-403.
Shoulder
Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J., Irnich, D., Witt, C.M., Linde, K. and Acupuncture Trialists’ Collaboration, 2018. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp.455-474.
Lee, S.H. and Lim, S.M., 2016. Acupuncture for poststroke shoulder pain: a systematic review and meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2016.
Yin, C., Buchheit, T.E. and Park, J.J., 2017. Acupuncture for chronic pain: an update and critical overview. Current opinion in anaesthesiology, 30(5), pp.583-592.
Elbow
Gadau, M., Yeung, W.F., Liu, H., Zaslawski, C., Tan, Y.S., Wang, F.C., Bangrazi, S., Chung, K.F., Bian, Z.X. and Zhang, S.P., 2014. Acupuncture and moxibustion for lateral elbow pain: a systematic review of randomized controlled trials. BMC Complementary and Alternative Medicine, 14(1), pp.1-19.
Tang, H., Fan, H., Chen, J., Yang, M., Yi, X., Dai, G., Chen, J., Tang, L., Rong, H., Wu, J. and Liang, F., 2015. Acupuncture for lateral epicondylitis: a systematic review. Evidence-based complementary and alternative medicine, 2015.
Hsu, C.Y., Lee, K.H., Huang, H.C., Chang, Z.Y., Chen, H.Y. and Yang, T.H., 2016. Manipulation therapy relieved pain more rapidly than acupuncture among lateral epicondylalgia (tennis elbow) patients: a randomized controlled trial with 8-week follow-up. Evidence-Based Complementary and Alternative Medicine, 2016.
Ural, F.G., Öztürk, G.T., Bölük, H. and Akkuş, S., 2017. Ultrasonographic evaluation of acupuncture effect on common extensor tendon thickness in patients with lateral epicondylitis: a randomized controlled study. The Journal of Alternative and Complementary Medicine, 23(10), pp.819-822.
Wong, C.W.Y., Ng, E.Y.L., Fung, P.W., Mok, K.M., Yung, P.S.H. and Chan, K.M., 2017. Comparison of treatment effects on lateral epicondylitis between acupuncture and extracorporeal shockwave therapy. Asia-Pacific journal of sports medicine, arthroscopy, rehabilitation and technology, 7, pp.21-26.
Hip
Manheimer, E., Cheng, K., Wieland, L.S., Shen, X., Lao, L., Guo, M. and Berman, B.M., 2018. Acupuncture for hip osteoarthritis. Cochrane Database of Systematic Reviews, (5).
Helen Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
The British Acupuncture Council factsheet explores a number of research trials and concludes acupuncture could be considered as an option in this condition, in that most trials have found it to be effective (see link below).
A randomised controlled trial (n=224) found acupuncture intervention superior to waiting list control for insomnia, and the effect continued over 13 weeks, and the treatment was safe with a very low side effect profile (Chung et al, 2018). Another RCT (n=72) using sleep monitors as well as patient questionnaires found varying degrees of sleep improvement and a significant improvement in the Insomnia Severity Index (Yin et al, 2017).
A recent systematic review (Shergis et al, 2016), looked at 30 studies (n=2363 in total), some trials used a medicine for the control group, whereas others used a sham or placebo in comparison to acupuncture. Acupuncture was found superior in both cases, although many of the studies had some risk of bias, meaning that further better designed studies would be needed to corroborate these trends.
There is also promising research for acupuncture in insomnia where this is linked to another condition such as depression and sleep quality (Dong et al, 2017 – systematic review and meta-analysis for depression-related insomnia); or stroke (Lee et al, 2016 – systematic review and meta-analysis of 13 RCTs for insomnia after stroke).
Mechanisms of action:
Acupuncture is believed to stimulate the nervous system and has been shown to affect the levels of neurotransmitters in the body. Studies have shown effects which may be linked to a an influence on sleep, in particular acupuncture can increase the levels of a number of neurotransmitters and their modulators including a significant increase in melatonin secretion at night-time (Spence et al, 2004; n=18 with a related decrease in anxiety scores).
