How does acupuncture work? The science behind the needles

Over 35,000 scientific studies on acupuncture are listed in the Pubmed search engine – a figure that impressively underlines the immense interest and importance of this traditional healing method in modern science. Despite this considerable amount of research, the effectiveness of acupuncture remains controversial and the subject of scientific debate in many places.

Acupuncture, as an alternative healing method within Traditional Chinese Medicine (TCM), has been practiced for over 3,000 years. This practice is based on the idea that inserting needles into specific body points releases energy blockages and influences the flow of vital energy, also known as Qi. However, this long history has been accompanied by an ongoing curiosity about the scientific basis and effectiveness of this method.

Important findings

• More than 35,000 scientific studies on acupuncture are registered in Pubmed, around 20,000 of them in the last ten years.
• A 2020 meta-study on chronic back pain found no significant improvement compared to sham treatments.
• Health insurance companies in Germany have been covering the costs of up to ten acupuncture treatments for certain chronic pain since 2007.
• Serious side effects from acupuncture are rare, but dizziness and nerve irritation have been documented.
• The effect of acupuncture has not yet been sufficiently scientifically proven, but it does show positive therapeutic effects in some cases.

With this introductory section on acupuncture and its scientific investigation, we hope to provide a basic overview. The following sections will delve deeper into the mechanisms and effectiveness of this fascinating healing modality, showing how acupuncture actually works and what scientific evidence exists to support it.

Introduction to acupuncture

Acupuncture is a healing method that is thousands of years old and has its origins in Traditional Chinese Medicine (TCM). It has been practiced in Germany since the 1950s and has become increasingly important in recent decades. Around 40% of practicing orthopaedists in Germany offer acupuncture in their practice, which illustrates its increasing popularity.

History of acupuncture

The history of acupuncture dates back to the 2nd century BC, when the historian Sima Qian first mentioned it in writing. The Yellow Emperor’s Inner Classic, the Huangdi Neijing, describes 160 acupuncture points and various needles. In addition, this treatment method has been practised in China and Japan since the 2nd century BC, which underlines its deep roots in Asian culture. To this day, around 400 acupuncture points are used in acupuncture, which are located on 12 main meridians and 8 extra meridians.

Basics of TCM and acupuncture

Acupuncture is based on the principles of traditional Chinese medicine, which regards meridians and the energy flow Qi as central concepts. There are around 365 main acupuncture points in total, which are located along 14 meridians in the body. These points are strategically stimulated to restore the body’s energy balance and alleviate various ailments.

The depth of the needles varies depending on the area of the body and can be between a few millimetres and 3 centimetres. When used correctly, acupuncture is generally well tolerated and its potential effects, such as sedation, pain relief and anti-inflammation, are well documented. In the modern practice of TCM acupuncture, many acupuncturists follow the recommendations of health insurance companies, which cover the costs of acupuncture for certain orthopaedic diagnoses.

Acupuncture: The basic mechanisms

Over 3000 years of experience and recognition by the World Health Organization (WHO) underpin the importance of acupuncture. This traditional method uses acupuncture mechanisms to improve health by specifically controlling the flow of Qi. Anatomical studies show that the majority of acupuncture points are located where nerves emerge from muscle tissue.

The concept of meridians and Qi

The concept of Qi is central to Traditional Chinese Medicine (TCM). It describes the vital energy that flows through meridians acupuncture in the body. These meridians are networks that connect specific acupuncture points. If the flow of Qi is disturbed, illnesses can occur. The insertion of needles releases blockages and allows the Qi energy to flow freely again. There are a total of 12 main meridians and 8 extra meridians with over 360 acupuncture points.

Effect on bodily functions

Acupuncture mechanisms intervene deeply in body regulation. The stimulation of acupuncture points can release endorphins and serotonin, which relieves pain and improves general well-being. In addition, acupuncture improves local blood circulation and leads to an improvement in pain modulation. The effects are both muscle-relaxing and anti-inflammatory, which is beneficial for chronic complaints such as back pain, migraines and osteoarthritis.

