Acupuncture is popular and widely practiced in the U.S.  One-third of the practitioners are physicians with others being chiropractors, massage therapists, acupuncturists, etc.  Unfortunately, the research suggests that acupuncture doesn't live up to its reputation except in studies done in China or done by strong advocates of acupuncture.  When studies are done with careful controls to eliminate bias, benefits seem small at best and usually non-existent.  The American taxpayer gets soaked for billions of dollars per year being forced to support insurance plans which pay for acupuncture.  Of course, its not the only ineffective or wasteful treatment. 

Alcoholism Not Helped: There were few differences associated with treatment assignment and there were no treatment differences on alcohol use measures, although 49% of subjects reported acupuncture reduced their desire for alcohol. The placebo and preference for treatment measures did not materially effect the results. Generally, acupuncture was not found to make a significant contribution over and above that achieved by conventional treatment alone in reduction of alcohol use. 503 patients randomized in Minneapolis. J Subst Abuse Treat 2002 Mar;22(2):71-7

Cocaine Dependence: Acupuncture No Value: In a meta-analysis of controlled studies of acupunture in the treatment of cocaine dependence, 9 study were found which had a total of 1747 participants. Acupuncture had no beneficial effect on increasing abstinence. The pooled odds ratio estimating the effect of acupuncture on cocaine abstinence at the last reported time-point was 0.76 (P = 0.30). Efficacy of acupuncture for cocaine dependence: a systematic review & meta-analysis. Mills EJ, et al. Canadian College of Naturopathic Medicine, North York, Ontario, Canada. . Harm Reduct J. 2005 Mar 17;2(1):4.

Depression: Acupuncture No Clear Benefit for Depression: In a meta-analysis of random assignment controlled studies of either manual acupuncture or electroacupuncture compared with any control procedure in subjects with depression, 7 randomised comparative trials involving 509 patients were included. The evidence is inconsistent on whether manual acupuncture is superior to sham, and suggests that acupuncture was not superior to waiting list. Evidence suggests that the effect of electroacupuncture may not be significantly different from antidepressant medication, weighted mean difference -0.43(95% CI -5.61 to 4.76). There is inconclusive evidence on whether acupuncture has an additive effect when given as an adjunct to antidepressant drugs. The effectiveness of acupuncture for depression--a systematic review of randomised controlled trials. Mukaino Y, et al. Peninsula Medical School, Exeter, UK. . Acupunct Med. 2005 Jun;23(2):70-6.

Very Small Study Reports Possible Acupuncture Benefit: In a DB PC study of 30 depressed patients receiving either active or inactive laser acupuncture treatment twice weekly for 4 weeks and then weekly for 4 more weeks, Beck Depression Inventory scores fell from baseline by 16.1 points in the intervention group and by 6.8 points in the sham control group (P<0.001). Laser acupuncture for mild to moderate depression in a primary care setting--a randomised controlled trial. Quah-Smith JI, et al. Monash University , Victoria , Australia . . Acupunct Med. 2005 Sep;23(3):103-11. Ed: Acupuncture has a very poor track record in studies for other diseases.  This is probably a fluke finding due to the very small size and other factors.

Dyspnea: Acupuncture Didn't Help Difficulty Breathing in Cancer: In a DB PC study of dyspnea in 47 patients with lung or breast cancer, dyspnea scores were slightly higher for patients receiving a single session of true versus placebo acupuncture, for both the period immediately following acupuncture treatment and for the daily one week follow-up. Acupuncture for dyspnea in advanced cancer: a randomized, placebo-controlled pilot trial [ISRCTN89462491]. Vickers AJ, et al.  BMC Palliat Care. 2005 Aug 18;4(1):5

Fibromyalgia: Acupuncture No Better than Sham in Excellent Study of Fibromyalgia: In a 12-week with 6-month follow-up DB PC study of 100 adults with fibromyalgia, patients received twice-weekly treatment of either an acupuncture program that was specifically designed to treat fibromyalgia, or 1 of 3 sham acupuncture treatments: acupuncture for an unrelated condition, needle insertion at nonacupoint locations, or noninsertive simulated acupuncture. The mean subjective pain rating among patients who received acupuncture for fibromyalgia did not differ from that in the pooled sham acupuncture group (mean between-group difference, 0.5 cm [95% CI, -0.3 cm to 1.2 cm]). Participant blinding was adequate throughout the trial. A randomized clinical trial of acupuncture compared with sham acupuncture in fibromyalgia. Assefi NP, et al. University of Washington, Seattle. Ann Intern Med. 2005 Jul 5;143(1):10-9.

