Is there any proof that acupuncture is an effective pain remedy?

Question

I have heard of acupuncture being used for pain management. Are there clear scientific proofs that indicate it is more effective than a placebo treatment for pain? If so what types of pain has it been shown to effective for?

Answer 1

tl;dr

Current research seems to indicate that the brain is responding to anticipation or visual stimulus of needles being inserted, not that any of the theories supporting acupuncture are correct.

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Steven Novella reviewed the following article:

Chae Y, Lee IS, Jung WM, Park K, Park HJ, Wallraven C. Psychophysical and neurophysiological responses to acupuncture stimulation to incorporated rubber hand. Neurosci Lett. 2015 Feb 11;591C:48-52. doi: 10.1016/j.neulet.2015.02.025.

I'm going to quote from Novella's review because it's easier for a lay person to read/understand, and I don't have full access to the paper.

As background, he states:

There have been in total several thousand clinical studies looking at the apparent effects of acupuncture. These have failed to convincingly reject the null hypothesis, meaning that they have not demonstrated a clear biological response to acupuncture for any indication. The better controlled studies consistently show that needle location does not matter (sham acupuncture), and that needle insertion does not matter (placebo acupuncture). You can literally have a non-acupuncturist randomly poke someone with toothpicks and get the same response as the full acupuncture treatment.

And described the current paper:

A recent study looked at performing acupuncture on a phantom limb. They used a now well-established technique of tricking the brain into incorporating a dummy body part as if it were real. They placed subjects in front of a table so that one of their arms was below the table, with a rubber arm above the table placed in such a way that visually the rubber arm looked like their own arm. They then stroke the rubber arm and the subjects real arm simultaneously. The brain sees and feels the rubber arm being stroked, and this sensory feedback is often enough for the brain to create the sensation of ownership over the rubber arm.

The researchers then placed acupuncture needles into the rubber arm that subjects had incorporated as their own. Obviously there is no possibility of any physiological response from the needle penetrating the rubber arm. I further think it is reasonable to conclude that placing a needle into a rubber arm cannot activate acupuncture points (if they existed) or alter Qi (if it existed). This experiment nicely eliminates local physiological responses and any Qi responses to the needles.

The researchers performed functional MRI scanning (fMRI) on subjects while needles were placed in their phantom rubber limbs. Keep in mind that fMRI research involves collecting lots of data and aggregating it. So the researchers are not looking at brain reactions in real time, just the aggregate brain activity of many subjects over many trials. They then look for statistical associations in the activity.

What they found was the same brain activation that previous studies have found with acupuncture of real limbs.

When the rubber hand was fully incorporated with the real body, acupuncture stimulation to the rubber hand resulted in the experience of the DeQi sensation as well as brain activations in the dorsolateral prefrontal cortex (DLPFC), insula, secondary somatosensory cortex (SII), and medial temporal (MT) visual area. The insular activation was associated with the DeQi sensation from the rubber hand.

If these results hold up, this implies that the brain is simply responding to the expectation and visualization of the needle penetration. Actual needle penetration is unnecessary. The most parsimonious interpretation of this data is that acupuncture is all in the mind. There is no need to hypothesize the existence of Qi, acupuncture points, or a specific physiological mechanism for acupuncture.

There are plenty of studies that show that the perception of pain is easily manipulated by simple things such as distraction. Swearing, distorting body image, and crossing your arms while one of them is pricked will all reduce pain perception. Pain perception is closely tied to attention, and so simple distraction is effective. It’s no surprise, therefore, that the brain responds to phantom stimulation.

At the very least this study demonstrates that all prior studies looking at fMRI responses to acupuncture needle insertion were likely simply showing a non-specific brain response to the expectation and/or visualization of needle insertion, without the need to invoke any specific physiological responses.

Answer 2

Acupuncture is often used to treat pain conditions such as headache, lower back and osteoarthritis. It is based on scientific evidence that treatment can stimulate nerves under the skin and in muscle tissue and as result body is producing pain-relieving substances (such as endorphins)^NHS.

NICE recommends acupuncture only as a treatment option for chronic lower back pain, chronic tension-type headaches and migraines which are based on the scientific evidence.

However more research is needed to established whatever acupuncture should be used for other pain remedies.

^{Source: Acupuncture - Evidence at NHS}

Read more about evidence at: Evidence Search at NICE and Cochrane Library.