RESEARCH EVIDENCE
There is abundant scientific evidence to support the clinical use of acupuncture for a wide variety of biomedical conditions. Clinical comparison trials are emerging as we new gold standard in acupuncture research. Scientists understand the mechanisms of acupuncture at a level on par with other biological science and medical disciplines
Acupuncture Expansion in the Oregon Healthcare System: Acupuncture for Pain Management, Substance Use, and Mental Health
I submitted this 2025 literature review in my role as OAA Research Chair to the Oregon Health Authority's (OHA's) Health Evidence Review Commission in February 2025, with the goal of expanding acupuncture insurance coverage of conditions and number of treatments by the Oregon Health Plan (OHP) Medicaid.
Acupuncture for Pain Management, Mental Health, and Substance Use
On April 30, 2024, I presented on acupuncture for pain, mental health, and substance use at the OPAT (Opioids, Pain, and Other Drugs) conference in Sunriver, Oregon.
Click here for my OPAT presentation (developed in my role as OAA Research Committee Chair). The content in this presentation was based on written material developed for the Oregon Health Authority's (OHA's) Oregon Pain Management Commission (OPMC) "Know About Pain" video module. See below.
Acupuncture for Pain Management, Mental Health, and Substance Use
Click here for the written content (developed for the Oregon Health Authority's Oregon Pain Management Commission video "Know About Pain" in my role as OAA Research Chair). The presentation above was based on this content. The OPMC is adding a 5-minute segment on acupuncture for pain in the new video module, scheduled to be finished by January 2025.
Comments to CDC Regarding Update to Opioid Prescription Guidelines: Management of Acute and Chronic Pain
In 2022 the CDC accepted public comment regarding their new Opioid Prescription Guidelines. Here are the comments submitted by the Oregon Acupuncturists Association (OAA) Research Committee, written by me in my role as Research Committee Chair.
Mechanisms of Acupuncture
(see full HERC document for references)
Ultrasound visualizations show collagen connective tissues winding and pulling around acupuncture needles upon insertion into tissue, stimulating matrix deformation, microstructural cellular changes, and mechanotransduction.
Mechanical connective tissue forces trigger downstream physiological cascades involving biochemical, bioelectrical, and molecular expression pathways that produce tangible physiological effects:
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Nociceptive/analgesic, pain-relieving actions
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Anti-inflammatory actions
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Antioxidant effects
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Autonomic vagus nerve regulation
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Increased endogenous opioids
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Action on cannabinoid CB2 receptors
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Neuromodulation via neurotransmitter actions
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Neuroendocrine actions
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Neuroimmune regulation via mast cell activation
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Neuroplastic brain changes visible on MRI/fMRI
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Neural growth and /regeneration/apoptosis reduction
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Whole-brain impacts via the default mode network
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Microbiome changes (which affect mood and pain perception)
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Microcirculatory changes
The changes that occur within the brain and body affect the psychological interpretation and experience of pain.
Addressing Sham and Placebo Effects
(see full HERC document for references)
It is imperative that the acupuncture scientific literature be considered in light of the potential treatment effects produced by sham acupuncture research controls and how use of this type of control can minimize the effect size measured and reported in sham-controlled studies.
a. An Important Note on Sham Acupuncture:
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Equivalent outcomes between verum and sham/minimal acupuncture may have created “consistent underestimation of the true effect size of acupuncture interventions”2,3,4,6,7 and under-reporting in the early literature
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These results have been used to debunk the credibility of acupuncture.
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Sham and placebo-controlled acupuncture produce demonstrated treatment effects.
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Many newer, more carefully designed trials show stronger differences between acupuncture and sham
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Clinical effectiveness comparison outcomes are emerging as the new standard in acupuncture research.
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Both acupuncture and sham often have clinically superior outcomes to standard of care and to no intervention controls.
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Acupuncture often shows an equivalent clinical effect to standard care
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Often, a combination of acupuncture plus standard of care emerges as most clinically effective.
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b. An Important Note on Placebo Effect
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Discussions regarding whether the clinical results of acupuncture are due to the placebo effect have led to some interesting and valuable research.
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Research demonstrates that the “placebo effect” may be a collection of treatment effects such as:
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the medical ritual and symbolic importance of treatment
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enhanced/augmented effect with more elaborate medical rituals
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the patient-practitioner relationship
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listening to and caring for the patient
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encouragement, empathy, reassurance, mutual respect, trust, honesty, touch
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practitioner and patient personalities and interaction of each
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practitioner communication style
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practitioner appearance of competence
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the treatment setting
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type of intervention
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the practitioner’s desire to help
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education: explaining likely benefits of a treatment
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the patient’s desire to heal, expectations for treatment, and hope
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the nature of the patient’s illness (subjective symptoms, chronic pain)
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reduced anxiety, increased optimism, improved coping
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“mental, social, and contextual factors” embedded in medical encounters
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The placebo effect causes physiological change, such as increased “endogenous opioids and cannabinoids, and low levels of cholecystokinin” and increased dorsolateral prefrontal cortex activity “leading to increased activity within the descending pain-modulatory pathway.”
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Patients have experienced clinically measurable benefits for treatment of “irritable bowel syndrome, low-back pain, episodic migraine, cancer-related fatigue, allergic rhinitis, and menopausal hot flashes” from open-label (honest) placebo treatments
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The large body of evidence points to acupuncture’s beneficial effects on pain management, and questions surrounding placebo effect merely detract from this consideration.
