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.
Our Nausea page may also be of use regarding Post Operative Nausea and Vomiting Research
Research and Resources on Post Operative Pain and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “post operative pain” yields over 3,860 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives 583 results; of which 38% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used in this area, leading to a small but growing body of research,, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Sun et al’s (2008) systematic review of 15 RCT’s (n=1166) in the British Journal of Anaesthesia drew the conclusion that acupuncture around the time of surgery “may be a useful adjunct for acute postoperative pain management.” They also found lower incidence of opioid side effects such as post-operative nausea and vomiting (PONV); dizziness and urinary retention in acupuncture groups. They also stated that further large and well-designed studies are needed to further examine this area including the most effective points and timings to use.
A systematic review of 5 trials for acupuncture post back surgery (Cho et al, 2015) found encouraging but limited evidence in this area, calling for more rigorously designed trials to further the research body. Chen et al (2021, 9 RCT’s; n=671) systematic review found acupuncture could improve function and reduce PONV after total knee arthroscopy surgery, with pain relief from acupuncture mainly achieved within the 48h post-surgery. Again limitations were acknowledged in the methodical quality of studies, with further large, high quality studies called for.
Wu et al (2016, systematic review of 13 studies) found that the evidence supported acupuncture use as an adjuvant therapy post surgery on the first day, significantly reducing postoperative pain and the use of opioids. A Systematic review of 35 trials into acupuncture and post-operative pain has indicated promise in this area, indicating that further research is needed as to whether using both local and distal points can be beneficial over an either/or approach (Zhu et al, 2019).
Kumar and Tewari (2023) reviewed the evidence for dental treatment during and post-op. Root canal treatment has a high incidence of postoperative pain and potential side effects from drug treatment; and they found that from their review of 5 studies (n=312), acupuncture reduced the failure of nerve block in patients with irreversible pulpitis and controlled pain both during (intraoperative) and postoperative pain from root canal. Acupuncture lowered the amount of painkiller drugs needed. The researchers noted that more in-depth clinical research with larger studies was warranted due to the small number and variable quality of studies. Additionally, against a backdrop of Covid-19, researchers advocated acupuncture, as a non-aerosol generating alternative that could assist in pain management whist awaiting treatment, or where other techniques were not appropriate.
Ben-Ayre et al (2023: n=99) conducted a randomised controlled trial that examined the impact of integrative therapies on pain and anxiety among patients undergoing gynaecological oncology (cancer) surgery; addition of intraoperative acupuncture significantly reduced severe pain, compared with the control group and the group that received preoperative touch/relaxation only. The combination of preoperative touch/relaxation and intraoperative acupuncture also improved the patients’ scores in the Measure Yourself Concerns and Wellbeing (MYCAW) questionnaire.
Mechanisms of action:
Acupuncture studies have shown it can: provide pain relief by stimulating nerves in body tissues and leading to endorphin release (natural painkilling substances), as well as downregulating the brain and nervous system’s reaction to stress and pain (Zhao 2008; Zijlstra et al, 2003; Pomeranz, 1987).
Acupuncture has been shown in animal models to promote the release of factors that involved in the reduction of inflammation (vascular and immunomodulatory factors – (Kim et al, 2008; Kavoussi and Ross, 2007 [review article]; Zijlstra et al, 2003), and also to affect levels of serotonin (in an animal model), and other peptides in the brain and nervous system and modulate blood flow in the brain and elsewhere in the body, in humans (Zhong and Li, 2007; Shi et al, 2010). More detail on neurotransmitters in acupuncture for pain is in our blog.
Post-Operative Inflammation and Immunity Study
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.
Evidence Based Acupuncture – Factsheet on Chronic Pain
Post-Operative Pain References:
Ben‐Arye, E., Segev, Y., Galil, G., Marom, I., Gressel, O., Stein, N., Hirsh, I., Samuels, N., Schmidt, M., Schiff, E. and Lurie, I., 2023. Acupuncture during gynecological oncology surgery: A randomized controlled trial assessing the impact of integrative therapies on perioperative pain and anxiety. Cancer, 129(6), pp.908-919.
Chen, Z., Shen, Z., Ye, X., Xu, Y., Liu, J., Shi, X., Chen, G., Wu, J., Chen, W., Jiang, T. and Liu, W., 2021. Acupuncture for Rehabilitation After Total Knee Arthroplasty: A systematic review and meta-analysis of randomized controlled trials. Frontiers in medicine, 7, p.1050.
Cho, Y.H., Kim, C.K., Heo, K.H., Lee, M.S., Ha, I.H., Son, D.W., Choi, B.K., Song, G.S. and Shin, B.C., 2015. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta‐analysis of randomized controlled trials. Pain Practice, 15(3), pp.279-291.
Kumar, G. and Tewari, S., 2023. Acupuncture for Management of Endodontic Emergencies: a Review. Journal of Acupuncture and Meridian Studies, 16(1), pp.1-10.
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.
Sun, Y., Gan, T.J., Dubose, J.W. and Habib, A.S., 2008. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British journal of anaesthesia, 101(2), pp.151-160.
Wu, M.S., Chen, K.H., Chen, I.F., Huang, S.K., Tzeng, P.C., Yeh, M.L., Lee, F.P., Lin, J.G. and Chen, C., 2016. The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis. PloS one, 11(3), p.e0150367.
Zhu, J., Xu, Q., Zou, R., Wu, W., Wang, X., Wang, Y., Ji, F., Zheng, Z. and Zheng, M., 2019. Distal acupoint stimulation versus peri-incisional stimulation for postoperative pain in open abdominal surgery: a systematic review and implications for clinical practice. BMC complementary and alternative medicine, 19(1), pp.1-14.
Mechanism Of Action in Pain References:
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther. 2007 Sep;6(3):251-7.
Kim HW, Uh DK, Yoon SY et al. Low-frequency electroacupuncture suppresses carrageenan-induced paw inflammation in mice via sympathetic post-ganglionic neurons, while high-frequency EA suppression is mediated by the sympathoadrenal medullary axis. Brain Res Bull. 2008 Mar 28;75(5):698-705.
Pomeranz B. Scientific basis of acupuncture. In: Stux G, Pomeranz B, eds. Acupuncture Textbook and Atlas. Heidelberg: Springer-Verlag; 1987:1-18.
Shi H, Li JH, Ji CF, Shang HY, Qiu EC et al.[Effect of electroacupuncture on cortical spreading depression and plasma CGRP and substance P contents in migraine rats]. Zhen Ci Yan Jiu. 2010 Feb;35(1):17-21.
Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol. 2008 Aug;85(4):355-75.
Zhong G.-W. Li W. Effects of acupuncture on 5-hydroxytryptamine1F and inducible nitricoxide synthase gene expression in the brain of migraine rats. Journal of Clinical Rehabilitative Tissue Engineering Research. 2007;11(29)(pp 5761-5764)
Zijlstra FJ, van den Berg-de Lange I, Huygen FJ, Klein J. Anti-inflammatory actions of acupuncture. Mediators Inflamm. 2003 Apr;12(2):59-69.