Acupuncture

Acupuncture is the practice of stimulating specific points under your skin using very thin needles.

Key points

  1. Acupuncture involves stimulating certain points on your body with needles.
  2. There are 2 broad types of acupuncture in New Zealand: traditional Chinese acupuncture, and Western medical acupuncture.
  3. Acupuncture is generally safe as long as you see a registered and trained provider who uses sterile needles.
  4. Traditional Chinese acupuncture is not regulated in New Zealand. Be careful when reading acupuncture websites and advertising, as the practice of making false claims is quite common.
  5. Acupuncture may be mildly effective for a limited number of conditions, mainly some types of pain and some types of nausea. However, the overall evidence is weak and conflicting.
  6. It's not recommended that you have acupuncture as a sole treatment for your health problem, but it can normally be safely used alongside standard treatments, such as with a doctor, nurse, or physiotherapist.

What is acupuncture?

undefined

Acupuncture is a form of complementary and alternative medicine (CAM) and refers to a therapy used to stimulate certain points on your body, normally with needles.

There are 2 main types of acupuncture practised in New Zealand: traditional Chinese acupuncture and Western medical acupuncture.

Traditional Chinese acupuncture

Chinese acupuncture as it is practised now is a highly modified version of an ancient practice. It is based on the belief that a life force called Qi (pronounced ‘chee’) flows through your body. Traditional acupuncturists also use the concepts of yin and yang, and the 5 elements (wood, water, fire, earth, metal).

The acupuncturist may say there is an imbalance in these elements, and use a variety of techniques, including acupuncture, to bring your body into balance and harmony. These are not scientific concepts, and the language that acupuncturists use is not compatible with the language of other health practitioners in New Zealand.

There are different styles of Chinese acupuncture, and some traditional acupuncturists now also use the modern-day knowledge of anatomy but still use this traditional language. 

Western acupuncture

Western medical acupuncture is also known as dry needling. This is done for musculoskeletal problems, and the aim is to insert the needle into trigger points in your body to try and improve pain and function. The needle points in Western acupuncture may align with the points of traditional Chinese acupuncture.

What conditions is acupuncture used to treat?

Traditional Chinese Medicine (TCM) providers may use acupuncture to attempt to treat a wide range of health conditions. Some of the conditions treated are pain, mental health conditions, cancer, infertility, digestive problems, respiratory problems, menstrual problems, erectile dysfunction, alcoholism, diabetes, menopause, high blood pressure, baldness and smoking cessation. 

Non-TCM providers, such as some physiotherapists, may use Western medical acupuncture to treat various pain and injury problems, but not some of the other conditions treated by TCM providers. 

The use of acupuncture is not always based on scientific evidence. Read about the evidence below at does acupuncture work? 

What happens during acupuncture treatment? 

Acupuncture involves using very thin disposable needles being placed in your skin to stimulate specific sensory nerves under your skin and in your muscles.

The insertion of needles in certain points can cause your nervous system to release different pain-relieving molecules and can cause changes in your brain. 

In a typical session, the acupuncturist discusses your symptoms, examines you and talks you through the treatment options they can offer.  

The first session can take up to an hour and follow up appointments about 15–30 minutes. You usually have 6–12 treatments, spread over a few months, for each condition. 

Depending on what is being treated, 5–20 needles are gently inserted into your skin. You may feel an aching sensation when they are first placed but it should not be painful. The needles stay in place for 10–20 minutes while you relax. They may be moved or twirled during this time. 

At times you may experience tingling or aching sensations, but you should not feel pain. Let your acupuncturist know if it becomes too uncomfortable or you feel any pain. 

When the needles are removed you may be a bit sore, and sometimes have some bruising and a little bleeding. 

Many traditional Chinese medicine providers offer other CAM treatments such as herbal medicine, cupping, moxibustion (burning artemesia near your skin), skin scraping, electro-acupuncture and tui na (Chinese massage). These other treatments are not discussed on this page.

What are the risks of acupuncture?

Acupuncture is generally very safe. Rare side effects include puncturing your lungs, puncturing the lining of your abdomen, puncturing an organ, infection, breaking a needle and it staying under your skin, and nerve damage.

More common side effects include short-term pain or bruising in the area (about 1 in 30). 

Serious side effects are more common with poorly trained and unregistered acupuncturists. Registered acupuncturists are required to use disposable sterile needles. 

Talk to your doctor before having acupuncture if you have a bleeding disorder, use blood thinners, have a pacemaker or are pregnant.

Does acupuncture work? 

Most of the research has been done for pain conditions rather than for other conditions such as infertility, cancer and organ problems. Whether acupuncture works or not is a highly controversial area, and the research is inconclusive and conflicting. Much of the effect, if any, may be due to the placebo effect. Read more about the placebo effect

There are some important points to note about the research on acupuncture.

  • The diseases treated by traditional acupuncturists don’t exist in Western medicine. One Western diagnosis can have many Eastern diagnoses, eg, diabetes can be diagnosed as lung fire, kidney fire or stomach fire.
  • The treatments are often individualised, and the results may depend on the experience of the practitioner, the cultural context in which it is performed and the expectations of the patient. 
  • There are many different styles and techniques that are taught and practised, and the acupuncture points chosen by practitioners vary widely.
  • In high-quality research there should be a second group of patients to compare results with who gets placebo treatment. In acupuncture research this is called sham acupuncture. For various reasons this is difficult to perform.
  • The research quality is highly variable, and many studies are poor quality. Many of the studies have been done in China, where there is concern about publication of fake data.