Noteworthy Studies
The Acupuncture Evidence Project
The Acupuncture Evidence Project was published by the Department of Veterans Affairs in 2017. The authors of this project performed a systematic review and meta-analysis of the evidence supporting acupuncture to treat pain conditions. One hundred and twenty two conditions were reviewed. Evidence of effect was found for 117 conditions. No evidence of effect was found for five conditions. Level of “evidence of effect” increased for 24 conditions over time. Positive acupuncture treatment effects were found for migraine prophylaxis, headache, chronic low back pain, allergic rhinitis, knee osteoarthritis, chemotherapy-induced nausea and vomiting, post-operative nausea and vomiting, post-operative pain. Cost-effectiveness was identified for 10 conditions: allergic rhinitis, ambulatory anesthesia, chronic pain, depression, dysmenorrhea, headache, low back pain, migraine, neck pain, osteoarthritis, and post-operative nausea and vomiting. Evidence of safety was identified for acupuncture in general prior to this review, as well as nine conditions: allergic rhinitis, ambulatory anesthesia, Alzheimer's disease, cancer-related psychological symptoms, depression, low back pain, migraine, knee osteoarthritis, and prostatitis pain/chronic pelvic pain syndrome.
McDonald J, Janz S. The acupuncture evidence project: A comparative literature review. Australian Acupuncture and Chinese Medicine Association. January 2017. https://www.asacu.org/wp-content/uploads/2017/09/Acupuncture-Evidence-Project-The.pdf
The Evidence Map of Acupuncture
The evidence map of acupuncture was published in 2104 by the Department of Veterans Affairs. The authors of this publication reported the results of a systematic review and meta-analysis of the evidence supporting acupuncture to treat pain conditions found in randomized controlled trials published in English. Their goals were to create an evidence map providing a visual overview of the evidence distribution for acupuncture (what is known and where there is little or no evidence base) and to create executive summaries to assist stakeholders interpretations of the acupuncture evidence base to inform policy and clinical decision making. One thousand two hundred twenty three (1,223) studies were electronically located; 183 of these met inclusion criteria (65 for pain, 44 for wellness, 20 for mental health, and 49 for “other”). The authors found strong evidence of a positive effect from acupuncture for headaches, chronic pain, and migraines. They found potential positive effects for dysmenorrhea, osteoarthritis, general pain, cancer pain, labor pain, prostatitis, temporomandibular pain, plantar heel pain, pregnancy pain, and ankle sprain. They found unclear, but high-level, evidence for back and neck pain, as well as unclear evidence for surgery analgesia, post-operative pain, fibromyalgia, shoulder pain, and rheumatoid arthritis. No evidence was found for effectiveness with carpal tunnel. Compared with nonsteroidal anti-inflammatory drugs (NSAIDs), acupuncture more effectively relieved acute low back pain in 5 studies; risk ratio, 1.11; 95% confidence interval: 1.06, 1.16). Acupuncture was also more effective than sham acupuncture for pain relief (2 studies; mean difference, -9.38; 95% confidence interval: -17.00, -1.76), but was not more effective for function/disability.
Hempel S, Shekelle PG, Taylor SL, Solloway MR. The evidence map of acupuncture. Department of Veterans Affairs VA-ESP Project #05-226. January 2014. https://www.hsrd.research.va.gov/publications/esp/acupuncture.pdf
If you're interested in locating research related to the efficacy of acupuncture for a specific condition, consider the following resources:
Society for Acupuncture Research https://www.acupunctureresearch.org/
PubMed
https://pubmed.ncbi.nlm.nih.gov/
Cochrane Library
https://www.cochranelibrary.com/cdsr/reviews
AcuTrials
http://acutrials.ocom.edu/s/acutrials/page/about
RESEARCH SPOTLIGHT
Remembering Dr. Hugh MacPherson
Written by: Magdalena Ganss
Obtained on February 7, 2021, from the OCOM Library E-Newsletter
Dr. Hugh MacPherson (also known as Professor MacPherson) was, by all accounts, a well-loved man of many talents and had a very rounded personality. It has been said that Professor MacPherson always had time for everything, which was most likely due to his passion for learning and giving. After earning his PhD in mathematics in 1979, Dr. MacPherson went on to study Chinese medicine and became a licensed practitioner in 1983. Following his licensure, Dr. MacPherson dedicated a great deal of time to acupuncture research through the lens of science, an effort which brought the field of acupuncture vastly closer to becoming a widely accepted form of complementary medicine in the western world.
One of Professor MacPherson’s greatest contributions was the development and publication of STRICTA (STandards for Reporting Interventions in Clinical Trials of Acupuncture), which has become the cornerstone of standards for scientific acupuncture studies. This effort was achieved alongside OCOM’s own Dean Emeritus of Research, Dr. Richard Hammerschlag, who kindly shared some memories of Professor MacPherson:
“Hugh was a great friend and colleague, with whom I was fortunate to collaborate with on several projects. Hugh visited OCOM and presented one of the first groups of Research Grand Rounds that were a successful part of OCOM's NIH-funded research education grant. Hugh's talk, on his experience of developing a research program to assess acupuncture effectiveness for low-back pain, was well-received, not only because he was adept at explaining the language of research, but because he was also a practicing acupuncturist, who owned and ran a clinic in his home city of York, UK, and a leader of an acupuncture college in the north of England, which he had co-founded.”
Among Professor MacPherson’s diverse hobbies were cycling, beekeeping, and wind-surfing—a sport he particularly enjoyed practicing in the Hood River when he came to Portland for lectures. Professor MacPherson was passionate about his work and continued working until his retirement in July of 2020, only one month before he passed away from pancreatic cancer. The entire OCOM community and beyond is immensely grateful for all of Dr. MacPherson’s contributions to Chinese medicine.