How does acupuncture really work?

The question of the reality of acupuncture is still the subject of intensive research and debate in the scientific community. In a typical acupuncture treatment, between ten and twenty needles are used, which are inserted into the acupuncture points along the meridians and left in the skin for around 30 minutes. There are a total of 365 of these points through which the Qi flows.

Studies show that acupuncture has a wide range of effects. For example, 75% of patients with headaches or lumbar syndrome reported a significant improvement in their symptoms six months after treatment. In patients with arthritic pain, an 85% improvement was even observed. These positive results were confirmed by a study of 200,000 patients conducted by Charité Berlin. The statistical significance of the results was a p-value of

Acupuncture function can be helpful for various complaints; it shows positive effects for chronic headaches, back pain and allergic asthma. However, it is also important to be aware of the possible side effects. These are rare and usually consist of redness and slight bleeding at the injection sites.

The time to effect varies: For acute pain or stress, an improvement can often be noticeable within a few minutes to hours. For chronic pain, however, it can take up to five sessions before the first results are visible.

The distinction between real acupuncture and sham acupuncture is also very important. Studies have shown, for example, that there is no noticeable difference between real acupuncture and sham acupuncture for menopausal symptoms. This underlines the need for further research into real acupuncture and its exact mechanisms of action.

The neurobiological effects of acupuncture

Acupuncture has become increasingly important in Germany in recent decades, particularly in psychiatric clinics. Neurobiology Acupuncture shows a variety of potential effects that affect the nervous system as well as the release of endorphins and blood circulation.

Reactions of the nervous system

One of the main effects of acupuncture is the stimulation of the nervous system. By activating specific nerve pathways, the neurobiology of acupuncture can help to change the transmission of pain signals and promote the release of pain-relieving neurotransmitters. These mechanisms are particularly relevant in the treatment of mental illnesses, which are often characterized by dysregulation of the nervous system.

Release of endorphins

One of the most remarkable neurobiological effects of acupuncture is the release of endorphins. Endorphins are the body’s own painkillers that can increase well-being and reduce pain sensations. Numerous studies have shown that acupuncture promotes the release of endorphins, which is particularly important in the treatment of chronic pain and addiction. In addiction medicine, acupuncture has been shown to alleviate withdrawal symptoms, which is attributed to the increased release of endorphins.

Circulation-promoting effect

Another important aspect of neurobiology acupuncture is its effect on blood circulation. The targeted stimulation of certain acupuncture points can increase blood flow locally, which can contribute to healing and pain relief. This effect is particularly important in rehabilitation after strokes, as improved blood circulation supports the recovery of damaged tissue.

The following table shows an overview of the neurobiological effects of acupuncture:

Acupuncture and pain relief

Acupuncture has established itself as an effective method of pain relief that is used successfully for both chronic and acute pain. Various studies and clinical observations prove the effectiveness of acupuncture in reducing pain, which is even recognized by the World Health Organization (WHO). Acupuncture pain relief is used in particular for chronic headaches, back pain and joint pain, with three out of four cases showing a significant and long-lasting improvement.

Chronic pain treatment

Chronic pain, such as that associated with back and joint disorders, is one of the most commonly treated conditions using acupuncture. In many cases, acupuncture is considered comparable to conventional medical therapies. Statutory health insurance companies in Germany cover the costs of acupuncture treatments for chronic knee and lumbar spine disorders, and private health insurance companies reimburse acupuncture costs depending on the policy. A positive change in chronic pain acupuncture usually occurs between the third and sixth session. It is particularly important to note that side effects such as slight bruising or a temporary increase in symptoms are usually only very minor and temporary.

