AlternativesNatural Remedies

Alexander technique

Alexander technique

What is the Alexander technique

Alexander technique has been defined as “lessons in proprioceptive musculoskeletal education (without exercises)” but can be more simply described as a type of taught physical therapy involving a series of movements designed to correct posture and bring the body into natural alignment with the object of helping it to function efficiently. The Alexander Technique is a form of physical therapy involving a series of movements designed to correct posture and bring the body into natural alignment and aid relaxation 1. The Alexander technique is a taught self-care method that helps people enhance their control of reaction and improve their way of going about everyday activities 2. Alexander technique uses enhanced kinesthetic awareness and voluntary inhibition to prevent non-beneficial movement patterns 3. The primary focus is put on the relationship between head, neck and back as crucial in effecting an overall integrated pattern of coordinated behavior. Through this conscious re-education of thinking and moving unnecessary muscle tension is released, which leads to more ease in movement and breathing and a better coordinated “use” (technical Alexander technique term describing the manner in which a person moves and behaves). Alexander technique is usually taught one-to-one by licensed teachers and combines verbal instructions with hands-on guidance. The psychophysical connection through hands-on work is specific for Alexander technique and distinguishes it from bodywork techniques. Learning the Alexander technique can help you to become aware of the inappropriate ways in which you hold, move and use your body, particularly your back. Bad posture and continual muscle misuse can lead to serious musculoskeletal problems including:

  • Head, neck and back pain
  • Muscle aches and spasms
  • Bursitis (inflammation of joints)
  • Repetitive strain injuries.

The Alexander technique stresses that movement should be economical and needs only the minimum amount of energy and effort. With awareness, it is possible to change postural habits and redistribute muscle effort more evenly and gently throughout the body. The Alexander technique can benefit you in many areas, including:

  • Posture and balance
  • Sporting performance
  • Back pain management
  • Stress management
  • Increased confidence and self-esteem.

Alexander technique has been defined as “lessons in proprioceptive musculoskeletal education (without exercises)” but can be more simply described as a type of taught therapy involving a series of movements designed to correct posture and bring the body into natural alignment with the object of helping it to function efficiently 4 and is reported to aid relaxation 5. At the end of the 19th century the Australian actor Frederick Matthias Alexander developed this technique in order to improve his voice 6. The Alexander technique increases your awareness of body position and movement, eliminating bad habits of posture, muscle tension and movement. The Alexander technique is a ‘re-education’ method rather than a therapy, and practitioners call themselves teachers.

The main principles of the Alexander technique are:

  • “how you move, sit and stand affects how well you function”
  • “the relationship of the head, neck and spine is fundamental to your ability to function optimally”
  • “becoming more mindful of the way you go about your daily activities is necessary to make changes and gain benefit”
  • “the mind and body work together intimately as one, each constantly influencing the other”

Teachers of the Alexander technique say that conditions such as backache and other sorts of long-term pain are often the result of misusing your body over a long period of time, such as moving inefficiently and standing or sitting with your weight unevenly distributed.

The aim of the Alexander technique is to help you “unlearn” these bad habits and achieve a balanced, more naturally aligned body.

The Alexander technique focuses on making you aware of how you move and think. Some simple suggestions include:

  • Sitting – most of us have a habitual way of sitting, such as always crossing one leg. What does it feel like to sit the ‘other’ way? The most comfortable sitting position is to put both feet flat on the floor and position the torso over the pelvis.
  • Standing – most of us have a habitual way of standing, such as always putting the weight of our body through one leg. What does it feel like to stand the ‘other’ way?
  • Walking – does your chin, stomach or pelvis lead the way when you walk? The easiest way to learn to walk is to take some Alexander lessons. You will learn directions for freeing your neck, which will allow your head to go forward and up, and your back to lengthen and widen. Movement then becomes a pleasurable thing.

According to n Alexander Technique website 7 – “the Alexander Technique is a skill for self-development teaching you to change long-standing habits that cause unnecessary tension in everything you do.” The chief principle underlying Alexander technique can be expressed as: “use affects functioning.” By this reasoning, it can also be said that mis-use results in dysfunction. Alexander technique sets out to “re-educate” the body to a state of liberated capacity for movement and uninhibited, efficient respiration. Because results of Alexander technique training include, in many cases, the decrease of stress and its documented constricting effects on thoracic function, it is argued those who suffer from illnesses which have emotional or stress-related components also stand to gain particular benefits from Alexander technique 8.

Everyday things like tensing when the phone rings, rushing to pick up the children from school or worrying about deadlines lead to physical and mental strain. Over the years, this accumulates and can cause illness, injury or common aches and pains that may seem to come from nowhere. Working with your Alexander Technique teacher, you will learn to recognize your usual reactions to the stresses of life. You will find out how you have been contributing to your problems, how to prevent them and regain control.

The Alexander Technique is a taught self-care method that helps people enhance their control of reaction and improve their way of going about everyday activities. It is usually taught through one-to-one practical lessons involving integrated didactic and hands-on implicit guidance, that enable people to reduce habits associated with musculoskeletal pain 9. Applying the Alexander Technique in daily life is associated with improved postural tone, balance, coordination and motor control 10, whilst health benefits include long-term improvements in chronic low-back pain 9. Alexander Technique lessons have been found in a recent trial to be beneficial for people with chronic neck pain at 12 months, however the cost-effectiveness of this intervention is unknown 11.

Alexander technique lessons stimulate your ability to learn simultaneously on different levels; physically, intellectually and emotionally. You learn to recognize your harmful habits, how to stop and think, and to choose a better response. Gradually you learn to apply your new understanding and skill in everyday activities and more complex ones, to bring awareness and poise into everything you do. You learn to become aware of, and then gradually strip away, the habits of movement, tension and reaction that interfere with natural and healthy coordination. Just like riding a bike, once learned, the Alexander technique stays with you for life 7.

The Alexander technique teaches you the skilful ”use of the self”, i.e. how you use yourself when moving, resting, breathing, learning, organizing your awareness and focus of attention and, above all, choosing your reactions to increasingly demanding situations.

While Alexander technique is a taught discipline and requires practice, it does not involve physical exercise as the term is generally understood. Leading practitioners of Alexander technique such as the late Dr Wilfred Barlow have maintained that this is particularly important to remember in the case of sufferers from breathing disorders who emphatically do not require, in his words, “breathing exercises” but instead, “breathing education” 12.

The Alexander technique is well-known amongst performing artists (musicians, singers and actors in particular) throughout most of the developed world. Many such performers practise Alexander technique regularly, reportedly in order to enhance voice projection and stamina. Linked to these reported benefits are many anecdotes of improvement amongst performers and non-performers with asthma who find that their symptoms and dependence on medication decreases as they become more proficient in Alexander technique 12. Clinical literature examining the effects of the Alexander technique on respiratory function, however, is scant.

