Acupuncture for Pain No Better Than Placebo and Not Without Harm

According to New Study Published in PAIN®

Philadelphia, PA, March 23, 2011 – Although acupuncture is commonly used for pain control, doubts about its effectiveness and safety remain. Investigators from the Universities of Exeter & Plymouth (Exeter, UK) and the Korea Institute of Oriental Medicine (Daejeon, South Korea) critically evaluated systematic reviews of acupuncture as a treatment of pain in order to explore this question. Reporting in the April 2011 issue of PAIN®, they conclude that numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain, and serious adverse effects continue to be reported.

“Many systematic reviews of acupuncture for pain management are available, yet they only support few indications, and contradictions abound,” commented lead investigator Professor Edzard Ernst, MD, PhD, Laing Chair in Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, UK. “Acupuncture remains associated with serious adverse effects. One might argue that, in view of the popularity of acupuncture, the number of serious adverse effects is minute. We would counter, however, that even one avoidable adverse event is one too many. The key to making progress would be to train all acupuncturists to a high level of competency.”

Researchers carefully identified and critically examined systematic reviews of acupuncture studies for pain relief and case reviews reporting adverse effects. Reviews were defined as systematic if they included an explicit Methods section describing the search strategy and inclusion/exclusion criteria. Systematic reviews had to focus on the effectiveness of any type of acupuncture for pain. Of the 266 articles found, 56 were categorized as acceptable systematic reviews.

The authors observe that recent results from high-quality randomized controlled trials have shown that various forms of acupuncture, including so-called "sham acupuncture," during which no needles actually penetrate the skin, are equally effective for chronic low back pain, and more effective than standard care. In these and other studies, the effects were attributed to such factors as therapist conviction, patient enthusiasm or the acupuncturist's communication style.

If even sham acupuncture is as good as or better than standard care, then what is the harm? The answer lies in the adverse effect case studies. These studies were grouped into three categories: Infection (38 cases), trauma (42 cases) and other adverse effects (13 cases). Many of these adverse side effects are not intrinsic to acupuncture, but rather result from malpractice of acupuncturists. The most frequently reported complications included pneumothorax, (penetration of the thorax) and bacterial and viral infections. Five patients died after their treatment.

In an accompanying commentary, Harriet Hall, MD, states her position forcefully: "Importantly, when a treatment is truly effective, studies tend to produce more convincing results as time passes and the weight of evidence accumulates. When a treatment is extensively studied for decades and the evidence continues to be inconsistent, it becomes more and more likely that the treatment is not truly effective. This appears to be the case for acupuncture. In fact, taken as a whole, the published (and scientifically rigorous) evidence leads to the conclusion that acupuncture is no more effective than placebo."

The article is “Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews” by E. Ernst, Myeong Soo Lee and Tae-Young Choi (DOI: 10.1016/j.pain.2010.11.004). The accompanying commentary is "Acupuncture’s claims punctured: Not proven effective for pain, not harmless" by Harriet Hall, MD (DOI: 10.1016/j.pain.2011.01.039). Both appear in PAIN®, Volume 152, Issue 4 (April 2011) published by Elsevier.

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Notes for EditorsFull text of the articles is available to journalists upon request. Contact Christine Rullo at 215-239-3709 or for copies. Journalists wishing to set up interviews with the authors of “Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews” should contact Dr. Edzard Ernst at To speak with Dr. Harriet Hall, author of “Acupuncture’s claims punctured: Not proven effective for pain, not harmless,” please contact her directly at

About the Authors
Edzard Ernst, MD, PhD
Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK

Myeong Soo Lee, PhD
Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, South Korea
and Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, UK

Tae-Young Choi, PhD
Division of Standard Research, Korea Institute of Oriental Medicine, Daejeon, South Korea

Harriet Hall, MD
Puyallup, WA, USA
Dr. Hall is a retired family physician, former U.S. Air Force flight surgeon and prolific writer about alternative medicine and quackery. She is a regular contributor to the Science-Based Medicine blog ( and writes for numerous publications and sites including Skeptic and Skeptical Inquirer.

About PAIN®PAIN®, the official journal of the International Association for the Study of Pain® (IASP®), publishes 12 issues per year of original research on the nature, mechanisms, and treatment of pain. This peer-reviewed journal provides a forum for the dissemination of research in the basic and clinical sciences of multidisciplinary interest and is cited in Current Contents and MEDLINE. It is ranked 1st out of the 25 journals in the ISI Anesthesiology category according to the Journal Citation Reports 2010.

About The International Association for The Study Of PAIN® (IASP®)Founded in 1973, IASP® is the world's largest multidisciplinary organization focused specifically on pain research and treatment. It is the leading professional forum for science, practice, and education in the field of pain bringing together scientists, clinicians, health care providers, and policy makers to stimulate and support the study of pain and to translate that knowledge into improved pain relief worldwide. IASP currently has more than 7,500 members from 130 countries and in 85 chapters.

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

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