Pain Background

Pain can broadly be broken down into acute and chronic pain. According to Chronic Pain Ireland (1), acute pain is referred to as a useful pain and is defined as lasting less than 3 months. Chronic pain persists longer than 3 months and serves no protective function.

The PRIME study (2), conducted by researchers at NUI Galway, looked at chronic pain in Ireland and found that almost 36% of respondents reported having chronic pain. Of those with chronic pain, 42% had experienced it for more than 5 years and 42% did not know the cause of their pain, which was consistent with previous research.

A previous large-scale European study (3) found a 13% prevalence of chronic pain in Ireland, which is significantly lower but still a relatively high proportion of the population. The difference between the two studies was reported to

likely to be at least partly how the two studies defined chronic pain. The Irish study used a more inclusive definition of chronic pain, which did not use ‘severity’ criterion, whereas the European study used more ‘‘conservative’’ criteria. It should be noted that the PRIME study researchers mention that those who have pain may have been more likely

to respond because of the relevance of the questionnaire. Areas of the body most commonly reported to be affected by chronic pain were the lower back (47.2%), the knee (30.4%), the neck (29.7%), and the shoulder (27.3%).

A follow-up paper published by the same research team (4), estimated that the total cost of chronic pain to the Irish economy for those aged 20 and above was estimated at €5.34 billion per year, or 2.86% of Irish GDP in 2008.

There is strong clinical evidence showing that acupuncture can help with pain. Some research is listed below.

Cochrane Reviews

An overview of Cochrane reviews conducted in 2025, which looked at non-pharmacological and non-surgical treatments for low back pain in adults (5), found moderate-certainty evidence that when compared to sham acupuncture, true acupuncture probably does provide an improvement in function for acute or subacute lower back pain. They also concluded that compared to no treatment, acupuncture probably also provides a reduction in pain intensity, and function, with moderate-certainty evidence, for chronic lower back pain. And also, compared to usual care, acupuncture probably does provide an improvement in function.

Other smaller Cochrane reviews looking at various manifestations of pain in the body were limited by the volume of studies available, and were unable to draw conclusions by themselves.

Meta Analysis

A 2018 meta-analysis in the Journal of Pain (6), which is also where part 2 of the PRIME study was published, concluded that: “…acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time.” and “…decreases in pain after acupuncture cannot be explained solely in terms of placebo effects.”

One synthesis of systematic reviews from the Lithuanian journal Medicina (7) found that many RCTs of acupuncture had methodological shortcomings, including inadequate statistical power with a high risk of bias. This doesn’t bring us any closer to identifying how effective acupuncture is for treating pain, however it does point to the requirement for continued high quality research, a significant challenge when one considers the financial cost of carrying out these kinds of studies without the backing of large multinational companies or government support.

A meta-analysis published by JAMA in 2012 (8) concluded: “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option.” 

Another meta-analysis from the Pain journal, published in 2018 (9), which set out to determine whether or not the effects of acupuncture are persistent after a course of treatment concluded: “The effects of a course of acupuncture treatment for patients with chronic pain do not appear to decrease importantly over 12 months.”

A systematic review from the BMJ in 2020 consisting of researchers from the Mayo Clinic in the US and also researchers from China (10), critically analysed publications regarding the use of acupuncture for pain management among patients with cancer in a palliative care settings. The results indicated a favourable effect for acupuncture, and they concluded that it may be a safe and effective treatment for this indication, but did call out the need for further studies in this area.

Finally, a network meta-analysis published in 2025 in the Heliyon journal, conducted by a research team in China (11), evaluated the comparative effectiveness of true acupuncture with placebo, sham, or active controls, for chronic non-specific low back pain (CNSLBP). The study found true acupuncture to be effective and superior to placebo/sham/controls, particularly when combined with other therapies such as traditional Chinese medicine, education, or exercise, in managing chronic non-specific low back pain. The findings demonstrated clinically meaningful reductions in pain intensity and improvements in functional capacity.

Studies

One RCT conducted by a team in Germany that was published in JAMA in 2022 (12), investigated if adding preoperative acupuncture to standard pharmacological therapy effective for pain control in patients after caesarean delivery. The trial included 180 patients, and found that acupuncture was safe and effective in reducing pain and accelerating mobilization of patients after caesarean delivery, and that acupuncture could be recommended as routine, supplemental therapy for pain control in patients after elective caesarean delivery.