Austin 1992 13 reported benefit in a group of ten healthy subjects who received 20 private Alexander technique lessons at weekly intervals, as against a matched control group who received no treatment and showed no significant changes in respiratory function. There was a significant increase in:

  • the highest forced expiratory flow measured with a peak flow meter (PEF) (9%)
  • maximum voluntary ventilation (MVV) (6%)
  • maximal inspiratory pressure (MIP) (12%)
  • maximal expiratory mouth pressure (MEP) (9%)

Calls for empirical studies of Alexander technique have been made by those with an interest in voice disorders following anecdotal reports of its beneficial effects 14 and these too are suggestive of possible benefits to those who suffer from asthma. Calls for randomized controlled trials in the area of pulmonary/respiratory function and other areas have yet to be heard although progress is being made in other areas, e.g. a planned trial in Parkinsons disease 15. However, the currently available evidence is insufficient to assess the potential for Alexander technique in the treatment of asthma.

Does Alexander technique work?

Proponents of the Alexander technique often claim it can help people with a wide range of health conditions. Some of these claims are supported by scientific evidence, but some have not yet been properly tested.

There’s evidence suggesting the Alexander technique can help people with:

  • long-term back pain – lessons in the Alexander technique may lead to reduced back pain-associated disability and reduce how often you feel pain for up to a year or more 16
  • long-term neck pain – lessons in the Alexander technique may lead to reduced neck pain and associated disability for up to a year or more 17, 5
  • Parkinson’s disease – lessons in the Alexander technique may help you carry out everyday tasks more easily and improve how you feel about your condition 18

If you have one of these conditions and are considering trying the Alexander technique, it’s a good idea to speak to your doctor or specialist first to check if it might be suitable for you.

Some research has also suggested the Alexander technique may improve general long-term pain, stammering and balance skills in elderly people to help them avoid falls. But the evidence in these areas is limited and more studies are needed.

There’s currently little evidence to suggest the Alexander technique can help improve other health conditions, including asthma, headaches, osteoarthritis, difficulty sleeping (insomnia) and stress.

Alexander technique risks and limitations

For most people, Alexander technique lessons are safe and pose no health risks. No manipulation of your body is involved, just gentle touch.

However, the technique may not be suitable for certain people, such as those with:

  • a specific spinal injury
  • severe pain from a herniated (ruptured) disc
  • severe spinal stenosis (narrowing of the spine)
  • a fracture of the vertebrae (the bones in the spine)

In such cases, specialist medical treatment will be needed.

It’s important to remember that most teachers of the Alexander technique aren’t medical professionals. They do not diagnose, offer advice on or treat conditions that should be managed by a suitably qualified mainstream healthcare professional.

Alexander technique back and neck pain

Neck and back pain together now represent the leading cause of disability in all high income countries, and globally for the 25–64 year age group 19. Chronic neck pain is regarded as often complex in origin and nature and particularly difficult to manage 20. Furthermore, the challenge of chronic neck pain is likely to grow due to increasing computer and mobile technology use, with recognized consequences such as ‘text neck’ 21.

A randomized controlled trial 16 designed to examine the effectiveness of the Alexander technique, massage, exercise advice, and behavioral counseling for chronic and recurrent low back pain. The Alexander technique involves assessment of the individual’s normal posture and movements, aiming to release tension from the head, neck and spine, and improve musculoskeletal use when seated and moving. Sixty-four general practitioners surgeries from the south and west of England were recruited to the study. From each surgery a random selection of patients (aged 18 to 65) with chronic or recurrent back pain were invited to participate. Participants had presented to the surgery with back pain more than three months previously (this criteria excluded acute presentations), were suffering pain for three or more weeks and scored above four on the Roland disability scale (number of activities impaired by pain). Patients indicate the number of specified activities or functions limited by back pain (for example, getting out of the house less often, walking more slowly than usual, not doing usual jobs around the house) 22. The Roland disability scale is designed for self report and has good validation characteristics 23. The second primary outcome measure was number of days in pain during the past four weeks (a four week period facilitated recall): this is distinct from intensity of pain or disability 24. The researchers excluded anyone with potential spinal disease, a previous spinal surgery, nerve root pain in the leg, alcohol abuse, a history of psychosis, unable to walk 100m, or who had previous experience in the Alexander technique.

People from each surgery (total of 579) were randomly allocated to one of eight treatment groups (average 72 in each group). Four of the groups were instructed to do extra exercise (doctor prescription of exercises and nurse-led behavioral counseling) along with one of the following treatments: normal care, six sessions of therapeutic massage, six lessons in the Alexander technique, or 24 lessons in the Alexander technique. The other four groups had the same treatments but with no added exercise.

A total of 152 Alexander technique teachers and therapists were involved in educating and carrying out the techniques. People were assessed by postal questionnaire at start of the study, three months, and one year after they had been allocated a treatment. The main outcome that the researchers examined was disability, assessed using the Roland Morris questionnaire and covering issues such as types of activities limited by pain. They also looked at other outcomes of quality of life and other back pain and disability scales.

What were the results of the study?

Of the 579 people who were allocated a group and completed the questionnaire at the beginning of the study, 80% of the study sample (463) completed the one-year follow-up. When they first enrolled in the study, the characteristics of the participants were similar across all treatment groups and the majority had chronic back pain, experiencing 90 or more days of pain over the past year.

At three months, after exercise had been taken into account, Roland disability score and average number of days with back pain over the past month had significantly decreased in all groups compared to control (massages and 6 or 24 Alexander technique lessons). At one year, 6 or 24 Alexander technique lessons had significantly decreased Roland disability score and average number of days with back pain compared to control, but massage no longer showed significant decrease in disability score. The greatest improvement was seen in the 24-lesson group. Compared to control, exercise, following adjustment for the other techniques, significantly decreased both Roland disability score and average number of days with back pain at three months, but at one year, exercise was only significantly effective on disability score.

When the researchers compared individual groups, they found that the effect of 24 Alexander technique lessons combined with exercise was no different to the effect of 24 Alexander technique lessons alone. Six Alexander technique lessons combined with exercise were 72% as effective as 24 lessons alone without exercise. No adverse effects were reported for the Alexander technique.

What interpretations did the researchers draw from these results?

The researchers conclude that one-to-one instruction in the Alexander technique by registered teachers has long-term benefits in chronic back pain. Six lessons combined with exercise had almost comparable effectiveness to 24 lessons in the Alexander technique.

