Acupuncture Research

Sham Acupuncture

Sham acupuncture is not an inert placebo

Many Randomised Controlled Trials use ‘sham acupuncture’ as a pill-equivalent placebo.  Sham acupuncture can involve needling at non-acupuncture points.  This is not the same as taking an inactive pill; it is not an inert placebo!  Consequently, these trials often show that the difference between sham and ‘real’ acupuncture is not always significant (negative outcome). But in some trials where usual care is investigated against sham and ‘real’ acupuncture, both types of acupuncture perform better than usual care (positive outcome). This means those research trials using sham acupuncture will sometimes report ‘real’ acupuncture is not effective, yet often trials of acupuncture versus ‘usual care’ or some other intervention, will give a positive outcome. 

Traditional Methods

Often Not
Tested

Another problem is that many research trials often do not use Traditional Medicine treatment methods and ‘under treat’, instead they are testing ‘Medical’ or ‘Western’ Acupuncture, which is different to Traditional Chinese Medicine Acupuncture. The equivalent mistake would be using for example, insulin (used for diabetes) to treat a headache, rather than a painkiller and saying the insulin did help the headache (not surprisingly!). 

The dose is important and is often inadequate compared to clinical practice (especially in China where it is used in hospitals, often daily).  So the equivalent would be having a severe headache and taking a pinch of paracetamol and expecting it to dull your headache pain.

Quality of Research

Lack of funds

There is not any money in researching acupuncture unlike medications, so good quality research studies are limited due to underfunding.

With these limitations in mind, I’ve selected some research studies which I’ve referenced on this website and used more generally to inform my work as an acupuncturist.

Benefits

The following effects of acupuncture have been proposed:

  • Modulating endocrine and neuroendocrine
  • Increasing blood flow to the uterus and ovaries
  • Modulating cytokines
  • Modulating endogenous regulatory systems, including sympathetic nervous system – this regulates fertility hormones.
  • Reducing stress, anxiety and depression

Acupuncture improves IVF chances.

  • Increases number of follicles and retrieved eggs, thickness of endometrial lining and implantation success.
  • Acupuncture increases the odds of clinical pregnancy (65% compared with controlled groups).
  • Acupuncture is associated with 13% more births (61%) than IVF only (48%) or acupuncture only on day of embryo transfer (51%).

References - Fertility

Stener-Victorin E, Wu X. Effects and mechanisms of acupuncture in the reproductive system. Auton Neurosci. 2010;157(1-2):46-51. doi:10.1016/j.autneu.2010.03.006
https://pubmed.ncbi.nlm.nih.gov/20350839/

Anderson BJ, Haimovici F, Ginsburg ES, Schust DJ, Wayne PM. In vitro fertilization and acupuncture: clinical efficacy and mechanistic basis. Altern Ther Health Med. 2007;13(3):38-48.
https://pubmed.ncbi.nlm.nih.gov/17515023/

Anderson B, Rosenthal L. Acupuncture and in vitro fertilization: critique of the evidence and application to clinical practice. Complement Ther Clin Pract. 2013;19(1):1-5. doi:10.1016/j.ctcp.2012.11.002
https://pubmed.ncbi.nlm.nih.gov/23337556/

References - Assisted Reproduction

Manheimer E, Zhang G, Udoff L, et al. Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis. BMJ. 2008;336(7643):545-549. doi:10.1136/bmj.39471.430451.BE
https://pubmed.ncbi.nlm.nih.gov/18258932/

Villahermosa DI, Santos LG, Nogueira MB, Vilarino FL, Barbosa CP. Influence of acupuncture on the outcomes of in vitro fertilisation when embryo implantation has failed: a prospective randomised controlled clinical trial. Acupunct Med. 2013;31(2):157-161.
https://pubmed.ncbi.nlm.nih.gov/23512550/

Hullender Rubin LE, Opsahl MS, Wiemer KE, Mist SD, Caughey AB. Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes. Reprod Biomed Online. 2015;30(6):602-612. doi:10.1016/j.rbmo.2015.02.005
Full paper here (or email me for a copy)  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458185/

Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K. Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil Steril. 2002;77(4):721-724. doi:10.1016/s0015-0282(01)03273-3
https://pubmed.ncbi.nlm.nih.gov/11937123/

Benefits

  • Acupuncture decreases levels of male hormones or androgens, leading to less acne and hirsutism.
  • Menstrual frequency is increased.
  • Blood sugar and insulin levels are decreased, so controls hyperglcaemia.
  • Reduces cortisol levels
  • Lowers sympathetic nerve activity “flight or fight”
  • Increases blood flow to the ovaries.
  • Benefits are superior to exercise alone.

References

Jedel E, Labrie F, Odén A, et al. Impact of electro-acupuncture and physical exercise on hyperandrogenism and oligo/amenorrhea in women with polycystic ovary syndrome: a randomized controlled trial. Am J Physiol Endocrinol Metab. 2011;300(1):E37-E45.
https://pubmed.ncbi.nlm.nih.gov/20943753/

Lim CE, Wong WS. Current evidence of acupuncture on polycystic ovarian syndrome. Gynecol Endocrinol. 2010;26(6):473-478. doi:10.3109/09513591003686304
https://pubmed.ncbi.nlm.nih.gov/20230329/

Stener-Victorin E, Jedel E, Janson PO, Sverrisdottir YB. Low-frequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am J Physiol Regul Integr Comp Physiol. 2009;297(2):R387-R395
https://pubmed.ncbi.nlm.nih.gov/19494176/

Stener-Victorin E, Waldenström U, Tägnfors U, Lundeberg T, Lindstedt G, Janson PO. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet Gynecol Scand. 2000;79(3):180-188.
https://pubmed.ncbi.nlm.nih.gov/10716298/

 

Benefits

The studies for acupuncture and acupressure are limited and most tend to be done during labour.