Clinical Guidelines

Acupuncture is recommended as treatment for chronic pain under the UKs National Institute for Health and Care Excellence (NICE) guidelines (13). In the section on why they recommend acupuncture, they state:“Many studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture. There was not enough evidence to determine longer-term benefits.”

The 2024 American Chronic Pain Association (ACPA), co-authored a ‘Resource Guide to Chronic Pain Management’ with Stanford University’s Division of Pain Medicine (14), and in it they recommend acupuncture for the treatment of chronic pain.

The Joint Commission in the US includes acupuncture amongst its recommended non-pharmacologic pain treatment modalities in its report on ‘Pain Assessment and Management Standards for Hospitals’ (15).

The US Department of Health and Human Services, in its ‘Pain Management Best Practices Report’ (16), also include acupuncture amongst the non-pharmacologic treatments listed, stating:“It is generally considered safe when performed by a licensed, experienced, well-trained practitioner using sterile needles, and although there are risks as with any intervention, the risks are minimal. The therapeutic value of acupuncture in the treatment of various pain conditions, including osteoarthritis; migraine; and low-back, neck, and knee pain has growing evidence in the form of systematic reviews and meta-analyses”.

Written By:

Seamus Fitzgerald

References:

  1. https://chronicpain.ie/what-is-chronic-pain/ 
  2. Raftery, M. N., Sarma, K., Murphy, A. W., De la Harpe, D., Normand, C., & McGuire, B. E. (2011). Chronic pain in the Republic of Ireland—Community prevalence, psychosocial profile and predictors of pain-related disability: Results from the Prevalence, Impact and Cost of Chronic Pain (PRIME) study, Part 1. Pain, 152(5), 1096–1103
  3. Breivik, H., Collett, B., Ventafridda, V., Cohen, R., & Gallacher, D. (2006). Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment. European Journal of Pain, 10(4), 287–287.
  4. Miriam N. Raftery, Padhraig Ryan, Charles Normand, Andrew W. Murphy, Davida de la Harpe, Brian E. McGuire, The Economic Cost of Chronic Noncancer Pain in Ireland: Results From the PRIME Study, Part 2, The Journal of Pain, Volume 13, Issue 2, 2012, Pages 139-145, ISSN 1526-5900
  5. Rizzo RRN, Cashin AG, Wand BM, Ferraro MC, Sharma S, Lee H, O’Hagan E, Maher CG, Furlan AD, van Tulder MW, McAuley JH. Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews. Cochrane Database of Systematic Reviews 2025, Issue 3. Art. No.: CD014691.
  6. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis, Vickers, Andrew J. et al. The Journal of Pain, Volume 19, Issue 5, 455 – 474
  7. Paley CA, Johnson MI. Acupuncture for the Relief of Chronic Pain: A Synthesis of Systematic Reviews. Medicina (Kaunas). 2019 Dec 24;56(1):6
  8. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453
  9. MacPherson H, Vertosick EA, Foster NE, Lewith G, Linde K, Sherman KJ, Witt CM, Vickers AJ; Acupuncture Trialists’ Collaboration. The persistence of the effects of acupuncture after a course of treatment: a meta-analysis of patients with chronic pain. Pain. 2017 May;158(5):784-793
  10. Yang J, Wahner-Roedler DL, Zhou X, et al, Acupuncture for palliative cancer pain management: systematic review, BMJ Supportive & Palliative Care 2021;11:264-270
  11. Feng Gao, Dongming Jia, Shengxia Xue, Comparative Efficacy of Acupuncture for Chronic Low Back Pain: A Network Meta-Analysis, Heliyon, 2025, e43132, ISSN 2405-8440
  12. Usichenko TI, Henkel BJ, Klausenitz C, et al. Effectiveness of Acupuncture for Pain Control After Cesarean Delivery: A Randomized Clinical Trial. JAMA Netw Open. 2022;5(2):e220517
  13. https://www.nice.org.uk/guidance/ng193/chapter/recommendations 
  14. https://www.acpanow.com/acpa-stanford-guide.html#/ 
  15. https://www.jointcommission.org/standards/r3-report/r3-report-issue-11-pain-assessment-and-management-standards-for-hospitals/ 
  16. https://www.hhs.gov/sites/default/files/pain-mgmt-best-practices-draft-final-report-05062019.pdf