This well conducted randomized trial has strengths in that it involved a large number of participants with a sample size large enough to assess meaningful differences in the measured outcomes for each of the different treatments. It also followed the majority of these participants across the one year period. The study demonstrates the effectiveness of the Alexander technique, with and without exercise, in reducing disability score on a recognized scale.

A few points to consider:

  • Instruction and education in the Alexander techniques involved a large number of trained professionals (152) and there may have been minor differences in the treatments given across the sample.
  • The fact that the Alexander technique requires education by a registered professional does mean that referral is going to be affected by local care arrangements and resources across the country.
  • Although the effectiveness was measured up to one year, longer follow-up would be valuable to assess longer-term outcomes and possible adverse effects.
  • Assessments were by postal questionnaire and disability, quality of life and pain are highly subjective measures. How one person views their level of pain and disability is going to be different from another.
  • All people in the groups had chronic back pain and fulfilled certain criteria. Many that the researchers contacted initially were not eligible for the study. Importantly, this study has no implications for care of acute low back pain.

Low back pain is a highly prevalent condition in the US with many adults suffering at some point in their lives, some of whom experience recurrent problems. It can also be highly disabling, cause significant work loss, and reduced quality of life for the individual. It is now well known that remaining active, rather than bed rest, is the best approach to back pain. However, there has been conflicting evidence on the effectiveness of posture or exercise education. These new findings are likely to promote further research into the benefits and possible limitations of the Alexander technique, the people for whom it would be most suitable, and the best approach to instructing sufferers.

If you’re thinking about trying the Alexander technique, it’s important to choose a teacher who’s experienced and qualified.

There aren’t currently any laws or regulations stating what training someone must have to teach the Alexander technique. Professional organizations offer courses (often for three years) and membership upon successful completion of the course.

  1. Dennis JA, Cates CJ. Alexander technique for chronic asthma. Cochrane Database of Systematic Reviews 2000, Issue 2. Art. No.: CD000995. DOI: 10.1002/14651858.CD000995
  2. Essex H, Parrott S, Atkin K, et al. An economic evaluation of Alexander Technique lessons or acupuncture sessions for patients with chronic neck pain: A randomized trial (ATLAS). Bril V, ed. PLoS ONE. 2017;12(12):e0178918. doi:10.1371/journal.pone.0178918.
  3. Klein SD, Bayard C, Wolf U. The Alexander Technique and musicians: a systematic review of controlled trials. BMC Complementary and Alternative Medicine. 2014;14:414. doi:10.1186/1472-6882-14-414.
  4. Dennis JA, Cates CJ. Alexander technique for chronic asthma. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD000995. DOI: 10.1002/14651858.CD000995.pub2.
  5. Woodman J, Ballard K, Hewitt C, MacPherson H. Self-efficacy and self-care-related outcomes following Alexander Technique lessons for people with chronic neck pain in the ATLAS randomised, controlled trial. European Journal of Integrative Medicine. 2018;17:64-71. doi:10.1016/j.eujim.2017.11.006.
  8. Drake J. Thorsons introductory guide to the Alexander Technique. London: Thorsons/Harper Collins, 1993.
  9. Woodman JP, Moore NR. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. International journal of clinical practice. 2012. January;66(1):98–112. doi: 10.1111/j.1742-1241.2011.02817.x
  10. Cacciatore TW, Mian OS, Peters A, Day BL. Neuromechanical interference of posture on movement: evidence from Alexander technique teachers rising from a chair. Journal of neurophysiology. 2014. August 1;112(3):719–29. doi: 10.1152/jn.00617.2013
  11. MacPherson H, Tilbrook H, Richmond S, Woodman J, Ballard K, Atkin K, et al. Alexander Technique Lessons or Acupuncture Sessions (ATLAS) for People with Chronic Neck Pain: a Randomized Trial. Annals of internal medicine. 2015;163(249). doi: 10.7326/M15-0667
  12. Barlow W. The Alexander principle. 2nd Edition. London: Gollancz, 1990.
  13. Austin JH, Ausubel P. Enhanced respiratory muscular function in normal adults after lessons in proprioceptive musculosketal education. Chest 1992;102(2):486-90.
  14. D’Antoni ML, Harvey PL, Fried MP. Alternative medicine: does it play a role in the management of voice disorders?. Journal of Voice 1995;9(3):308-11.
  15. Ballard K, Magonet D, Williamson M, Wohl M, Mills C, Kiefer S. Alexander Technique in the UK: possibilities for future research into the Alexander Technique.
  16. Randomised controlled trial of Alexander technique lessons, exercise, and massage (ATEAM) for chronic and recurrent back pain. BMJ 2008; 337 doi:
  17. Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial. Ann Intern Med. 2015;163(9):653-662. DOI: 10.7326/M15-0667
  18. Evidence for the effectiveness of Alexander Technique lessons in medical and health‐related conditions: a systematic review. Int J Clin Pract. 2012 Jan;66(1):98-112. doi: 10.1111/j.1742-1241.2011.02817.x.
  19. GBD Disease and injury incidence and prevalence collaborators, global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the global burden of disease study 2015. Lancet. 2016;388:1545–1602.
  20. Jull G., Sterling M., Falla D., Treleaven J., O’Leary S. first ed. Churchill Livingston Elsevier; Edinburgh: 2008. Whiplash, Headache and Neck Pain.
  21. Xie Y., Szeto G., Dai J. Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: a systematic review. Appl. Ergon. 2017;59(Pt. A):132–142.
  22. Deyo R. Outcome measures for low back pain research: a proposal for standardising use. Proceedings of the 2nd international forum for primary care research on low back pain, 30-31 May, the Hague, 1997
  23. Beurskens A, de Vet H, Koke A. Responsiveness of functional status in low back pain: a comparison of different instruments. Pain1996;65:71-6
  24. Von Korff M, Deyo R, Cherkin D, Barlow W. Back pain in primary care. Spine1993;18:855-62.
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AlternativesNatural Remedies



What is acupuncture

Acupuncture is a technique of insertion and manipulation of fine needles in specific points on the body to achieve therapeutic purposes 1. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation.

Acupuncture has been practiced widely in China for more than 4000 years and is an integral part of traditional Chinese medicine. It was first described in the medical writings The Yellow Emperor’s Classic of Internal Medicine1 around 200 BC. As early as 5000 years ago, stones were sculpted and formed into crude needles to be used as medical instruments 2. In time, other materials, including bamboo, fish bones, bronze, gold, and silver, have been refined into acupuncture needles.

Modern acupuncture needles are thin and flexible and are made of solid surgical stainless steel. Unlike hypodermic needles, acupuncture needles are finely tapered, allowing them to slide smoothly into the skin (see Figure 1). Certain acupuncture needles are thinner than the average strand of human hair.