Acute pain therapy

Acute pain therapy using acupuncture is often used for various pain conditions such as headaches and back pain. Patients often report a rapid response to the therapy after the first treatment. A typical acupuncture session lasts around 30 to 45 minutes, with the needles remaining in the skin for around twenty minutes. The cost of such a session is between 30 and 70 euros, depending on the duration and complexity of the treatment. Many patients appreciate that the stimulating stimulus of the needles leads to an increased release of pain-relieving substances in the brain, which is what makes acute pain therapy so effective.

Since 2001, more than two million patients have been treated as part of the GERAC studies, which underlines the wide range of applications and acceptance of acupuncture. Acupuncture shows a greater reduction in the symptoms of chronic back pain and knee pain (gonarthrosis) compared to standard therapy carried out according to guidelines. However, no clear effectiveness has yet been demonstrated for migraines and tension headaches.

Studies on the effectiveness of acupuncture

The evaluation of the effectiveness of acupuncture is based on a large number of scientific studies carried out by various researchers worldwide. The following section provides an overview of more well-known acupuncture studies and the resulting scientific evidence acupuncture.

Overview of scientific studies

In China, a ratio of 1.31 acupuncture practitioners per 100,000 inhabitants was recorded in 2020. A study from the USA in 2021 found that around 1.5% of the population had already experienced acupuncture. In Europe, around 1.4% of respondents had used acupuncture in the last 12 months. Germany conducted notable studies such as the GERAC and ART studies, which included over 3,600 patients in controlled randomized experiments.

Some notable results of these acupuncture studies suggest that patients with chronic back pain who received acupuncture experienced almost twice as much improvement as with standard therapies over a six-month period. These GERAC studies led to statutory health insurance companies in Germany covering the costs of acupuncture treatments.

Critical examination of the study situation

The methodological approaches and the validity of the results of acupuncture studies are variable. Some systematic reviews identified 52% of the Cochrane publications examined as being of low quality. Differences between acupuncture and sham acupuncture were described as small but consistent. The work of Klaus Linde, which presents clinically relevant effects, is particularly emphasized. This leads to a lively debate within the scientific community about the actual effectiveness.

A systematic review from 2017 documented clear therapeutic effects for at least eight indications, in particular chronic back pain and osteoarthritis of the knee. In addition, acupuncture showed potentially positive effects for 38 other conditions, while no evidence was found for five specific conditions.

The acupuncture studies in Germany and worldwide continue to contribute significantly to the discussion and underline the need for ongoing research. Huge amounts of data, such as those available in the “individual patient data” meta-analysis, can help to evaluate efficacy more transparently and precisely. As long as the acupuncture studies present such a diverse range of results, the discussion about scientific evidence acupuncture and criticism acupuncture will remain topical.

Acupuncture compared to placebo

The evaluation of the placebo effect of acupuncture is of great importance in order to objectively assess the effectiveness of this treatment method. Two thirds of all menopausal women experience hot flushes and sweats for an average of five years. In one study, 327 women over the age of 40 were treated, with 163 women receiving real acupuncture and 164 women receiving sham acupuncture. The results of these acupuncture placebo studies offer insights into the actual effectiveness.

The analyzed data shows that 137 women from the acupuncture group and 143 women from the placebo group were included. The HF score, which measures hot flushes, decreased by about 40 percent in both groups compared to baseline. After treatment, the mean HF score was 15.36 in the acupuncture group and 15.04 in the placebo group. The mean difference between the two groups was 0.33 (95% CI -1.85 to 2.75; p = 0.70), indicating that the effect of acupuncture was not significantly better than that of sham treatment.

Interestingly, studies have shown that the placebo effect for vasomotor symptoms can be up to 50 percent. These findings are crucial in order to correctly classify the placebo effect of acupuncture and evaluate it in practice.

A survey from 2019 shows that 20% of women and 10% of men in Germany have already used acupuncture. Statutory health insurance companies have covered up to 10 sessions within 6 weeks for chronic pain of the lumbar spine and knee joint since 2007. Clinical studies such as GERAC, ARC and ART, which included more than 300,000 participants, confirm significant improvements in some cases. In the comparative studies, the acupuncture group showed a significant improvement in symptoms compared to the untreated group, but no statistically significant difference to the control group with sham treatment.

