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What evidence is there for or against acupuncture being an effective treatment?

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    The study of acupuncture takes years and involves careful study of effects by very smart and sensitive (and even skeptical) people. So not only is there evidence, there are thousands of years of study. Is it Western-style scientific evidence? Not so much.
    – Dronz
    Commented Feb 9, 2016 at 23:08
  • @Dronz and the proper conclusion of all those thousands of studies? No good evidence acupuncture is an effective treatment for anything. See my new answer to this old question.
    – BradC
    Commented Jan 4 at 15:52
  • @BradC So only the modern Western mindset can be considered "proper" or "good"?
    – Dronz
    Commented Jan 7 at 22:22
  • @Dronz Not sure if you're just quibbling with terminology or if you also object to the substance of my answer below, but no, you can't sidestep legitimate questions about study methodology and effectiveness, placebo, and bias by invoking "non-Western-styles of thinking" or something. Just because something has been used for thousands of years doesn't mean it works. Like herbal medicine: there came a time that we actually tested them, and those that worked we call medicine and those that didn't we call herbal tea or perhaps potpourri or in some cases poison.
    – BradC
    Commented Jan 8 at 15:22
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    @Dronz This entire site is centered around "scientific skepticism" (see the FAQ in meta), because it provides the best tools to properly distinguish (in this case) between treatments that purport to treat health conditions, and treatments that have been shown via robust, reliable, and repeatable evidence to treat health conditions. If you want to label that "Western" then fine, call it what you like. People are certainly entitled to do what they say makes them feel better, but that's different than asking whether acupuncture actually does what its proponents claim it can do.
    – BradC
    Commented Jan 8 at 20:33

4 Answers 4

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Acupuncture is based on the belief that diseases are caused by blockages of your qi, which flows in so-called meridians in your body. By sticking needles into those meridians you can manipulate the flow of qi and eliminate the blockages.

The concepts of qi and meridians are unscientific, they date back to a time where there was no scientific method and knowledge of human anatomy was practically nonexistant. There is no evidence that qi and meridians exist at all.

Sticking needles into your body still could have some effect, although it will have nothing to do with your qi. There are tons of clinical studies about acupuncture, but few conclusive results. A major problem is that controlling for the placebo effect is complicated, as people usually notice whether you stick needles into them or not. Some of the newer and better clinical trials used fake acupuncture needles that do not penetrate the skin. Another often used method is to stick the needles outside of the "proper" acupuncture points as a control.

Acupuncture is believed to be helpful in a large variety of conditions, I'll take pain relief as an example as it is somewhat plausible that sticking needles into your skin could have an effect on the perception of pain.

A review from 2009 in BJ concludes:

A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.

My conclusion is that acupuncture is just a particularly effective placebo.

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    @Andrew Grimm: as long as sticking needles involve the risk of you accidentally puncturing a major arteries, I don't think anyone without any knowledge of human physiology should attempt acupuncture on their own.
    – Lie Ryan
    Commented Mar 20, 2011 at 18:07
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    Well, I wouldn't equate claims about acupuncture being effective with it being correctly explained by its practitioners. The nonexistence of qi and meridians wouldn't make a difference more than us argumenting wether our model of an electron "is really" an electron. In fact, I find that to be a straw man argument from the woo community. They claim that we skeptics are stuck on the fact that we can't explain, trying to smokescreen that we point out that the EFFECTIVENESS is undocumented. ALL models are WRONG, SOME models are USEFUL.
    – Tormod
    Commented Apr 30, 2011 at 9:13
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    "My conclusion is that acupuncture is just a particularly effective placebo" - How could one conclude anything if the results are unclear?
    – DJG
    Commented Feb 26, 2014 at 21:49
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    It's worth noting that the UK's NHS has a page discussing this topic: nhs.uk/Conditions/Acupuncture/Pages/Evidence.aspx - it observes that there is evidence for a number of cases, that differ from the placebo ("sham" acupuncture, that just imitates the sensation of acupuncture without any pressure/puncture) in a statistically significant way. And while most of the conditions with "some evidence" are pain issues, Irritable Bowel Syndrome has more physical effects, like diarrhoea, and is on the list.
    – Glen O
    Commented Apr 7, 2015 at 2:55
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    Showing the theory is bunk doesn't prove it doesn't work--after all, if the exorcist drives out the demon infection with the holy penicillin does that mean it won't help the patient? I see acupuncture as a collection of teachers passing on what works with a big helping of hocus-pocus on top trying to explain why it works. Lacking proper study there certainly will be placebo effects but that doesn't mean it's all placebo effect. Commented Nov 21, 2015 at 22:25
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It seems to be highly variable and condition-specific, although this latest review of reviews has some interesting results (mind you that's in paediatric population):

Efficacy and safety of acupuncture in children: An overview of systematic reviews. (highlighting is mine)

We included 24 systematic reviews, comprising 142 RCTs with 12787 participants. Only 25% (6/24) reviews were considered to be high quality (10.00 ± 0.63). High-quality systematic reviews and Cochrane systematic reviews tends to yield neutral or negative results (P=0.052, 0.009 respectively). The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia and pain reduction) is promising.

