Acupuncture is a treatment in which thin needles are inserted through the skin at specific points on the body to relieve pain and treat various health conditions. It originated as part of Traditional Chinese Medicine (TCM), a system of healthcare that has evolved over thousands of years, and is now one of the most widely studied complementary therapies in Western medicine. Most sessions last 20 to 30 minutes, and a typical course of treatment involves 6 to 12 sessions spread over several weeks.
How Acupuncture Works
Acupuncture has two explanatory frameworks: the traditional one it was built on and the modern scientific understanding that has developed around it.
In Traditional Chinese Medicine, the body’s vital energy, called qi (pronounced “chee”), flows along specific channels known as meridians. When qi moves freely, a person stays healthy. When it becomes blocked or unbalanced, illness or pain can develop. The human body has more than 2,000 acupuncture points along these meridians, and inserting needles at specific points is believed to restore the flow of energy and rebalance the body.
From a Western science perspective, acupuncture is a mechanical stimulus that activates local cells and nerve receptors. Needle insertion triggers the release of natural painkillers, hormones, and neurotransmitters in the surrounding tissue. These chemical signals then activate the body’s nervous, hormonal, and immune systems together, which helps explain why a needle in your leg can affect a headache or why treating one area of the body produces changes elsewhere.
What It Feels Like
Acupuncture needles are extremely thin, far thinner than the needles used for blood draws or injections. The most commonly used type is called a filiform needle, essentially a fine, flexible strand of stainless steel. Most people feel little to no pain when needles are inserted.
Once a needle is properly placed, practitioners look for what’s called the “de qi” sensation. This is often described as a feeling of heaviness, tingling, or numbness around the needle site. Some people feel a dull ache or a spreading warmth. The practitioner may gently twirl the needle, move it up and down, or apply mild heat or a small electrical current to achieve this response. De qi is considered a sign that the treatment point has been activated.
Conditions With Strong Evidence
Acupuncture has the most research support for pain-related conditions. A large 2018 review of over 8,000 participants found acupuncture was more effective than no treatment for back and neck pain, and a separate analysis of nearly 2,000 participants showed it outperformed sham (fake) acupuncture as well. The American College of Rheumatology and the Arthritis Foundation conditionally recommend it for osteoarthritis of the knee, hip, or hand, with the strongest results seen in knee osteoarthritis.
For migraines, an evaluation of 22 studies with nearly 5,000 people found moderate-quality evidence that acupuncture reduces how often migraines occur. A similar review of tension headaches, covering about 2,350 people across 12 studies, showed it may reduce their frequency as well.
Acupuncture also has meaningful evidence for several non-pain conditions. It is widely accepted as helpful for nausea and vomiting caused by cancer treatment. A 2017 study of about 500 women with stress incontinence found that 18 sessions of electroacupuncture over six weeks reduced urine leakage, with roughly two-thirds of participants seeing a 50 percent or greater improvement. There is also evidence supporting its use for seasonal allergies and for joint pain caused by aromatase inhibitors, a class of breast cancer drugs. In a study of 226 women taking these medications, six weeks of twice-weekly acupuncture significantly reduced joint pain compared to sham treatment or no treatment.
After surgery, acupuncture shows promise as well. An evaluation of 11 studies with 682 participants found that patients who received acupuncture the day after an operation reported less pain and used less opioid medication during recovery.
Common Variations
Traditional needle acupuncture is the most widely practiced form, but several variations exist. In electroacupuncture, practitioners attach a small device to the inserted needles that passes a mild electrical current between them. This is used to provide stronger or more sustained stimulation and has been studied specifically for conditions like urinary incontinence and chronic pain.
Auricular acupuncture focuses exclusively on points in the ear, which practitioners consider a microsystem that maps to the entire body. It’s commonly used for addiction treatment, anxiety, and pain management.
Dry needling is a related but distinct technique used primarily by physical therapists. It uses the same type of thin needle but targets muscular trigger points, the tight knots that develop in overworked or injured muscles. Unlike traditional acupuncture, dry needling has no connection to meridian theory or qi. Its goal is strictly mechanical: release muscle tension and reduce localized pain. Regulation of dry needling varies by state.
Safety and Side Effects
Acupuncture is one of the lower-risk physical therapies available. The most common side effects are minor and local: small amounts of bleeding at the needle site, brief pain during insertion, and temporary symptom flare-ups. These occur in roughly 1 to 5 percent of patients over a treatment series, and many practitioners consider bleeding and mild soreness to be normal responses rather than true adverse events.
Serious complications are extremely rare. A large meta-analysis estimated that about 1 in 10,000 patients experiences a serious adverse event during a course of treatment. The most concerning possibilities, including pneumothorax (a punctured lung from a chest-area needle placed too deeply), strong cardiovascular reactions, or fainting-related falls, each occur at a rate of roughly one to three cases per million treatments. These risks drop further when treatment is performed by a properly trained practitioner.
Certain situations call for extra caution. People with bleeding disorders or those taking blood-thinning medications may bruise more easily. Patients with pacemakers should avoid electroacupuncture, since the electrical current can interfere with the device. During pregnancy, practitioners avoid specific points on the lower abdomen, sacral region, and certain points on the limbs, particularly before 37 weeks, because these points are traditionally believed to stimulate uterine activity.
What a Typical Treatment Course Looks Like
For chronic pain, the most commonly studied treatment schedule involves one to three sessions per week over a period of 4 to 12 weeks, with each session lasting 20 to 30 minutes. Most clinical trials used between 6 and 12 total sessions. Research suggests that pain relief tends to hold for roughly 18 weeks after a course of treatment ends, at which point a follow-up round may be worth considering to maintain the benefit.
Your first visit will typically be longer than subsequent ones. The practitioner will take a detailed health history, ask about your symptoms, and may examine your tongue or check your pulse, both of which are diagnostic tools in Traditional Chinese Medicine. They’ll then develop a treatment plan based on your condition, selecting specific acupuncture points and deciding on session frequency.
Practitioner Training and Licensing
In the United States, licensed acupuncturists complete a three-year master’s degree program from an accredited institution. National certification is administered by the National Certification Board for Acupuncture and Herbal Medicine. Some practitioners qualify through a combination route that includes at least one year of formal education and up to two years of supervised apprenticeship, with each apprenticeship year requiring a minimum of 1,000 contact hours under direct supervision. Licensing requirements vary by state, but most states require both a graduate degree and passage of a national board exam before a practitioner can treat patients independently.
Medical doctors, chiropractors, and physical therapists may also perform acupuncture or dry needling with additional training, though their certification requirements are typically less extensive than those for dedicated acupuncturists.