Headaches: Acupuncture No Better for Tension Headaches than Random Superficial Needling: Tension-type headache is a bilateral headache of a pressing or tightening quality without a known medical cause. It is episodic if it occurs on less than 15 days a month and as chronic if it occurs more often. A survey from the United States found a one year prevalence of 38% for episodic tension-type headache and 2% for chronic tension-type headache. In a 12-week DB PC study of 270 adults with tension headaches, the number of headaches decreased similarly for both the actually acupuncture 12-session treatments and the superficial needling at non-acupuncture sites control group vs. the waiting list control group (7.2 vs. 6.6 vs. 1.5).  Acupuncture in patients with tension-type headache: randomised controlled trial. Dieter Melchart, et al. Technische Universitat Muenchen, Germany. BMJ  2005;331:376-382 (13 August). The authors noted that 3 previous sham controlled studies for no difference for acupunture, where as two others did find acupunture benefit. The authors note that acupunture is likely to have high placebo value due to it being exotic, complex, with doctor-patient contact, and a detailed ritual. 

Headaches: Migraine Helped Just as Much by Sham Acupuncture as by Real Acupuncture: In an 8-week DB PC study of 302 patients with migraine headaches at 18 outpatient centers in Germany, patients received acupuncture, sham acupuncture, or waiting list control. Acupuncture and sham acupuncture were administered by specialized physicians in 12 sessions per patient. Between baseline and weeks 9 to 12, the mean number of days with headache of moderate or severe intensity decreased by 2.2 days from a baseline of 5.2 days in the acupuncture group compared with a decrease to 2.2 days from a baseline of 5.0 days in the sham acupuncture group, and by 0.8 days from a baseline of 5.4  days in the waiting list group. The proportion of responders (reduction in headache days by at least 50%) was 51% in the acupuncture group, 53% in the sham acupuncture group, and 15% in the waiting list group. Acupuncture for patients with migraine: a randomized controlled trial. Linde K, et al. Technische Universitat Munchen, Munich, Germany. . JAMA. 2005 May 4;293(17):2118-25.

Irritable Bowel: Acupuncture No Better than Sham Acupuncture for Irritable Bowel: In a randomized study of 25 patients with irritable bowel syndrome symptoms persisting for more than 1 year, there was no significant difference between true acupuncture was performed at LI-4 (colonic meridian, needle only) and sham acupuncture at BL-60 (urinary vesicle meridian, needle only) except at the first session (p = 0.05). No comparable effect was seen in the second session. Researchers could not show a therapeutic benefit of this treatment modality in irritable bowel syndrome. Acupuncture treatment for irritable bowel syndrome. A double-blind controlled study. Fireman Z, et al. Hillel Yaffe Medical Center, Hadera, Israel. . Digestion. 2001;64(2):100-3.

Irritable Bowel Syndrome Not Significantly Benefited by Acupuncture vs. Sham: In a 13-week DB, sham acupuncture-controlled trial of traditional Chinese acupuncture with 60 patients with well-established IBS, the blinded comparator was sham acupuncture administered by the second of two acupuncturists who alone was aware of the randomization, and who otherwise followed the prescription of the first. Patients in treated and sham groups improved significantly during the study-mean improvement in scores being equal (minus 1.9) and significant for both (P<0.05; one-tailed t test). There was a small numeric but non-significant difference between the response rate in patients receiving acupuncture (40.7%) and sham treatment (31.2%). Several secondary end-points marginally favored active treatment, but an improved symptom score of any degree of magnitude occurred more often with sham therapy (65.6% vs 59.2%). For no criterion was statistical significance approached. Researchers concluded that the magnitude of any effect appears insufficient to warrant investment in acupuncture services. Acupuncture for irritable bowel syndrome: A blinded placebo-controlled trial. Forbes A, et al. St Mark's Hospital, Harrow, United Kingdom. . World J Gastroenterol. 2005 Jul 14;11(26):4040-4.