It was unclear for Hypoxic Ischemic Encephalopathy (HIE), Attention Deficit Hyperactivity Disorder (ADHD), mumps, Autism Spectrum Disorder (ASD), asthma, nausea/vomiting and myopia. Acupuncture is not effective for epilepsy. Only six reviews reported adverse events (AEs) and no fatal side effects were reported.

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    Something tells me that this 3-day-old preview of a paper will be getting a lot of critical attention over the next couple of months.
    – Oddthinking
    Commented May 10, 2015 at 0:41
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    I'm confused about this: "High-quality systematic reviews and Cochrane systematic reviews tends to yield neutral or negative results" and this "The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia and pain reduction) is promising" How can both of those statements be true?.
    – user316117
    Commented May 22, 2017 at 22:26
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Linde, Klaus, et al. "Acupuncture for tension-type headache." Cochrane Database Syst Rev 1.1 (2009)., based on eleven trials with 2317 participants (median 62, range 10 to 1265) that met the inclusion criteria:

In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.

You can find many more meta-reviews on http://onlinelibrary.wiley.com/cochranelibrary/search (search for "acupuncture"). E.g. here are more results (one paragraph per result):

There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia.

There is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, much of which may be due to expectation or placebo effects.

The currently available evidence from a very heterogeneous group of randomised and quasi-randomised controlled trials evaluating the effects of acupuncture for the treatment of acute ankle sprains does not provide reliable support for either the effectiveness or safety of acupuncture treatments, alone or in combination with other non-surgical interventions; or in comparison with other non-surgical interventions. Future rigorous randomised clinical trials with larger sample sizes will be necessary to establish robust clinical evidence concerning the effectiveness and safety of acupuncture treatment for acute ankle sprains.

Due to a small number of clinical and methodologically diverse trials, little can be concluded from this review. There is little evidence to support or refute the use of acupuncture for shoulder pain although there may be short-term benefit with respect to pain and function. There is a need for further well designed clinical trials.

Acupuncture might be able to provide short-term relief from tennis elbow, but more research is needed. (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003527/abstract)

Also, this Quora thread on this question contains some interesting references. Here is the summary of the best answer by Jim Seidman (see Quora link for all the references):

NIH's definition of acupuncture: *The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. Acupuncture may correct imbalances of flow at identifiable points close to the skin.

Is there evidence that acupuncture works? No, not within the scope of the NIH's definition, as there is no evidence that qi exists. But yes, within the scope of asking whether pain relief may be possible by mild deliberate trauma to the epidermis.

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There is no (high quality, replicable) evidence that acupuncture is an effective treatment for any condition.

A 2022 article discusses the overall findings (or lack thereof) in a Systematic Review of Systematic Reviews of Acupuncture.

Some key points (I won't reproduce all the embedded links, see the article for all linked citations):

There have been thousands of clinical studies looking at acupuncture for various conditions, most of which are very low quality and even fatally flawed. But when you conduct thousands of studies, especially with some wiggle room in the methods, many of them are going to be positive, even with a completely null effect.

So if you do enough studies, some of them are going to show some measurable effect, just due to chance. That's why its so important to do meta-analysis studies over the entire body of literature, not to cherry-pick individual studies that provide interesting results.

The entire article is detailed and interesting, but I'll skip ahead to the quoted conclusion of the meta-meta-analysis:

"Despite a vast number of randomized trials, systematic reviews of acupuncture for adult health conditions have rated only a minority of conclusions as high- or moderate-certainty evidence, and most of these were about comparisons with sham treatment or had conclusions of no benefit of acupuncture. Conclusions with moderate or high-certainty evidence that acupuncture is superior to other active therapies were rare."

To be clear, there were a very small number of health conditions that (at first glance) appeared to show some appreciable effect, but don't amount to good evidence when examined in more detail:

Of the 56 health condition reviewed here, only 4 had high-quality evidence. Of those four, one was negative – for assistive reproduction, essentially there were no increases in the chance of success with implantation. One, dealing with stroke recovery, used electroacupuncture, which is not acupuncture but rather electrical nerve stimulation.... The other two that involved acupuncture with positive results were for shoulder pain and fibromyalgia, and they both had low numbers of studies. There wasn’t a single indication which had a high number of high quality studies showing a positive effect.

(emphasis mine).

I'll quote the author's conclusion in full:

Given that there are several thousand published clinical trials looking at acupuncture, over decades, if acupuncture actually worked for anything I would think that by now we would be seeing a clear signal in the data – but we are not. As this review demonstrates, most of the evidence is low quality, and almost none is deemed high quality evidence. Only two subsets had high quality evidence of acupuncture showing an effect, and these suffered from small numbers and methodological issues that were overlooked by the reviewers. Further, if you do enough studies for enough conditions, you’re going to come up with some positive evidence just by chance alone, especially if you throw in a little publication bias.

The overall pattern of the acupuncture literature, therefore, is clearly negative. It is consistent, I would even argue highly predictive, of a null phenomenon. We see this same pattern with other scientifically implausible claims, such as ESP and homeopathy. It’s likely not a coincidence.

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