Figure 1. Comparison of acupuncture needles with a 20-gauge hypodermic needle. Matchstick shown for indication of needle sizes

acupuncture needle

Acupuncture is based on the idea that living beings have an inner energy, known as Qi (pronounced chee), and it is the flow of this inner energy that sustains them. According to traditional Chinese medical philosophy, balanced Qi is vital to optimal health; illness and disease are caused by the imbalance or interruption in the flow of Qi. Although acupuncture was developed for prevention of illness, it is useful in managing disease symptoms by reintroducing balanced flow of Qi, its main focus. According to the philosophy of traditional acupuncture, energy circulates in ‘meridians’ located throughout the body. Pain or ill health happens when something occurs to cause this meridian energy circulation to be blocked. The way to restore health is to stimulate the appropriate combination of acupuncture points in the body by inserting very thin needles. Sometimes in painful conditions, electrical stimulation along with the needles is also used. According to acupuncture theory, one way you can tell that acupuncture is relieving pain is that you may feel numbness or tingling, called De Qi, where the needle is inserted.

Jesuit missionaries introduced acupuncture to Europe in the 17th century, when they returned from China. The Jesuits were active in disseminating the idea and practice of acupuncture throughout Europe. In addition, traveling physicians helped pioneer acupuncture use in Europe 3.

In the United States, acupuncture gained public and professional attention in 1971, when New York Times reporter James Reston wrote about his experience with acupuncture after an emergency appendectomy in China 4. The operation was a success, but Reston soon had a considerable amount of postoperative pain and bloating. To provide relief, Chinese physicians offered acupuncture as a therapeutic modality. Reston, impressed by the effectiveness of this “ancient” procedure, described the overall improvement of his symptoms with no recurrence afterward. Through his newspaper article, he exposed countless Americans to acupuncture for the first time.

Today millions of Americans use acupuncture each year, often for chronic pain, but there has been considerable controversy surrounding its value as a therapy and whether it is anything more than placebo. Research exploring a number of possible mechanisms for acupuncture’s pain-relieving effects is ongoing.

Research suggests that acupuncture can help manage certain pain conditions – may help ease types of pain that are often chronic such as low-back pain, neck pain, and osteoarthritis/knee pain, but evidence about its value for other health issues is uncertain.

Acupuncture also may help reduce the frequency of tension headaches and prevent migraine headaches. Therefore, acupuncture appears to be a reasonable option for people with chronic pain to consider. However, clinical practice guidelines are inconsistent in recommendations about acupuncture.

The effects of acupuncture on the brain and body and how best to measure them are only beginning to be understood. Current evidence suggests that many factors—like expectation and belief—that are unrelated to acupuncture needling may play important roles in the beneficial effects of acupuncture on pain.

How does acupuncture work

There are many theories that may explain how acupuncture works. Many studies in animals and humans have demonstrated that acupuncture can cause multiple biological responses, including circulatory and biochemical effects. These responses can occur locally or close to the site of application or at a distance. They are mediated mainly by sensory neurons to many structures within the central nervous system. This can lead to activation of pathways affecting various physiological systems in the brain as well as in the periphery 5. In summary, possible mechanisms of the effects of acupuncture on neurological conditions include stimulation of neuronal cell proliferation 6, facilitation of neural plasticity 7, reduction of the post-ischaemic inflammatory reaction 8 and prevention of neuronal apoptosis 9.

Figure 2. Acupuncture points

acupuncture points

Gate Control Theory of Pain

This theory postulates that specific nerve fibers transmit a pain signal to the brain via the spinal cord, and input of other nerve fibers can inhibit the pain signal transmission 10. Acupuncture is thought to stimulate inhibitory nerve fibers for a short period, thus reducing transmission of the pain signal to the brain.

Endorphin Model

During the 1970s, researchers isolated endogenous endorphins in the central nervous system. Clinical studies reported that inserting acupuncture needles into specific acupuncture points triggered the production of endorphins in cerebrospinal fluid after patients underwent acupuncture treatments 11. The pain-alleviating effects of acupuncture were reduced when naloxone was used to pretreat the patient, which may indicate that acupuncture-induced analgesia may be partly mediated through endogenous opioids 12.

Recent research has found that traditional Chinese medicine acupuncture therapy has a direct effect in the up-regulation of μ-opioid receptor binding availability in the central nervous system compared with placebo (sham) acupuncture 13. This finding may help explain some of the analgesic effects seen with acupuncture therapy.

Neurotransmitter Model

Research in animals has found that acupuncture can modulate serotonin, norepinephrine, and neurons that transmit or secrete γ-aminobutyric acid 14. It is postulated that through the neurotransmitter model, acupuncture can be efficacious for treatment of depression, anxiety, and addiction.

Other Theories

Other theories postulate that acupuncture indirectly influences the autonomic system. Acupuncture treatment can affect respiration, heart rate, blood pressure, circulation, and immune function 15. Research indicates the increased electrical conductivity of tissues along acupuncture meridians 16. This result suggests that manipulation of the acupuncture meridians with needles may modulate the transmission of certain signals within the body. The current scientific theories provide a basis for stating that acupuncture has an effect on the nervous system, but its effects cannot be explained with a single mechanism.

Who Provides Acupuncture Treatments ?

Nonphysician, licensed acupuncturists provide most acupuncture treatments in the United States. Although formal training programs differ from state to state, the National Certification Commission for Acupuncture and Oriental Medicine has developed rigorous certification criteria and examination requirements for licensed acupuncturists. The licensing mandates of a state should be checked to ensure the qualifications of a practitioner before a patient begins acupuncture treatment by that practitioner.

If you decide to visit an acupuncturist, check his or her credentials. Most states require a license, certification, or registration to practice acupuncture; however, education and training standards and requirements for obtaining these vary from state to state. Although a license does not ensure quality of care, it does indicate that the practitioner meets certain standards regarding the knowledge and use of acupuncture. Most states require a diploma from the National Certification Commission for Acupuncture and Oriental Medicine for licensing.

With the growth of integrative medicine, more physicians are seeking formal training in medical acupuncture. Physicians trained in medical acupuncture may be desirable practitioners, especially in complex cases in which conventional allopathic therapies need to be considered in developing an integrative treatment plan. The American Academy of Medical Acupuncture is a physician resource for training and certification.

Ask the practitioner about the estimated number of treatments needed and how much each treatment will cost. Some insurance companies may cover the costs of acupuncture, while others may not.

  • Don’t use acupuncture to postpone seeing a health care provider about a health problem. Help your health care providers give you better coordinated and safe care by telling them about all the health approaches you use. Give them a full picture of what you do to manage your health.