This acupuncture comparison illustrates how important carefully conducted acupuncture placebo studies are in order to precisely evaluate the therapeutic value of this ancient healing art and to use it optimally in modern medicine.

Areas of application of acupuncture

Acupuncture has proven to be extremely effective in a variety of treatment areas. According to the World Health Organization (WHO), there are around 100 indications that can be treated with acupuncture. In 2017, the Acupuncture Evidence Project reviewed the research results for 122 conditions and confirmed a clear treatment effect for eight indications, such as headaches, lower back pain, hay fever and knee osteoarthritis. A positive, moderate effect was also confirmed for 38 conditions.

Frequently treated complaints

The most common acupuncture complaints include chronic and acute pain, including:

• Chronic back pain
• Migraine and tension headaches
• Neck pain
• Knee osteoarthritis
• Hay fever

In an analysis, the Cochrane Collaboration found acupuncture to be very effective for tension headaches and migraines. Acupuncture can also have a supportive effect on conditions such as depression, particularly in combination with antidepressants.

Special areas of application

In addition to the frequently treated complaints, there are also special acupuncture applications that can deliver impressive results. These include

• Recovery after colon cancer resection
• Insomnia
• States of anxiety
• Temporomandibular pain
• Prostatitis/chronic pelvic pain syndrome

A randomized controlled trial from 2013 found that patients using acupuncture reported a slight improvement in quality of life, but this only lasted for two months.

In view of the wide range of acupuncture applications and uses, acceptance of this traditional Chinese method is growing steadily. It is not surprising that acupuncture is also becoming increasingly important in Western medicine and is seen as a valuable addition to conventional treatments.

The role of acupuncture points

The importance of acupuncture points, also known as acupuncture body points, should not be underestimated. These acupuncture points are distributed along the meridians of the body and play an essential role in traditional Chinese medicine (TCM). There are a total of 361 classic acupuncture points spread over 14 meridians. These points are selected according to specific criteria that are tailored to the patient’s state of health and the complaints to be treated.

A typical acupuncture session lasts about 30 minutes, with the needles remaining in the skin for about 20 minutes. This session can lead to immediate relaxation, which is particularly helpful for acute pain conditions. For complaints such as fresh cold symptoms or newly developed back pain, 1 to 3 sessions are usually sufficient. Other non-chronic complaints may require 4 to 10 sessions, depending on the patient’s response, whereas long-standing complaints or chronic illnesses often require 15 to 20 sessions to bring lasting improvement.

The process of placing the acupuncture points is precise and careful. There is a small risk of side effects, which are typically minor and may include minor bleeding or bruising. In very rare cases, if a nerve is slightly injured, local sensations may be felt for up to four weeks. In general, however, acupuncture activates the body’s own regulatory mechanisms, which can have a positive effect on the pain experience.

Interestingly, the effects of acupuncture can last far beyond the last treatment. However, this depends on whether the underlying causes of the illness have been treated. For some patients, the effects of acupuncture can last for years or even permanently. Others may need ongoing treatments for recurring problems.

Experiences and reports from patients

The acupuncture experiences of patients are varied and rich, including both positive and critical voices. They reflect the individual perception and the perceived effects of the therapy.

Success stories from the field

Many patients report positive acupuncture success stories. In 2017, the Acupuncture Trialists’ Collaboration found that acupuncture is particularly effective for chronic musculoskeletal pain, headaches and osteoarthritis. For example, one patient reported that her migraine attacks became significantly less frequent and less intense after attending regular acupuncture sessions. Patient reports on acupuncture also often state that the therapy is very helpful for functional disorders.

Another patient described how his chronic back pain, which had been present for years, improved significantly after several acupuncture treatments. These acupuncture success stories give hope and highlight the positive effects of the treatment.