Cochrane reviews

The most highly regarded organisation for synthesising research in medicine is called Cochrane. Cochrane carries out systematic reviews of health-related research using methods that minimise bias and provide more reliable findings. There are more than 60 Cochrane reviews on acupuncture for a variety of conditions.

On the whole they have not found support for most of the claims of effectiveness by acupuncturists. They either found insufficient evidence or evidence for a small benefit for the use of acupuncture for a limited number of conditions. The evidence does not align with the claims made by many TCM providers. 

ACC report

A 500-page report commissioned by ACC in 2018 concluded that there was some evidence for small short-term relief of some pain conditions, such as some forms of neck pain, some forms of elbow pain, low back pain, some forms of knee pain, and heel pain. The evidence did not support the use of acupuncture for most of the pain conditions they looked at. 

Overall

Overall, acupuncture may have a mild positive effect for some conditions, but it is unlikely to be useful as a sole treatment. Acupuncture is a very passive treatment, where someone is doing something to you. This is in contrast to active treatment where you take an active part in your own treatment, such as stretching and exercise.

Active treatments are probably more effective than passive treatments. But passive treatments like acupuncture may have a role in helping you do those active treatments.

If you are considering acupuncture it is recommended you discuss this with the primary health provider treating your pain, such as your doctor or physiotherapist. 

Read more about sifting the evidence.

Is there any misleading information I should look out for?  

Acupuncture websites and associated advertising such as billboards often say that acupuncture works for a variety of conditions. Acupuncturists may selectively present evidence that supports their view.

They may point to a 2017 report done by Australian acupuncturists called the Acupuncture Evidence Project. This report concluded that acupuncture could be effective in migraine, tension headache, hay fever, nausea and vomiting after surgery and chemotherapy, pain after surgery, low back pain and knee osteoarthritis.

This research was biased as it was funded by the Australian Acupuncture and Chinese Medicine Association, it did not have any medical reviewers from outside the acupuncture industry and it was not published in a medical journal. 

Many New Zealand acupuncture websites provide misleading or false information about the benefits of acupuncture. There have been many complaints to the Advertising Standards Authority that have been upheld, but the practice continues.

For example, 96% of New Zealand websites falsely claimed acupuncture could be effective for mental disorders, and 85% falsely claimed it could be effective for infertility.

The Acupuncture NZ website in August 2020 still listed acupuncture as a treatment for many conditions not supported by evidence, such as infertility, problems with your lungs, digestion, nerves, menopause, high blood pressure and mental health. 

Are all acupuncturists licensed and qualified?

As of August 2020, acupuncture in New Zealand is not regulated by legislation, but this may change shortly. The professional standards are therefore set by the independent acupuncture bodies. But membership to one of these bodies is voluntary.

Professional bodies are the New Zealand Acupuncturist Standards Authority and Acupuncture NZ. Eligibility for membership requires the acupuncturist to have an appropriate qualification and have completed a certain amount of training time. It is strongly recommended you check that the acupuncturist is a member of one of these bodies. Also, registration with these bodies is required to do ACC treatment.

Is acupuncture treatment subsidised? 

To be covered for acupuncture by a TCM provider under ACC, you first need to first see a non-TCM health provider who is authorised under ACC to make a diagnosis and lodge an initial claim (called an ACC45 form).

Authorised health providers include a doctor, nurse, osteopath, physiotherapist, podiatrist or chiropractor. ACC does not allow TCM providers to make diagnoses and lodge initial claims.

Once the claim has been accepted you can visit an acupuncturist with or without a referral. ACC subsidises the treatment for some but not all conditions. The average surcharge above the ACC subsidy is around $60 for a 30–45 minute treatment. If herbal medicine is offered then there is an additional surcharge. 

Apart from ACC, a limited number of health insurance plans have acupuncture treatment included. You can also see an acupuncturist privately without any subsidy. 

Learn more

Evidence for and against acupuncture  NHS, UK, 2019
Poking holes: ACC, acupuncture and the problem of proof Jonathon Harper and Daniel Ryan, The Spinoff, NZ, 19 June 2020
Ryan DJ. Acupuncture, ACC and the Medicines Act NZ Med J. 2017 Dec 1;130(1466).
Acupuncture evidence-based review ACC, NZ, 2018

References

  1. Melchart D, Weidenhammer W, Streng A, et al. Prospective investigation of adverse effects of acupuncture in 97 733 patients Arch Intern Med. 2004 Jan 12;164(1):104-5.
  2. The International Centre for Allied Health Evidence. Effectiveness and safety of acupuncture interventions for the treatment of musculoskeletal conditions: technical report Prepared for ACC, NZ, 2018
  3. Chinese clinical trials data 80 percent fabricated: Government Radio Free Asia, 2016
  4. McDonald J, Janz S. The acupuncture evidence project: A comparative literature review (Revised edition) Australian Acupuncture and Chinese Medicine Association Australia, 2017
  5. What can acupuncture help with? Acupuncture NZ, 2020
  6. Treatment we can help pay for ACC, NZ, 2020
  7. Insurance and ACC information Acupuncture NZ
  8. Paley CA, Johnson MI. Acupuncture for the relief of chronic pain: A synthesis of systematic reviews Medicina (Kaunas). 2019 Dec 24;56(1):6. 

Reviewed by

Jeremy Steinberg is a GP with special interests in musculoskeletal medicine, evidence-based medicine and use of ultrasound. He's been reviewing topics for Health Navigator since 2017 and in his spare time loves programming. You can see some of the tools he's developed on his website.
Credits: Health Navigator Editorial Team. Reviewed By: Dr Jeremy Steinberg, FRNZCGP Last reviewed: 04 Sep 2020