Acupuncture therapy

The Chinese people continue to use acupuncture as a primary healing modality for the prevention and treatment of most ailments. In the United States, physicians and patients most frequently request acupuncture as an adjuvant therapy for managing conditions associated with acute and chronic pain. These conditions range across different neurologic, musculoskeletal, and gastrointestinal symptoms (see Table 1). As acceptance of acupuncture increases within the medical community, the scope of acupuncture practice will likely broaden to mirror what is practiced worldwide to include non–pain-related conditions. These changing trends are likely to lead to additional research efforts focused on conditions in which a paucity of evidence for use exists.

Table 1. Traditional Uses of Acupuncture Therapy


Tension headache

Evidence suggests acupuncture can be helpful for management of migraine and tension-type headaches
 MusculoskeletalOsteoarthritis (knee)


Back pain

Neck pain

Postoperative pain

Evidence suggests acupuncture can be helpful for management of osteoarthritis of the knee, fibromyalgia, and back, neck, and postoperative pain
 GastrointestinalNausea and vomiting


Postoperative ileus


Evidence suggests acupuncture can be helpful for management of chemotherapy-induced nausea and postoperative nausea and vomiting

Inconsistent evidence suggests efficacy of acupuncture for management of constipation, postoperative ileus, and IBS

Further research may be helpful

 Gynecologic/reproductiveHot flashes



Inconsistent evidence suggests efficacy of acupuncture for management of hot flashes, infertility, and PMS

Further research may be helpful




Inconsistent evidence suggests efficacy of acupuncture for management of stress, anxiety, and depression

Further research may be helpful

 AddictionNicotine dependence

Alcohol dependence

Inconsistent evidence to make recommendations about the value of acupuncture in treatment of nicotine and alcohol dependence

Further research needed

 EndocrineObesityInconsistent evidence to make recommendations about the value of acupuncture in treatment of obesity

Further research needed

Less common
 ENTAllergic rhinitis


Inconsistent evidence to make recommendations about the value of acupuncture in treatment of allergic rhinitis and sinusitis

Further research needed



Inconsistent evidence to make recommendations about the value of acupuncture in treatment of asthma and COPD

Further research needed



Inconsistent evidence to make recommendations about the value of acupuncture in treatment of hypertension and angina

Further research needed



Inconsistent evidence to make recommendations about the value of acupuncture in treatment of insomnia and enuresis

Further research needed

Note: COPD = chronic obstructive pulmonary disease; ENT = ear, nose, throat; IBS = irritable bowel syndrome; PMS = premenstrual syndrome.

[Source 1]

Acupuncture benefits

What Does the Evidence Show ?

Although acupuncture has been used for thousands of years in Asia, the research community has started studying it only in the past few decades. The nature of acupuncture therapy involves tailoring treatments to the individual patient, and thus research on acupuncture has been difficult because of variable treatment interventions, techniques, and study size. Meta-analysis studies of acupuncture are limited because of the heterogeneity of pooling acupuncture treatment data.

Stroke Rehabilitation

A 2016 Cochrane review 17 involving 31 trials with a total of 2257 participants in the subacute or chronic stages of stroke. Two trials compared real acupuncture plus baseline treatment with sham acupuncture plus baseline treatment. There was no evidence of differences in the changes of motor function and quality of life between real acupuncture and sham acupuncture for people with stroke in the convalescent stage. Twenty-nine trials compared acupuncture plus baseline treatment versus baseline treatment alone. Compared with no acupuncture, for people with stroke in the convalescent phase, acupuncture had beneficial effects on the improvement of dependency (activity of daily living). The review authors conclusion was that acupuncture may have beneficial effects on improving dependency, global neurological deficiency, and some specific neurological impairments for people with stroke in the convalescent stage, with no obvious serious adverse events 17. However, most included trials were of inadequate quality and size. There is, therefore, inadequate evidence to draw any conclusions about its routine use 17. Rigorously designed, randomized, multi-center, large sample trials of acupuncture for stroke are needed to further assess its effects.

Period Pain

Another good quality review conducted in 2016 18 included 42 randomized controlled trials (4640 women). Acupuncture or acupressure was compared with a sham/placebo group, medication, no treatment or other treatment. Many of the continuous data were not suitable for calculation of means, mainly due to evidence of skew. The finding of that good quality review was there is insufficient evidence to demonstrate whether or not acupuncture or acupressure are effective in treating primary dysmenorrhoea (period pain) and for most comparisons no data were available on adverse events 18. The quality of the evidence was low or very low for all comparisons. The main limitations were risk of bias, poor reporting, inconsistency and risk of publication bias.

Peripheral Joint Osteoarthritis

In 2010 a Cochrane Review 19 was conducted to assess the effects of acupuncture for treating peripheral joint osteoarthritis. Sixteen trials involving 3498 people were included. Twelve of the randomized controlled trials included only people with osteoarthritis of the knee, 3 only osteoarthritis of the hip, and 1 a mix of people with osteoarthritis of the hip and/or knee. In comparison with a sham control, acupuncture showed statistically significant, short-term improvements in osteoarthritis pain; however, these benefits are small, do not meet the review authors pre-defined thresholds for clinical relevance and are probably due at least partially to placebo effects from incomplete blinding 19. 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 19.

Best estimate of what happens to people with osteoarthritis who have acupuncture 19:

Pain after 8 weeks:

  • People who had acupuncture rated their pain to be improved by about 4 points on a scale of 0 to 20.
  • People who received sham acupuncture rated their pain to be improved by about 3 points on a scale of 0 to 20.
  • People who received acupuncture had a 1 point greater improvement on a scale of 0-20. (5% absolute improvement).

Pain after 26 weeks:

  • People who had acupuncture rated their pain to be improved by slightly more than 3 points on a scale of 0 to 20.
  • People who received sham acupuncture rated their pain to be improved by slightly less than 3 points on a scale of 0 to 20.
  • People who received acupuncture had under a 1 point greater improvement on a scale of 0-20. (2% absolute improvement).

Physical function after 8 weeks :

  • People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68.
  • People who received sham acupuncture rated their function to be improved by about 8 points on a scale of 0 to 68.
  • People who received acupuncture had about a 3 point greater improvement on a scale of 0-68. (4% absolute improvement)

Physical function after 26 weeks :

  • People who had acupuncture rated their function to be improved by about 11 points on a scale of 0 to 68.
  • People who received sham acupuncture rated their function to be improved by about 10 points on a scale of 0 to 68.
  • People who received acupuncture had about a 1 point greater improvement on a scale of 0-68. (2% absolute improvement).