Acupuncture has also been shown to influence levels of serotonin, noradrenaline, dopamine, GABA and endorphins in mechanism of action studies (e.g. Samuels et al, 2008 – literature review; Zhou et al, 2008 in an animal model); and to increase nitric oxide activity in the brain in an animal model (Gao et al, 2007, n=48 mice). Acupuncture has been shown in mechanism of action studies to downregulate pain and stress reactions in the brain and nervous system and calm the sympathetic nervous system.
Resources:
British Acupuncture Council evidence based factsheet about Insomnia including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council Research Digest – Insomnia section (near to bottom of document)
References:
Chung, K.F., Yeung, W.F., Yu, B.Y.M., Leung, F.C.Y., Zhang, S.P., Zhang, Z.J., Ng, R.M.K. and Yiu, G.C., 2018. Acupuncture with or without combined auricular acupuncture for insomnia: a randomised, waitlist-controlled trial. Acupuncture in Medicine, 36(1), pp.2-13.
Dong, B., Chen, Z., Yin, X., Li, D., Ma, J., Yin, P., Cao, Y., Lao, L. and Xu, S., 2017. The efficacy of acupuncture for treating depression-related insomnia compared with a control group: a systematic review and meta-analysis. BioMed research international, 2017.
Gao, X.Y., Ma, Q.L. and Hu, B., 2007. Effects of acupuncture at” Sishencong”(EX-HN 1) on physiological functions in the sleep disorder model mouse. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 27(9), pp.681-683.
Samuels, N., Gropp, C., Singer, S.R. and Oberbaum, M., 2008. Acupuncture for psychiatric illness: a literature review. Behavioral Medicine, 34(2), pp.55-64.
Shergis, J.L., Ni, X., Jackson, M.L., Zhang, A.L., Guo, X., Li, Y., Lu, C. and Xue, C.C., 2016. A systematic review of acupuncture for sleep quality in people with insomnia. Complementary therapies in medicine, 26, pp.11-20.
Spence, D.W., Kayumov, L., Chen, A., Lowe, A., Jain, U., Katzman, M.A., Shen, J., Perelman, B. and Shapiro, C.M., 2004. Acupuncture increases nocturnal melatonin secretion and reduces insomnia and anxiety: a preliminary report. The Journal of neuropsychiatry and clinical neurosciences, 16(1), pp.19-28.
Yin, X., Gou, M., Xu, J., Dong, B., Yin, P., Masquelin, F., Wu, J., Lao, L. and Xu, S., 2017. Efficacy and safety of acupuncture treatment on primary insomnia: a randomized controlled trial. Sleep medicine, 37, pp.193-200.
Zhou Q et al. The effect of electro-acupuncture on the imbalance between monoamine neurotransmitters and GABA in the CNS of rats with chronic emotional stress-induced anxiety. Int J Clin Acupunct 2008 ;17: 79-84
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
References: British Acupuncture Council evidence based factsheet about Male Infertility including specific research, trials and mechanisms of action for acupuncture in this condition.
Helen Page under construction
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
Particular types of studies have shown acupuncture to modulate the body’s system toward normality, or homeostasis. For these reasons acupuncture has been sought by patients both with autoimmune conditions, as well as where the immune system is compromised or underactive.
Compromised immunity or an overactive/autoimmune condition may have many causes, so we will cover the studies that may be linked and of interest, but we are still working on these pages to bring more detail and research.
Immunity is based upon many factors, but measurable aspects of it can include blood levels of particular blood cells, in particular, types of white blood cell.
