When the opioid addiction crisis began to surge in the U.S. about a decade ago, Dr. Medhat Mikhael spent a lot of time talking to his patients about other ways to heal pain besides opioids, from other types of medications to alternative treatments.

As a pain management specialist at MemorialCare Orange Coast Medical Center in Fountain Valley, Calif., he didn’t anticipate leaving behind the short-term use of opioids altogether, since they work so well for post-surgical pain. But he wanted to recommend a remedy that was safer and still effective.

That turned out to be acupuncture.

“Like any treatment, acupuncture doesn’t work for everyone, but the majority of my patients who have tried it have found relief,” he says. “When I started looking into studies, I discovered how much evidence there was behind this treatment, and that made me feel comfortable suggesting it as an alternative or a complement to pain medication and other treatments.”

That blend of anecdotal success, research-backed results, and growing level of openness from the medical community are all driving the popularity of acupuncture as a therapy. According to a 2021 World Health Organization report, acupuncture is the most widely used traditional medicine practice globally, and it’s gaining traction in the U.S. In 2020, the Centers for Medicare & Medicaid services began covering acupuncture for the first time for chronic low back pain.

Although scientists don’t yet understand all the nuances of how it works, research indicates it can have a significant effect on certain conditions, and it shows promise for others.

What is acupuncture?

The goal of acupuncture is the same now as it was thousands of years ago when it was first developed in China: restoring balance to the body, says Kevin Menard, a sports medicine acupuncturist and Traditional Chinese Medicine practitioner in Sag Harbor, New York.

The practice is based on how energy, or qi, flows through the body along a series of channels called meridians—similar to the way nerves and vessels carry messages and blood throughout every system.

“According to Chinese medicine theory, each meridian is related to a specific organ, and placing thin needles at certain points along these meridians can effect certain changes in the body to restore homeostasis,” says Menard. The needles aren’t the type you’d use to draw blood; they’re very thin and flexible, almost like bits of wire.

Placement along the meridians is believed to cause reactions like sending more blood or lymphatic fluid to specific organs or allowing muscles to release in a way that reduces tension on joints and bones. The needles may also stimulate nerves and tweak nervous system regulation to result in a relaxation response, which relieves pain, Mikhael says.

Acupuncture is also thought to stimulate the immune system and control inflammation, Menard says, two effects that can bring benefits throughout the body. Depending on the condition or injury, relief might happen with just one treatment, but it usually takes a series of sessions, Menard says, especially if an issue is complex or chronic.

What the research says

Research on acupuncture has been extensive, and so far, robust evidence supports its effectiveness for some, but not all, conditions. According to one analysis published in February 2022 in the BMJ that analyzed more than 2,000 scientific reviews of acupuncture therapies, the science is strongest behind acupuncture’s efficacy for post-stroke aphasia; neck, shoulder, and muscle pain; fibromyalgia pain; lactation issues after delivery; lower back pain; vascular dementia symptoms; and allergy symptoms.

The National Institutes of Health (NIH) finds that acupuncture for pain relief tends to have the most evidence, especially for conditions that have become chronic like osteoarthritis and lower back pain, as well as tension headaches. A review of 11 clinical trials also suggests that acupuncture may help with symptoms associated with cancer treatment, the NIH notes.

That’s been a booming area of interest for the field, says Sarah Weaver, an acupuncturist and massage therapist at Northwestern Health Sciences University in Minnesota, which focuses on integrative health professions, such as acupuncture, chiropractic, and Traditional Chinese Medicine. For cancer patients, sessions there can focus on reducing nausea, numbness, and tingling (called neuropathy), brain fog, low appetite, acute and chronic pain, and mood challenges that come with cancer care.

“Often, people with cancer want to add complementary treatment that doesn’t affect their chemotherapy or radiation, and that’s where an option like acupuncture can be helpful,” she says. “It’s the reason more healthcare systems are bringing this treatment into their integrative care options.”

What’s next in the field

Acupuncture is far from a proven and accepted therapy for most conditions—even for the ones that show promise. That’s in part because the studies that support it are sometimes not high quality, and the field lacks standardized protocols that would better allow it to be scientifically evaluated, the recent WHO report finds.

For instance, one 2016 research review analyzed studies looking at acupuncture for substance abuse and addiction. Among the 83 research articles included in the review, the researchers found substantial variations in study quality, acupuncture frequency, how long needles were left in the body during treatment, which points along the meridians were used, and other potentially important factors. That made it difficult to evaluate how effective the acupuncture really was. The field also lacks clear terminology and universally accepted agreement about the location of acupuncture points, researchers argue.

Issues like these will have to be resolved to get more clarity, and to earn recommendations from reputable organizations in the future. International experts in the field are pushing to make clinical trials more rigorous in order to prove acupuncture’s utility for patient care and to help providers adopt the best practices as more benefits become clear.

Some potential directions for future studies include studying how acupuncture may affect hormonal regulation, such as alleviating hot flashes in menopause or addressing menstrual irregularity. Research indicates that the practice can boost estrogen and other hormones, and acupuncture for gynecological issues is becoming more popular, says Menard. Some researchers are also focused on studying acupuncture’s impact on fertility; some small, preliminary studies indicate its use may be linked to getting pregnant sooner and having better outcomes from IVF treatments.

Acupuncture for mental health issues like depression and anxiety is another major research direction, especially in terms of how these issues affect overall health. For example, chronic pain has often been linked to depressive symptoms, so researchers are looking at whether acupuncture can address both: a person’s pain and their depression. Researchers are hopeful. A study published in 2020 in the journal Frontiers in Neurology found that people with migraines who did acupuncture treatments had a lower risk of depression and anxiety, and tended to use medical services less often, compared to migraine patients who didn’t do acupuncture.

As the evidence base expands, acupuncture will likely continue to grow in popularity. Although acupuncture has been used for centuries, only in the past decade has there been a seismic shift in acceptance by both Western medical doctors and patients, Menard says. Ongoing research efforts and increased interest from health systems means that the treatment may be part of more conversations like Mikhael had with his patients.

“At the end of the day, doctors want their patients to feel better, and many people are looking for non-pharmaceutical paths for wellness,” Menard says. “Depending on the condition, those little needles can make a huge impact.”