Rheumatoid arthritis

A good quality systematic review 20 was conducted to evaluate the effects of acupuncture or electro-acupuncture on the objective and subjective measures of disease activity in patients with rheumatoid arthritis. Although the results of the study on electro-acupuncture show that electro-acupuncture may be beneficial to reduce symptomatic knee pain in patients with rheumatoid arthritis 24 hours and 4 months post treatment, the reviewers concluded that the poor quality of the trial, including the small sample size preclude its recommendation. The reviewers further conclude that acupuncture has no effect on ESR, CRP, pain, patient’s global assessment, number of swollen joints, number of tender joints, general health, disease activity and reduction of analgesics 20. These conclusions are limited by methodological considerations such as the type of acupuncture (acupuncture vs electroacupuncture), the site of intervention, the low number of clinical trials and the small sample size of the included studies.


One in five fibromyalgia sufferers use acupuncture treatment within two years of diagnosis. In 2013 a Cochrane Review 21 was conducted to examine the benefits and safety of acupuncture treatment for fibromyalgia. Nine trials (395 participants) were included. All studies except one were at low risk of selection bias; five were at risk of selective reporting bias (favoring either treatment group); two were subject to attrition bias (favoring acupuncture); three were subject to performance bias (favoring acupuncture) and one to detection bias (favoring acupuncture). Three studies utilized electro-acupuncture with the remainder using manual acupuncture without electrical stimulation. All studies used ‘formula acupuncture’ except for one, which used trigger points.

There was low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia 21. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. Electro-acupuncture is probably better than manual acupuncture for pain and stiffness reduction and improvement of global well-being, sleep and fatigue. The effect lasts up to one month, but is not maintained at six months follow-up. Manual acupuncture probably does not improve pain or physical functioning. Acupuncture appears safe. People with fibromyalgia may consider using electro-acupuncture alone or with exercise and medication. The small sample size, scarcity of studies for each comparison, lack of an ideal sham acupuncture weaken the level of evidence and its clinical implications. Larger studies are warranted.

Neuropathic pain in adults

Neuropathic pain may be caused by nerve damage, and is often followed by changes to the central nervous system. Due to the limited data available, there is insufficient evidence to support or refute the use of acupuncture for neuropathic pain in general, or for any specific neuropathic pain condition when compared with sham acupuncture or other active therapies 22. Five studies are still ongoing and seven studies are awaiting classification due to the unclear treatment duration, and the results of these studies may influence the current findings.

Cancer pain in adults

Forty per cent of individuals with early or intermediate stage cancer and 90% with advanced cancer have moderate to severe pain and up to 70% of patients with cancer pain do not receive adequate pain relief. Five randomized controlled trials with 285 participants were included in this review 23. All studies had a high risk of bias from inadequate sample size and a low risk of bias associated with random sequence generation. Only three studies had low risk of bias associated with incomplete outcome data, while two studies had low risk of bias associated with allocation concealment and one study had low risk of bias associated with inadequate blinding. In conclusion, there is insufficient evidence to judge whether acupuncture is effective in treating cancer pain in adults.

Shoulder pain

In 2005 a well conducted review 24 was done to determine the efficacy and safety of acupuncture in the treatment of adults with shoulder pain. Nine trials of varying methodological quality met the inclusion criteria. For all trials there was poor description of interventions. Varying placebos were used in the different trials. There was no significant difference in short-term improvement associated with acupuncture when compared to placebo. In conclusion, 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.

Lateral elbow pain

There is insufficient evidence to either support or refute the use of acupuncture (either needle or laser) in the treatment of lateral elbow pain. This review 25 has demonstrated needle acupuncture to be of short term benefit with respect to pain, but this finding is based on the results of 2 small trials, the results of which were not able to be combined in meta-analysis. No benefit lasting more than 24 hours following treatment has been demonstrated. No trial assessed or commented on potential adverse effect. Further trials, utilizing appropriate methods and adequate sample sizes, are needed before conclusions can be drawn regarding the effect of acupuncture on tennis elbow.

Low-Back Pain

  • A 2012 analysis of data on participants in acupuncture studies looked at back and neck pain together and found that actual acupuncture was more helpful than either no acupuncture or simulated acupuncture.
  • A 2010 review by the Agency for Healthcare Research and Quality found that acupuncture relieved low-back pain immediately after treatment but not over longer periods of time.
  • A 2008 systematic review of studies on acupuncture for low-back pain found strong evidence that combining acupuncture with usual care helps more than usual care alone. The same review also found strong evidence that there is no difference between the effects of actual and simulated acupuncture in people with low-back pain.
    Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).
  • Clinical practice guidelines issued by the American Pain Society and the American College of Physicians in 2007 recommend acupuncture as one of several nondrug approaches physicians should consider when patients with chronic low-back pain do not respond to self-care (practices that people can do by themselves, such as remaining active, applying heat, and taking pain-relieving medications).

Neck Pain

  • A 2009 analysis found that actual acupuncture was more helpful for neck pain than simulated acupuncture, but the analysis was based on a small amount of evidence (only three studies with small study populations).
  • A large German study with more than 14,000 participants evaluated adding acupuncture to usual care for neck pain. The researchers found that participants reported greater pain relief than those who didn’t receive it; the researchers didn’t test actual acupuncture against simulated acupuncture.


  • A 2012 analysis of data on individual participants in acupuncture studies looked at migraine and tension headaches. The analysis showed that actual acupuncture was more effective than either no acupuncture or simulated acupuncture in reducing headache frequency or severity.
  • A 2009 systematic review of studies concluded that actual acupuncture, compared with simulated acupuncture or pain-relieving drugs, helped people with tension-type headaches. A 2008 systematic review of studies suggested that actual acupuncture has a very slight advantage over simulated acupuncture in reducing tension-type headache intensity and the number of headache days per month.
  • A 2009 systematic review found that adding acupuncture to basic care for migraines helped to reduce migraine frequency. However, in studies that compared actual acupuncture with simulated acupuncture, researchers found that the differences between the two treatments may have been due to chance.

Episodic migraine

In a Cochrane Review 26, twenty-two trials involving 4985 participants, acupuncture was associated with a moderate reduction of headache frequency over no acupuncture after treatment. The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. The updated evidence 26 also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents

Attention Deficit Hyperactivity Disorder (ADHD) is a common childhood psychiatric disorder with features of inattention, hyperactivity and impulsivity.

A comprehensive search showed that there is no evidence base of randomized or quasi-randomized controlled trials to support the use of acupuncture as a treatment for ADHD in children and adolescents. Due to the lack of trials, we cannot reach any conclusions about the efficacy and safety of acupuncture for ADHD in children and adolescents. This excellent quality review 27 highlights the need for further research in this area in the form of high quality, large scale, randomized controlled trials.

Autism spectrum disorders (ASD)

Autism spectrum disorders (ASD) are lifelong disorders of development. People with ASD have particular difficulties with social interaction and communication and they lack flexibility in their thinking and behavior. No cure is currently available but interventions may improve symptoms.