Low Back Pain: Acupuncture Said Effective in Meta-Analysis: In a meta-analysis of 33 randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain, acupuncture was significantly more effective than sham treatment and no additional treatment. For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies. Meta-analysis: acupuncture for low back pain. Manheimer E, et al. University of Maryland. Ann Intern Med. 2005 Apr 19;142(8):651-63.

Low Back Pain: Studies Poor Quality: Small, Short-Term Benefit for Chronic Low Back Pain Probable: In a meta-analysis of all randomized trials of acupuncture (that involves needling) for adults with non-specific (sub)acute or chronic low-back pain, or dry-needling for myofascial pain syndrome in the low-back region, 35 RCTs were included; 20 were published in English, seven in Japanese, five in Chinese and one each in Norwegian, Polish and German. There were only three for acute low-back pain. For chronic low-back pain there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and at short-term follow-up. There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, effects are small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.  Acupuncture is not more effective than other conventional and "alternative" treatments. However, most of the studies were of lower methodological quality. Acupuncture and dry-needling for low back pain. Furlan AD, et al. Toronto, ON, Canada. . Cochrane Database Syst Rev. 2005 Jan 25;(1):CD001351

Nausea: Acupunture No Better than Placebo Non-Penitrating Acupuncture for Cancer Chemotherapy Nausea: In a single-blind PC study of 80 patients who were admitted to hospital for high-dose chemotherapy and autologous peripheral blood stem cell transplantation, patients were randomized to receive acupuncture (n = 41) or noninvasive placebo acupuncture (n = 39) at the acupuncture point P6 30 min before first application of high-dose chemotherapy and the day after. All patients received 8 mg ondansetron/day i.v. as basic antiemetic prophylaxis. There was no difference (P = 0.82): 61% failure in the acupuncture group and 64% in the placebo acupuncture group. Comparing nausea, episodes of vomiting or retching and number of additionally required antiemetic drugs did not provide any discrepancy with the main result. Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: a randomized controlled single-blind trial. Streitberger K, et al. University of Heidelberg, Germany. . Clin Cancer Res. 2003 Jul;9(7):2538-44.

Neck Pain: Acupuncture Minimally Effective: In a study of 135 adults with chronic mechanical neck pain, patients were randomly assigned to receive, over 4 weeks, 8 treatments with acupuncture or with mock transcutaneous electrical stimulation of acupuncture points using a decommissioned electroacupuncture stimulation unit. Both groups improved statistically from baseline, and acupuncture and placebo had similar credibility. There was a 12% lower level of pain between acupuncture and placebo, which was statistically but not clinically significant. Acupuncture versus placebo for the treatment of chronic mechanical neck pain: a randomized, controlled trial. White P, et al. University of Southampton, UK. . Ann Intern Med 2004 Dec 21;141(12):911-9.

Surgery: Acupunture No Benefit in Lowering Morphine Use After Abdominal Surgery:  In a DB PC study of 53 patients receiving either acupuncture or a control treatment after abdominal surgery, morphine usage (47 mg vs 41 mg) and pain scores (29.5 mm vs 40 mm) were similar in the control and acupressure groups. Minute sphere acupressure does not reduce postoperative pain or morphine consumption. Sakurai M, et al. University of Louisville. Anesth Analg. 2003 Feb;96(2):493-7

Stroke: Acupuncture Little Benefit in Stroke Rehabilitation: In a meta-analysis of 14 randomized trials with 1213 patients comparing acupuncture with no acupuncture in addition to stroke rehabilitation, acupuncture had no additional effect on motor recovery but has a small positive effect on disability, which may be due to a true placebo effect and varied study quality. Most studies were of the poor quality. Does acupuncture improve motor recovery after stroke? A meta-analysis of randomized controlled trials. Sze FK, et al. Shatin Hospital, N.T. Hong Kong. . Stroke. 2002 Nov;33(11):2604-19

Thomas E. Radecki, M.D., J.D.

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