Anti-Inflammatory Effects of Acupuncture: Neuro-Immune Modulated
A review article (Li et al, 2023) looked at 363 studies about the anti-inflammatory effects and mechanisms of acupuncture from the last five years. They concluded that acupuncture has a strong anti-inflammatory effect in multiple systems and diseases by regulating both local and systemic immune responses via neuro-immune regulation. Acupuncture was shown to modulate the immune cells and cytokines at the acupoint site and the target organs, within the immune, digestive, respiratory, nervous, locomotory, circulatory, endocrine, and genitourinary systems. Further, acupuncture activates the neuro-immune pathways in the brain and spinal cord to regulate inflammation, such as the cholinergic anti-inflammatory, vagus-adrenal medulla-dopamine, and sympathetic pathways, as well as the hypothalamus-pituitary-adrenal axis.
Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines. They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis. They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.
Iatrogenic Bone Marrow Depletion
Shih et al (2023) carried out a systematic review and meta-analysis of the effectiveness of acupuncture in relieving chemotherapy-induced bone marrow suppression due to chemotherapy. Looking at 25 RCT’s (n=1713), they examined outcome measures of G-CSF (a type of protein that helps the body make more blood cells, particularly white blood cells); of white and red blood cell counts, neutrophils and natural killer cells counts. The results showed that acupuncture significantly increased the levels of G-CSF, WBC, RBC, NEU, ANC, Hb, PLT, and NK cells compared with control groups. The levels of PLT and NK cells also increased cumulatively over time. They suggested a role alongside conventional medicine for acupuncture in this area.
Immune Markers in Patients with Vascular Dementia
Zhi et al (2021; n=60) compared a vascular dementia group (VD) with a healthy control group to see if acupuncture can change the number and type of immune cells and molecules in the blood of patients with VD. This wasn’t an RCT, as they did not have a VD control group, so the findings can be interpreted with caution. They used blood tests to measure immune markers; Flow cytometry was used to count different types of immune cells, e.g. T cells, B cells, and natural killer (NK) cells. And ELISA was used to measure different inflammation markers, such as interleukins (IL), tumour necrosis factor-alpha (TNF-α), and interferon-gamma (IFN-γ).
Acupuncture was found (in Zhi et al’s 2023 study) to increase CD3+ T cells, CD4+ T cells, and regulatory T cells (Tregs) in the blood of patients with VD. These are types of immune cells that help regulate immune responses and prevent excessive inflammation. Acupuncture treatment also decreased the level of TNF-α in the blood of patients with VD. TNF-α is a molecule that causes inflammation and can damage brain cells. The study concluded that acupuncture treatment may improve the immune system of patients with VD by changing the number and type of immune cells and molecules in the blood, the theory being that mediating neuroinflammation would be beneficial to VD patients.
CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body. They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions. Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone. These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.
Surgical Procedures and Immunity
Immune suppression can be a complication of major surgery, so Li et al (2013) carried out an RCT to examine the effect of electroacupuncture (EA) on immune function and point specificity in patients undergoing supratentorial craniotomy. With n=29 in three groups; control, EA group, and sham acupoints. EA partially reduced immune suppression after surgery, as measured by the levels of cytokines and immunoglobulins in peripheral blood, however without point specificity. They concluded EA may be a useful adjunct to general anaesthesia for improving immune function in patients undergoing major surgery, although sham acupuncture also produced some benefits, so further research in larger trials would be needed.
Measures of Immune / Inflammatory Biomarkers
Inflammatory and immune markers: Wang et al (2008) reviewed the evidence from 8 RCTs for acupuncture as a treatment for rheumatoid arthritis (RA) that compared acupuncture with placebo or active drug interventions. Five studies observed a reduction in the inflammatory/immune marker of ESR and three noted a reduction in CRP level after acupuncture treatment.
Acupuncture stimulates the body to create its own natural painkilling substances, such as Beta Endorphins (β-Endorphin). In studies acupuncture has been shown to stimulate the production of natural painkillers called opioid-like peptides (OLPs), including β-Endorphin: For example, this was shown in an RCT in 90 patients with a range of painful disorders (Petti et al, 1998). The same study showed acupuncture also and enhanced the activity of immune cells (lymphocytes, natural killer cells and monocytes) that help fight infections and diseases (Petti et al, 1998).