Current evidence does not support the use of acupuncture for treatment of ASD 28 high quality trials of larger size and longer follow-up are needed.

Induction of labour

Induction of labour is offered to pregnant women when it is thought the outcome will be better for the mother or her baby if the pregnancy does not continue and the baby is born. Common reasons for induction include the pregnancy going beyond the due date, pre-term or pre-labour rupture of the membranes, and concerns about the health of the mother or baby such as pre-eclampsia or poor growth of the baby.

Overall, there was no clear benefit from acupuncture or acupressure in reducing caesarean section rate 29. The quality of the evidence varied between low to high. Few trials reported on neonatal morbidity or maternal mortality outcomes. Acupuncture showed some benefit in improving cervical maturity, however, more well-designed trials are needed. Future trials could include clinically relevant safety outcomes.

Pain management in labour

Many women would like to avoid pharmacological or invasive methods of pain management in labour and this may contribute towards the popularity of complementary methods of pain management. A systematic review was done in 2011 using 13 trials with data reporting on 1986 women 30. Nine trials reported on acupuncture and four trials reported on acupressure. Less intense pain was found from acupuncture compared with no intervention. Pain intensity was reduced in the acupressure group compared with a placebo control. In conclusion, acupuncture and acupressure may have a role with reducing pain, increasing satisfaction with pain management and reduced use of pharmacological management 30. However, there is a need for further research.


In 2013 Cochrane Review 31 to assess the effectiveness and safety of acupuncture in people with glaucoma. The review found that it is impossible to draw reliable conclusions from available data to support the use of acupuncture for the treatment of glaucoma. Because of ethical considerations, randomized controlled trials comparing acupuncture alone with standard glaucoma treatment or placebo are unlikely to be justified in countries where the standard of care has already been established 31. Because most glaucoma patients currently cared for by ophthalmologists do not use nontraditional therapy, clinical practice decisions will have to be based on physician judgments and patient preferences, given this lack of data in the literature. Inclusion of the seven Chinese trials in future updates of this review may change their conclusions.

Slowing the progression of myopia in children and adolescents

Myopia (near-sightedness or short-sightedness) is one of the three commonly detected refractive (focusing) errors. Two trials are included in this review 32 but no conclusions can be drawn for the benefit of co-acupressure for slowing progress of myopia in children. Further evidence in the form of randomized controlled trials are needed before any recommendations can be made for the use of acupuncture treatment in clinical use. These trials should compare acupuncture to placebo and have large sample sizes. Other types of acupuncture (such as auricular acupuncture) should be explored further as well as compliance with treatment for at least six months or longer. Axial length elongation of the eye should be investigated for at least one year. The potential to reduce/eliminate pain from acupuncture experienced by children should also be reviewed.


A good quality review 33 examined the effectiveness and adverse effects of acupuncture in the treatment for depression. The review found there was a high risk of bias in the majority of trials. There was insufficient evidence of a consistent beneficial effect from acupuncture compared with a wait list control or sham acupuncture control. The reviewers found insufficient evidence to recommend the use of acupuncture for people with depression 33. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.


A Cochrane Review was conducted in 2014 34 to determine the effectiveness and safety of acupuncture in people with epilepsy. There were 17 randomized controlled trials with 1538 participants that had a wide age range and were suffering mainly from generalized epilepsy. The duration of treatment varied from 7.5 weeks to 1 year. All included trials had a high risk of bias with short follow-up. Compared with Chinese herbs, needle acupuncture plus Chinese herbs was not effective in achieving at least 50% reduction in seizure frequency (80% in control group versus 90% in intervention group. Based on those small, heterogeneous and high risk of biased evidence, the use of acupuncture for treating epilepsy cannot be supported.

Acute hordeolum (Stye infection)

Hordeolum is an acute, purulent inflammation of the eyelid margin usually caused by obstructed orifices of the sebaceous glands of the eyelid. The condition, which affects sebaceous glands internally or externally, is common. A Cochrane Review 35 was conducted to investigate the effectiveness and safety of acupuncture to treat acute hordeolum compared with no treatment, sham acupuncture, or other active treatment. There was low-certainty evidence suggesting that acupuncture with or without conventional treatments may provide short-term benefits for treating acute hordeolum when compared with conventional treatments alone. The certainty of the evidence was low to very low mainly due to small sample sizes, inadequate allocation concealment, lack of masking of the outcome assessors, inadequate or unclear randomization method, and a high or unreported number of dropouts. All randomized controlled trials were conducted in China, which may limit their generalizability to non-Chinese populations.

Because no randomized controlled trials included a valid sham acupuncture control, we cannot rule out a potential expectation/placebo effect associated with acupuncture. As resolution is based on clinical observation, the outcome could be influenced by the observer’s knowledge of the assigned treatment. Adverse effects of acupuncture were reported sparsely in the included randomized controlled trials and, when reported, were rare. Randomized controlled trials with better methodology, longer follow-up, and which are conducted among other populations are warranted to provide more general evidence regarding the benefit of acupuncture to treat acute hordeolum.

Bell’s palsy

Bell’s palsy or idiopathic facial palsy is an acute facial paralysis due to inflammation of the facial nerve. A number of studies published in China have suggested acupuncture is beneficial for facial palsy. A quality review 36 was conducted to examine the efficacy of acupuncture in hastening recovery and reducing long-term morbidity from Bell’s palsy. The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.


A 2012 Cochrane Review 37 involving thirty-three trials were included to determine the efficacy and safety of acupuncture for insomnia. They recruited 2293 participants with insomnia, aged 15 to 98 years, some with medical conditions contributing to insomnia (stroke, end-stage renal disease, perimenopause, pregnancy, psychiatric diseases). They evaluated needle acupuncture, electro-acupuncture, acupressure or magnetic acupressure. Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia. Larger high-quality clinical trials are required.

Restless legs syndrome

Restless legs syndrome is a sensorimotor movement disorder characterized by uncomfortable sensations in the legs and an urge to move them. The syndrome is very common and its lifestyle impacts justify a search for more effective and acceptable interventions. There is insufficient evidence to support the use of acupuncture for the symptomatic treatment of restless legs syndrome 38.

Cocaine dependence

More than 400 substance abuse clinics in the USA and Europe offer a treatment for cocaine dependence called auricular acupuncture. In this treatment, needles are usually inserted into five specific points in the ear, but some clinics use only four or three of the points. In this Cochrane review 39 the authors set out to discover whether auricular acupuncture is effective in treating cocaine dependence and whether the number of points used makes a difference. There is currently no evidence that auricular acupuncture is effective for the treatment of cocaine dependence 39. The evidence is not of high quality and is inconclusive. Further randomized trials of auricular acupuncture may be justified.