Critical voices and field reports

Despite many positive reports, there are also critical voices among the patient reports on acupuncture. Studies on acupuncture for chronic back pain show only moderate evidence of short-term pain relief. This was often not long-lasting. Some patients felt cheated after several sessions as they did not notice any significant improvement.

Other patients report minor side effects such as bruising or slight bleeding. Such acupuncture experiences make it clear that acupuncture does not bring the hoped-for relief for everyone. It is also emphasized that a complete conventional medical diagnosis should be carried out before any acupuncture treatment so that serious illnesses are not overlooked.

Although the risks are minimal, acupuncture is not always the ultimate solution. Nevertheless, the German Medical Association for Acupuncture (DÄGfA) emphasizes that the therapy is well researched and supported by several scientific studies.

Modern acupuncture techniques

Modern acupuncture includes a variety of innovative methods that are based on the traditional practices of Traditional Chinese Medicine (TCM). Among the most significant developments are electro-acupuncture and the moxibustion technique, both of which contribute to healing and relaxation in their own way.

Electroacupuncture

Electro-acupuncture extends conventional acupuncture with electrical impulses that are conducted through the needled acupuncture points. This technique is used particularly frequently to relieve pain, as it enables increased stimulation of the corresponding points. In a typical session, which lasts between 20 and 30 minutes, electrical stimulation devices are applied to constantly send small electrical currents through the needles, resulting in a more intense therapeutic effect. Over 90% of acupuncturists combine such modern techniques for holistic treatments.

Moxibustion

The moxibustion technique, which is also widely used within TCM, is based on burning dried herbs (usually mugwort) near the acupuncture points. This method is said to promote blood circulation and harmonize the Qi, the life energy. Moxibustion is particularly valued by many patients for musculoskeletal complaints, bronchial diseases and stomach and intestinal disorders. The technique is over 2000 years old and is often used in combination with other acupuncture methods to achieve optimal results. According to estimates, the proportion of microsystems used in modern acupuncture, such as ear and hand acupuncture, is around 15% of total sessions.

Acupuncture and health

Acupuncture has far-reaching significance in both preventive and therapeutic healthcare. Its positive effect on the immune system and quality of life makes acupuncture a popular treatment method.

Preventive effects

Preventive acupuncture can help to strengthen the immune system and promote general well-being. The targeted stimulation of more than 350 acupuncture points, which are known in Traditional Chinese Medicine (TCM), can reduce the risk of various diseases. In particular, the function of the gastrointestinal tract is improved and susceptibility to stress is reduced.

In Germany, around 9% of the population use this form of prevention. Doctors who specialize in acupuncture often succeed in improving their patients’ quality of life and keeping them healthy in the long term through preventive acupuncture. This is also supported by the World Health Organization (WHO), which lists various preventive areas of application.

Therapeutic advantages

Therapeutic acupuncture shows clear effects in the treatment of various chronic and acute complaints. According to a study by the Friedrich Schiller University in Jena, acupuncture has a pain-relieving effect that is demonstrably not due to the placebo effect. This method has proven particularly effective for chronic back pain, knee osteoarthritis and headaches.

• According to a study from 2020, acupuncture reduced the number of headache days from 16 to 6.
• Acupuncture shortens the duration of labor by around 2 hours if treatment begins in the last four weeks of pregnancy.
• Over 35,000 scientific studies support the therapeutic benefits of acupuncture, including studies investigating its effectiveness for depression and polyneuropathy.

In addition, serious side effects are rare with acupuncture, which contributes to its popularity. In Germany, the costs of acupuncture treatments for chronic lower back and knee pain are covered by statutory health insurance if the pain has persisted for at least six months. Private insurance companies also often cover the costs of acupuncture, particularly for pain therapy.

“Acupuncture is a valuable addition to conventional medical treatments and can significantly improve well-being.” – WHO

Through preventive acupuncture and its therapeutic application, many patients in Germany can experience a significant improvement in their quality of life.

