Acupuncture Research: The State of the Evidence

Introduction

Every so often, a discussion about acupuncture follows a fairly predictable path. Someone mentions that they’ve found it helpful for pain, headaches, menopausal symptoms, fertility treatment, or any number of other complaints. Before long, somebody else responds that there is “no evidence” for acupuncture, or that any benefits must be explained entirely by placebo.

These conversations have been happening for decades. What has changed over that time is the sheer volume of research available. Acupuncture is no longer a niche topic that has received only occasional scientific attention. Thousands of studies have now been published, along with hundreds of systematic reviews and meta-analyses attempting to make sense of the findings.

This creates an interesting problem of its own. The evidence base has become so large that it can be difficult for patients, practitioners and even researchers to maintain a clear overview of where things currently stand. One review may suggest positive results for a particular condition, while another appears more cautious. Some areas are supported by a substantial body of research, while others remain much less certain.

A recent review attempted to step back and look at the bigger picture. Rather than examining a single condition or a handful of studies, the authors reviewed systematic reviews and meta-analyses published between 2017 and 2022, asking a straightforward question: what does the overall evidence for acupuncture currently look like? The answer is more nuanced than either enthusiasts or sceptics sometimes suggest, but it also paints a very different picture from the claim that there is no evidence at all.

The review discussed in this article was published in Complementary Therapies in Medicine in 2025 by Moritz Hempen and Josef Hummelsberger. Rather than examining a single condition or a small collection of studies, the authors reviewed 862 systematic reviews and meta-analyses covering 184 different medical conditions. Their aim was to assess the overall state of acupuncture evidence between 2017 and 2022 and compare it with earlier evidence reviews. The result is one of the broadest overviews of acupuncture research published to date.

Why Evidence Is Important

Before looking at the findings themselves, it is worth pausing for a moment to consider why evidence matters in the first place.

Healthcare has always been full of ideas that seemed convincing at the time. Some eventually proved useful. Others did not. Good intentions, personal experience and longstanding tradition can all point us in the right direction, but none of them are infallible. Human beings are very good at seeing patterns, yet we are equally capable of mistaking coincidence for cause and effect.

This is one reason research became such an important part of modern healthcare. It provides a way of testing assumptions against reality. Sometimes the results confirm what practitioners have observed in clinics. Sometimes they challenge long-held beliefs. Occasionally they reveal that a treatment works well for some conditions but not for others.

As with any healthcare intervention, the important question is whether careful investigation finds evidence that it helps patients. Acupuncture’s history and popularity may make it interesting, but neither can tell us whether it is effective. Research does not answer every question, but it remains one of the best tools we have for moving beyond anecdotes and assumptions.

How Do We Measure Evidence?

When people hear the word “study”, it is easy to imagine that all research carries roughly the same weight. In reality, some forms of evidence are more informative than others.

An individual study can be useful, but it may involve a relatively small number of participants or produce findings that are difficult to reproduce. For that reason, researchers often look for ways to combine multiple studies and assess the overall pattern that emerges.

This is where systematic reviews and meta-analyses become valuable. A systematic review gathers together all relevant studies on a topic and evaluates their quality. A meta-analysis goes a step further by combining data from multiple studies and analysing the results collectively.

These approaches are not perfect, and their quality depends heavily on the quality of the underlying studies. Nevertheless, they sit near the top of the evidence hierarchy because they allow researchers to examine the broader picture rather than relying on individual papers in isolation.

The review discussed here focused entirely on these higher-level forms of evidence. Rather than asking what a single trial found, it asked what hundreds of reviews and meta-analyses collectively tell us about acupuncture.

What Did This Review Examine?

After applying exclusion criteria, the researchers identified 862 systematic reviews and meta-analyses covering 184 different medical conditions. They then assessed the quality of the reviews, the quality of the underlying data and the strength of the evidence available for each condition.

The conditions were grouped into four broad categories. Some showed evidence of positive effect. Others showed evidence of potential positive effect. A third group contained conditions where the evidence remained unclear or insufficient. The final category contained conditions where no evidence of benefit was found or where evidence suggested no meaningful effect.