Smoking cessation

Although pooled estimates suggest possible short-term effects there is no consistent, bias-free evidence that acupuncture, acupressure, or laser therapy have a sustained benefit on smoking cessation for six months or more 40. However, lack of evidence and methodological problems mean that no firm conclusions can be drawn. Electrostimulation is not effective for smoking cessation. Well-designed research into acupuncture, acupressure and laser stimulation is justified since these are popular interventions and safe when correctly applied, though these interventions alone are likely to be less effective than evidence-based interventions.

Uterine fibroids

Uterine fibroids are benign growths within the uterine muscle and are present in 30% of women during their reproductive years. To assess the benefits and harms of acupuncture in women with uterine fibroids, as systematic review 41 was done. No randomized double-blind controlled trials met the inclusion criteria. The effectiveness of acupuncture for the management of uterine fibroids remains uncertain. More evidence is required to establish the efficacy and safety of acupuncture for uterine fibroids. There is a continued need for well designed randomized controlled trials with long term follow up.


Endometriosis is a gynaecological disease that causes chronic pelvic pain, most notably painful menstruation, as the most common complaint.

The evidence to support the effectiveness of acupuncture for pain in endometriosis is limited, based on the results of only a single study that was included in this review 42. This review examined the effectiveness of acupuncture for reducing pain in endometriosis; however only one study met our inclusion criteria. The data from the included study, involving 67 women, indicated that ear acupuncture is more effective compared to Chinese herbal medicine for reducing menstrual pain. The study did not report whether participants suffered any side effects from their treatments. Larger, well-designed studies comparing acupuncture with conventional therapies are necessary to confirm these results.

Polycystic ovarian syndrome

Polycystic ovarian syndrome (PCOS) is where women have small cysts on their ovaries (organs that produce eggs) and is characterised by the clinical signs of infrequent or very light menstruation (periods), failure to conceive (become pregnant) and excessive hair growth. Thus far, only a limited number of randomized controlled trials have been reported. At present, there is insufficient evidence to support the use of acupuncture for treatment of ovulation disorders in women with PCOS 43.

Menopausal hot flushes

Hot flushes are the most common menopausal vasomotor symptom. Hormone therapy has frequently been recommended for relief of hot flushes, but concerns about the health risks of hormone therapy have encouraged women to seek alternative treatments.A Cochrane Review found insufficient evidence to determine whether acupuncture is effective for controlling menopausal vasomotor symptoms 44. When we compared acupuncture with sham acupuncture, there was no evidence of a significant difference in their effect on menopausal vasomotor symptoms. When we compared acupuncture with no treatment there appeared to be a benefit from acupuncture, but acupuncture appeared to be less effective than hormone therapy. These findings should be treated with great caution as the evidence was low or very low quality and the studies comparing acupuncture versus no treatment or hormone therapy were not controlled with sham acupuncture or placebo hormone therapy. Data on adverse effects were lacking.

Functional dyspepsia

A Cochrane Review 45 was done in 2014 to to assess the efficacy and safety of manual acupuncture and electroacupuncture in the treatment of functional dyspepsia. However, all the evidence was of low or very low quality. The body of evidence identified cannot yet permit a robust conclusion regarding the efficacy and safety of acupuncture for functional dyspepsia. It remains unknown whether manual acupuncture or electro-acupuncture is more effective or safer than other treatments for patients with functional dyspepsia.

Irritable bowel syndrome

Sham-controlled randomized controlled trials have found no benefits of acupuncture relative to a credible sham acupuncture control for IBS symptom severity or IBS-related quality of life 46. In comparative effectiveness Chinese trials, patients reported greater benefits from acupuncture than from two antispasmodic drugs (pinaverium bromide and trimebutine maleate), both of which have been shown to provide a modest benefit for IBS. Future trials may help clarify whether or not these reportedly greater benefits of acupuncture relative to pharmacological therapies are due entirely to patients’ preferences for acupuncture or greater expectations of improvement on acupuncture relative to drug therapy.

Stress urinary incontinence in adults

Stress urinary incontinence is a common disease among older people, especially women. The symptoms are leakage of urine when the person coughs, laughs or exercises. It affects social, psychological, physical and financial aspects of life.

The effect of acupuncture for stress urinary incontinence for adults is uncertain. There is not enough evidence to determine whether acupuncture is more effective than drug treatment 47.


A 2014 Cochrane Review 48 found limited evidence suggesting that acupuncture may have some antipsychotic effects as measured on global and mental state with few adverse effects. Better designed large studies are needed to fully and fairly test the effects of acupuncture for people with schizophrenia.

Vascular dementia

The effectiveness of acupuncture for vascular dementia is uncertain 49. More evidence is required to show that vascular dementia can be treated effectively by acupuncture. There are no randomized controlled trials and high quality trials are few. Randomized double-blind placebo-controlled trials are urgently needed.

Acupuncture side effects

Acupuncture is generally considered safe when performed by an experienced, well-trained practitioner using sterile needles. Improperly performed acupuncture can cause serious side effects.

The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices for use by licensed practitioners and requires that needles be manufactured and labeled according to certain standards. For example, the FDA requires that needles be sterile, nontoxic, and labeled for single use by qualified practitioners only.

Acupuncture in the developed parts of the world involves single-use, disposable needles packaged and sealed by the manufacturer in sterile conditions. Although case reports have highlighted major adverse events, such as organ puncture, infections, and bleeding complications, more recent, larger cohort studies using universal precautions have not found a significant complication rate. In a 2001 study of more than 34,000 acupuncture treatments in the United Kingdom, no serious adverse events (e.g, hospitalization, permanent disability, or death) were reported in relation to acupuncture therapy, and the rate of underlying minor adverse events (e.g, nausea, fainting, prolonged aggravation of existing symptoms, and psychological or emotional reaction) was reported to be between 0 and 1.1 per 10,000 treatments 50. Acupuncture involves puncturing the skin, and therefore slight bruising, bleeding, or soreness at the acupuncture site may occur because of needle penetration through capillaries. More serious adverse effects, such as a vasovagal response with a decrease in blood pressure and syncope, have been reported. Infections may occur at the needle site from the use of nonsterile needles. When herbs are burned too close to the skin, burn injuries can result around the needle site.

Acupuncture is generally considered safe for persons with bleeding disorders or taking anticoagulants. However, it is important for the patient to advise the practitioner of these facts so the practitioner can use vigilance in selecting insertion points. Acupuncture during pregnancy is a matter of continued debate. Certain acupuncture points are contraindicated because they may induce uterine contractions and premature labor.

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