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.

Neck pain is a common, painful condition, and is in the top three musculoskeletal system complaints reported by patients (BAcC factsheet – see link below).

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).

Neck Pain

Since 1005, over 50 NHS publications have recommended acupuncture for neck pain (many more worldwide; Birch et al 2018).

A randomised trial comparing Alexander technique with acupuncture or usual care alone (MacPherson et al, 2015; n=517) found both acupuncture and Alexander Technique benefitted the participants after a series of sessions, and this benefit ensured at 12 months post treatment, in that their disability level and pain measures were improved.   Essex et al (2017) looked at acupuncture and Alexander technique (ATLAS trial) data, in terms of cost effectiveness, using the NHS standard quality adjusted life years (QALYs) as well as neck pain measures, finding acupuncture to be cost effective as well as effective.  Alexander Technque whilst effect, was not cost effective as it cost more per the amount of gain that could be made.

Van der Velde et al’s (2016) review of whiplash acquired neck pain and disorders, finding acupuncture appeared a cost-effective intervention in these cases.  Seo et al, 2017 in a systematic review and meta-analysis of 16 trials of (electro)acupuncture in chronic neck pain found acupuncture to be effective, and even more so in combination with routine care, their drawings were tentative due to research quality of the trials used.

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).  One such study was Ho et al, (2017), an RCT of abdominal acupuncture in neck pain in Hong Kong (n=154), finding the true acupuncture group experienced symptomatic relief as well as quality of life measurement improvements. 

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 neck pain.

Mechanisms of Action

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).

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.

More detail on neurotransmitters in acupuncture for pain is in our blog.

Resources:

The British Acupuncture Council (BAcC) has produced an evidence based Neck Pain Factsheet including specific research, trials and mechanisms of action for acupuncture.

Evidence Based Acupuncture – Factsheet on Chronic Pain

References:

General Chronic Pain References:

Ambrósio, E.M.M., Bloor, K. and MacPherson, H., 2012. Costs and consequences of acupuncture as a treatment for chronic pain: a systematic review of economic evaluations conducted alongside randomised controlled trials. Complementary therapies in medicine, 20(5), pp.364-374.

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

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.

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.

Neck pain References:

MacPherson, H., Tilbrook, H., Richmond, S., Woodman, J., Ballard, K., Atkin, K., Bland, M., Eldred, J., Essex, H., Hewitt, C. and Hopton, A., 2015. Alexander technique lessons or acupuncture sessions for persons with chronic neck pain: a randomized trial. Annals of internal medicine, 163(9), pp.653-662.

van der Velde, G., Yu, H., Paulden, M., Côté, P., Varatharajan, S., Shearer, H.M., Wong, J.J., Randhawa, K., Southerst, D., Mior, S. and Sutton, D., 2016. Which interventions are cost-effective for the management of whiplash-associated and neck pain-associated disorders? A systematic review of the health economic literature by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal, 16(12), pp.1582-1597.

Essex, H., Parrott, S., Atkin, K., Ballard, K., Bland, M., Eldred, J., Hewitt, C., Hopton, A., Keding, A., Lansdown, H. and Richmond, S., 2017. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). PloS one, 12(12), p.e0178918.

Seo, S.Y., Lee, K.B., Shin, J.S., Lee, J., Kim, M.R., Ha, I.H., Ko, Y. and Lee, Y.J., 2017. Effectiveness of acupuncture and electroacupuncture for chronic neck pain: a systematic review and meta-analysis. The American journal of Chinese medicine, 45(08), pp.1573-1595.

Ho, L.F., Lin, Z.X., Leung, A.W.N., Chen, L., Zhang, H., Ng, B.F.L., Ziea, E.T.C. and Guo, Y., 2017. Efficacy of abdominal acupuncture for neck pain: a randomized controlled trial. PloS one, 12(7), p.e0181360.

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.

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.