One of the most significant findings was not simply the number of conditions reviewed, but the observation that the overall quality of evidence has improved compared with earlier assessments. Previous reviews covering the years up to 2017 identified fewer conditions supported by stronger evidence. The authors concluded that both the quantity and quality of acupuncture research have increased over time, resulting in a larger number of conditions now supported by positive or potentially positive evidence.

This is not unusual in healthcare. Many treatments move through a period of uncertainty before enough studies are available for firmer conclusions to emerge. The process can be slow and occasionally frustrating, but it is how scientific understanding develops.

Where Is The Evidence Strongest?

Among the 184 conditions assessed, ten were judged to have evidence of positive effect.

These were:

• Chronic pain

• Low back pain

• Knee osteoarthritis

• Post-operative nausea and vomiting

• Migraine

• Tension-type headache

• Cancer-related fatigue

• Menopausal symptoms

• Female infertility alongside assisted reproductive treatment

• Chronic pelvic pain and prostatitis in men

What stands out about this list is that it is not made up of obscure or unusual complaints. Many of these conditions are among the most common reasons people seek acupuncture treatment in the first place.

Chronic pain alone affects millions of people and remains one of the leading causes of disability worldwide. Migraines and tension headaches account for a substantial proportion of neurological consultations. Knee osteoarthritis becomes increasingly common with age and can have a significant impact on mobility and quality of life. Menopausal symptoms, cancer-related fatigue and persistent pelvic pain are all areas where patients frequently search for additional options when conventional treatment does not provide complete relief.

This does not mean acupuncture should automatically replace other forms of care. Nor does it mean that every patient with one of these conditions will respond in the same way. Research can tell us what tends to happen across groups of people, but it cannot predict individual outcomes with certainty.

Even so, this is not a list that sits comfortably alongside the claim that acupuncture has no evidence behind it. The more interesting conversation today concerns where the evidence is strongest, where it is emerging, and where important questions still remain unanswered.

The More Interesting Finding

The ten conditions listed above attracted most of the attention when the review was published, and that is understandable. People naturally want to know where the evidence is strongest. Yet the most interesting finding may actually lie elsewhere.

In addition to the ten conditions supported by evidence of positive effect, the review identified a further 82 conditions where the evidence suggested a potential positive effect. At the other end of the scale, only six conditions fell into the category of no evidence of effect or evidence of no effect. The remaining 86 conditions sat in the middle ground, where the available evidence was considered unclear or insufficient to support firm conclusions.

This distinction is important because discussions about healthcare evidence often become more black and white than the evidence itself.

Many people understandably assume that if a treatment has not been proven effective for a particular condition, then it must have been shown not to work. In research terms, those are very different conclusions. A lack of evidence and evidence of a lack are not the same thing.

To take a simple example, imagine a condition for which only a handful of small studies have been conducted. If those studies are poorly designed, involve too few participants, or produce inconsistent findings, researchers may conclude that the evidence is insufficient. That conclusion does not tell us whether the treatment works or does not work. It tells us that the available research is not yet robust enough to provide a confident answer.

This point can sometimes become lost in public discussions. Headlines tend to favour certainty, while research is often more cautious. Scientists are generally reluctant to make strong claims unless the evidence genuinely supports them. As a result, an absence of firm conclusions can be reported as though it were evidence against a treatment, when the reality may simply be that more high-quality research is needed.

The review’s findings reflect this broader picture. There are now areas where the evidence appears reasonably strong, areas where it looks promising but remains incomplete, and areas where important questions are still unresolved. That is a far cry from the idea that acupuncture exists outside the world of evidence altogether.

Why Acupuncture Research Can Be Challenging

Researching acupuncture presents some challenges that differ from those encountered in pharmaceutical research, although it is worth being careful not to exaggerate these difficulties.

One issue is that acupuncture is not always delivered in exactly the same way. Different practitioners may use different treatment strategies for the same condition. Some follow Traditional Chinese Medicine pattern diagnosis. Others use more biomedical approaches. Some treatments involve a relatively small number of points, while others are more individualised. Treatment frequency and duration can vary as well.

From a clinical perspective, this diversity is often seen as a strength. Practitioners adapt treatment to the individual rather than applying the same protocol to everybody. From a research perspective, however, variation can make studies more difficult to compare.