Effects upon the Synovial Pathway Activate Immune and Anti-Inflammatory Response
In an animal study, Sun et al, (2023) were able to show that electroacupuncture worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation. The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.
Reducing Inflammatory Cytokines in Animal Studies
Qi et al. (2014; n=60) investigated the effect of acupuncture on spastic cerebral palsy rats. The study found that acupuncture reduced the serum levels of inflammatory cytokines, which are molecules that promote inflammation. Acupuncture also improved the blood viscosity and erythrocyte electrophoresis indexes of the rats, which reflect the shape and flow of red blood cells.
Lisboa et al (2015) looked at the effects of electroacupuncture (EA) on experimental periodontitis in 32 rats over 10 days. Rats with induced periodontitis were divided into three groups: electroacupuncture; sham electric needles; or no treatment. A control group of healthy rats without periodontitis was also included. Post treatment measures included alveolar bone loss and periodontal ligament space around the teeth; osteoclast activity and number as indicated by RANKL and TRAP; and cytokine levels (IL-1β, MMP-8, IL-6, and COX-2) in the gums. The electroacupuncture group had less bone loss, less osteoclast activity and number, and decreased inflammatory cytokines; these suggest modulation of the inflammatory response.
Other Anti-Inflammatory Biomarkers in Animal Models
Liu et al (2014) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes. EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.
Mechanisms of Action
Per MacDonald et al (2015), acupuncture may: reduce inflammation by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
References:
Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8.
Li, G., Li, S., Wang, B. and An, L., 2013. The effect of electroacupuncture on postoperative immunoinflammatory response in patients undergoing supratentorial craniotomy. Experimental and Therapeutic Medicine, 6(3), pp.699-702.
Li, N., Guo, Y., Gong, Y., Zhang, Y., Fan, W., Yao, K., Chen, Z., Dou, B., Lin, X., Chen, B. and Chen, Z., 2021. The anti-inflammatory actions and mechanisms of acupuncture from acupoint to target organs via neuro-immune regulation. Journal of Inflammation Research, 14, p.7191.
Lisboa, M.R., Gondim, D.V., Ervolino, E., Vale, M.L., Frota, N.P., Nunes, N.L., Mariguela, V.C., Taba Jr, M., Messora, M.R. and Furlaneto, F.A., 2015. Effects of electroacupuncture on experimental periodontitis in rats. Journal of periodontology, 86(6), pp.801-811.
Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine, 32(4), pp.340-345.
McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.
Petti, F.., Bangrazi, A., Liguori, A., Reale, G. and Ippoliti, F., 1998. Effects of acupuncture on immune response related to opioid-like peptides. Journal of Traditional Chinese Medicine 18(1), pp.55-63.
Qi, Y.C., Xiao, X.J., Duan, R.S., Yue, Y.H., Zhang, X.L., Li, J.T. and Li, Y.Z., 2014. Effect of acupuncture on inflammatory cytokines expression of spastic cerebral palsy rats. Asian Pacific journal of tropical medicine, 7(6), pp.492-495.
Shih, Y.W., Wang, M.H., Monsen, K.A., Chang, C.W., Rias, Y.A. and Tsai, H.T., 2023. Effectiveness of Acupuncture for Relieving Chemotherapy-Induced Bone Marrow Suppression: A Systematic Review with a Meta-analysis and Trial Sequential Analysis. Journal of Integrative and Complementary Medicine.
Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine, 2023
Wang, C., De Pablo, P., Chen, X., Schmid, C. and McAlindon, T., 2008. Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 59(9), pp.1249-1256.
Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.
Zhi, H., Wang, Y., Chang, S., Pan, P., Ling, Z., Zhang, Z., Ma, Z., Wang, R. and Zhang, X., 2021. Acupuncture can regulate the distribution of lymphocyte subsets and the levels of inflammatory cytokines in patients with mild to moderate vascular dementia. Frontiers in Aging Neuroscience, 13, p.747673.
Helen