  • Acupuncture may increase satisfaction with pain management and reduce use of drug analgesia.
  • Acupressure may reduce pain intensity.
  • Acupressure probably reduces the need for caesarean section.

References

Smith CA, Collins CT, Levett KM, et al. Acupuncture or acupressure for pain management during labour. Cochrane Database Syst Rev. 2020;2(2):CD009232. Published 2020 Feb 7. doi:10.1002/14651858.CD009232.pub2
https://pubmed.ncbi.nlm.nih.gov/32032444/

Lim CE, Wilkinson JM, Wong WS, Cheng NC. Effect of acupuncture on induction of labor. J Altern Complement Med. 2009;15(11):1209-1214. doi:10.1089/acm.2009.0100
https://pubmed.ncbi.nlm.nih.gov/19922252/

Vas J, Aranda JM, Nishishinya B, et al. Correction of nonvertex presentation with moxibustion: a systematic review and metaanalysis. Am J Obstet Gynecol. 2009;201(3):241-259. doi:10.1016/j.ajog.2008.12.026
https://pubmed.ncbi.nlm.nih.gov/19733275/

Benefits

Research shows acupuncture influences neurochemical modulation and secretion, especially beta-endorphins, which has wide ranging therapeutic impacts in particular mood, sleep and vasomotor symptoms.  It reduces cortisol which then influences abdominal obesity, cognition and osteoporosis.

  • Reduces the frequency and severity of hot flushes.
  • Improves in sleep quality.
  • Warm acupuncture increases bone mineral density of the femur and lumbar spine and electroacupuncture relieves osteoporosis pain. Thought to be due to reducing cortisol levels which increases post menopause. Also increases serum oestrdiol.
  • Has some positive effects on improving cognitive scores.

References

Avis NE, Coeytaux RR, Isom S, Prevette K, Morgan T. Acupuncture in Menopause (AIM) study: a pragmatic, randomized controlled trial. Menopause. 2016;23(6):626-637. doi:10.1097/GME.0000000000000597 https://pubmed.ncbi.nlm.nih.gov/27023860/

Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H. Acupuncture to Treat Sleep Disorders in Postmenopausal Women: A Systematic Review. Evid Based Complement Alternat Med. 2015;2015:563236. doi:10.1155/2015/563236
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561166/

Xu G, Xiao Q, Zhou J, et al. Acupuncture and moxibustion for primary osteoporosis: An overview of systematic review. Medicine (Baltimore). 2020;99(9):e19334. doi:10.1097/MD.0000000000019334
https://pubmed.ncbi.nlm.nih.gov/32118767/

Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P. The Effectiveness of Acupuncture for Osteoporosis: A Systematic Review and Meta-Analysis. Am J Chin Med. 2018;46(3):489-513. doi:10.1142/S0192415X18500258

Pan H, Jin R, Li M, Liu Z, Xie Q, Wang P. The Effectiveness of Acupuncture for Osteoporosis: A Systematic Review and Meta-Analysis. The American Journal of Chinese Medicine. 2018; 46(3): p.489-513.
https://pubmed.ncbi.nlm.nih.gov/29614884/

Fan L, Wu Z, Li M, Jiang G. Effectiveness of electroacupuncture as a treatment for osteoporosis: A systematic review and meta-analysis. Medicine (Baltimore). 2021;100(3):e24259. doi:10.1097/MD.0000000000024259
https://pubmed.ncbi.nlm.nih.gov/33546047/

Bezerra AG, Pires GN, Andersen ML, Tufik S, Hachul H. Acupuncture to Treat Sleep Disorders in Postmenopausal Women: A Systematic Review. Evid Based Complement Alternat Med. 2015;2015:563236. doi:10.1155/2015/563236
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4561166/

Mingjuan Han, Yuxiu Sun, Wei Su, Shixi Huang, Sinuo Li, Mingyue Gao, Wenyan Wang, Fang Wang, Zhaohui Fang, Hong Zhao, “The Efficacy of Acupuncture on Anthropometric Measures and the Biochemical Markers for Metabolic Syndrome: A Randomized Controlled Pilot Study”, Evidence-Based Complementary and Alternative Medicine, vol. 2017, Article ID 8598210, 8 pages, 2017. https://doi.org/10.1155/2017/8598210
https://www.hindawi.com/journals/ecam/2017/8598210/

Lund KS, Siersma V, Brodersen J, et al.  Efficacy of a standardised acupuncture approach for women with bothersome menopausal symptoms: a pragmatic randomised study in primary care (the ACOM study) BMJ Open 2019;9:e023637. doi: 10.1136/bmjopen-2018-023637 https://bmjopen.bmj.com/content/9/1/e023637