There are also challenges surrounding control groups. Designing a convincing placebo for a tablet is relatively straightforward. Designing a convincing placebo for a hands-on treatment involving needles, touch, consultation and therapeutic interaction is more complicated. Researchers have developed various approaches over the years, including sham acupuncture techniques, but these methods remain the subject of ongoing debate.

The therapeutic relationship itself adds another layer of complexity. Healthcare is rarely a purely mechanical process. The quality of communication between practitioner and patient, a person’s expectations, their sense of being listened to, and the broader context of care can all influence outcomes. This is true across many healthcare disciplines, although it becomes particularly relevant when studying treatments that involve extended face-to-face interaction.

None of these challenges make acupuncture impossible to study. Clearly it can be studied, and increasingly it is being studied. They do, however, help explain why the research landscape can sometimes appear more complex than it does for interventions that are easier to standardise.

What This Means For Patients

For most readers, the practical question is not how many reviews were included in a study. It is what these findings mean when making decisions about their own health.

The first takeaway is that the evidence base for acupuncture is considerably larger than many people realise. Whether one ultimately decides to pursue treatment or not, it is difficult to describe acupuncture as a therapy that has escaped scientific scrutiny. Thousands of studies and hundreds of reviews have now examined its effects across a wide range of conditions.

The second takeaway is that evidence is not evenly distributed. Some conditions are supported by stronger research than others. This is true throughout healthcare and is not unique to acupuncture. Certain interventions become well supported because they have been studied repeatedly over many years. Other areas remain less certain because the research is newer, smaller, or more difficult to conduct.

The third takeaway is that evidence rarely provides absolute certainty about individual outcomes. Even when a treatment is supported by strong research, people respond differently. A therapy that helps one person may do very little for another. This applies equally to medication, physiotherapy, surgery and psychological therapies. Research tells us what tends to happen across groups. Clinical practice involves applying that knowledge to individuals.

For somebody considering acupuncture, the most useful question may therefore be relatively straightforward: what does the evidence suggest for my particular condition, and how does acupuncture compare with the alternatives available to me?

Those questions are far more informative than asking whether acupuncture works in a general sense. Healthcare interventions are rarely judged in such broad terms. We do not usually ask whether medication works, whether surgery works, or whether physiotherapy works. We ask which treatments are helpful for which problems, under what circumstances, and with what level of supporting evidence. Acupuncture deserves the same.

A Sign Of Maturity

One of the more interesting things about this review is what it suggests about the direction of the conversation itself. For many years, debates about acupuncture tended to revolve around a single question: does it work?

The review suggests that this question is becoming less useful than it once was. When the evidence base was relatively small, broad arguments about whether acupuncture worked at all were understandable. As the research literature has grown, those arguments have become less informative than questions about which conditions respond best, which patients are most likely to benefit, and where uncertainties still remain. As research accumulates, it becomes increasingly difficult to treat acupuncture's efficacy as a question requiring a simple yes or no answer.

A treatment that appears helpful for chronic pain may not have the same evidence behind it for another condition. Some applications have been studied extensively, while others remain at an earlier stage of investigation. Questions about effectiveness gradually give way to more detailed questions about patient selection, treatment protocols, comparative effectiveness, long-term outcomes and mechanisms of action.

This shift is something that happens across healthcare as fields mature. Early debates tend to focus on whether an intervention deserves serious consideration. Later discussions become more refined and more clinically useful.

The review by Hempen and Hummelsberger does not settle every question about acupuncture, and it would be unreasonable to expect it to. What it does provide is a valuable snapshot of where the evidence currently stands. The picture that emerges is neither one of universal effectiveness nor one of empty claims unsupported by research. It is a picture of an evolving evidence base that has grown substantially in both size and quality over recent decades.

For patients, practitioners and researchers alike, that is probably the most useful conclusion. The conversation has moved beyond the claim that there is no evidence. The more interesting discussion now concerns what the evidence tells us, where it is strongest, where uncertainties remain, and how future research can continue to improve our understanding.

Source

Hempen M, Hummelsberger J. The state of evidence in acupuncture: A review of meta-analyses and systematic reviews of acupuncture evidence (update 2017–2022). Complementary Therapies in Medicine. 2025;89:103149.

DOI: 10.1016/j.ctim.2025.103149

This review analysed 862 systematic reviews and meta-analyses covering 184 medical conditions.

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