Conclusion

The acupuncture summary illustrates that this traditional Chinese healing method has produced significant results in modern medical practice. Acupuncture works by stimulating specific points on the body and has been shown to be effective in relieving pain, stress and sleep disorders. Scientific studies, such as the GERAC study, confirm the effectiveness of acupuncture, especially for chronic back pain and migraines.

Despite the positive acupuncture results, there are challenges in interpreting the study situation. Methodological weaknesses, such as a lack of blinding, can lead to bias. In addition, studies comparing acupuncture with sham acupuncture often show similar results, which calls into question the specific effect of acupuncture. Nevertheless, acupuncture is classified as “moderately” effective in medical guidelines and has been recognized as a health insurance benefit in certain cases since 2007.

In conclusion, acupuncture has both advantages and limitations. While acupuncture is an effective adjunct to conventional medicine in many cases, it should always be considered as part of a comprehensive treatment plan. The low risks and documented therapeutic benefits make acupuncture a valuable option in modern healthcare.

References

• What acupuncture really does – https://www.quarks.de/gesundheit/medizin/was-akupunktur-wirklich-bringt/
• Is acupuncture really effective? What science says – https://www.swr.de/video/sendungen-a-z/marktcheck/gesundheit/ist-akupunktur-wirklich-wirksam-102.html
• Acupuncture: Harmonious balance of forces – https://www.aerzteblatt.de/archiv/40810/Akupunktur-Harmonisches-Gleichgewicht-der-Kraefte
• Acupuncture and how it works – Institute of Chinese Medicine – https://www.chinesisches-institut.de/die-akupunktur-und-ihre-wirkungsweise/
• Acupuncture – Orthopaedics at Ludgeriplatz – https://www.orthopaedie-ludgeriplatz.de/akupunktur/
• Acupuncture TCM Hamburg Arthro-Clinic Orthopaedist Ear acupuncture – https://www.arthro-clinic.de/behandlung/nicht-operative-massnahmen/akupunktur.html
• How does acupuncture work? – https://www.netdoktor.de/alternativmedizin/tcm/akupunktur/
• Acupuncture: Large-scale study confirms effect – https://www.aerzteblatt.de/archiv/40274/Akupunktur-Grossstudie-bestaetigt-Wirkung
• Pain and acupuncture – https://www.schmerzgesellschaft.de/patienteninformationen/ergaenzende-verfahren/schmerz-und-akupunktur
• Acupuncture: Who can benefit from treatment? – https://www.aok.de/pk/magazin/koerper-psyche/muskel-skelett-system/akupunktur-wem-hilft-eine-behandlung/
• Acupuncture: The state of research – https://www.carstens-stiftung.de/akupunktur-und-wissenschaft.html
• Alternative healing method: Who can acupuncture help? | BR.de – https://www.br.de/br-fernsehen/sendungen/gesundheit/akupunktur-heilmethode-schmerzen100.html
• Is acupuncture more effective than placebo? – https://www.aerztezeitung.de/Medizin/Ist-Akupunktur-wirksamer-als-Placebo-289666.html
• Acupuncture: when can needles help? – https://www.spektrum.de/news/akupunktur-wann-koennen-nadeln-helfen/2013961
• What is acupuncture? How does it work & what are its effects? – https://www.muenchener-verein.de/ratgeber/gesundheit/akupunktur-mehr-zu-anwendung-wirkung-der-nadelstiche/
• Acupuncture: Questions and answers – Tips & news – https://www.akupunktur-ulm.de/tipps-und-aktuelles/akupunktur-fragen-und-antworten
• Acupuncture – https://www.planet-wissen.de/gesellschaft/medizin/akupunktur/index.html
• Acupuncture is more than just a “placebo” – https://www.uniklinikum-jena.de/Uniklinikum Jena/Archive/PM_Archive 2004/Acupuncture is more than just a _placebo_-p-16322.html
• Acupuncture: Everything you need to know about its effects, use and costs – https://www.zdf.de/nachrichten/ratgeber/gesundheit/akupunktur-anwendung-wirkung-behandlung-kosten-100.html