A growing number of studies show acupuncture is effective for managing pain. While critics claim the research is flawed, a leading Melbourne lecturer, researcher and Chinese medicine practitioner says it’s time to take acupuncture research to the next level, writes Karen Keast.


Acupuncture has been practised in China for at least 2000 years. It arrived on Australian shores in the 1880s amid the gold rush era and in the past two decades has experienced rapid growth, with the profession joining national registration in 2012.

More than 4500 practitioners are now registered with the Australian Health Practitioner Regulation Agency (AHPRA) while there is increasing acceptance of acupuncture as a complementary and alternative medicine.

Acupuncture is the insertion of fine, sterile needles into specific points, or acupuncture points, along the body’s meridians, a network of invisible channels through the body, which are designed to clear energy blockages and encourage the normal flow of life energy, known as qi, throughout the individual.

While a large number of studies have been published examining the efficacy of acupuncture for pain management, in 2012 a notable meta-analysis, Acupuncture for Chronic Pain, found acupuncture is effective for treatment for several types of chronic pain, including back and neck pain, osteoarthritis, chronic headache and shoulder pain.

The analysis of patient-level data from 29 high-quality randomised controlled trials, including 17,922 patients, found statistically significant differences between acupuncture and sham (placebo) acupuncture and between acupuncture and no-acupuncture.

Patients receiving acupuncture had less pain, with scores of 0.23, 0.16 and 0.15 standard deviation (SD) lower than sham controls for back and neck pain, osteoarthritis and chronic headache respectively. When it came to no-acupuncture controls, the effect sizes were 0.55, 0.57 and 0.42 SDs for back and neck pain, osteoarthritis and chronic headache respectively.

“We found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain,” the authors state.

“Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects.

“Our results…provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain.”

The World Health Organisation (WHO) has recognised acupuncture as an effective treatment modality for the past two decades while the 2010 edition of the NHMRC's Acute Pain Management: Scientific Evidence rates level 1 evidence of acupuncture for post-operative pain. 

A growing number of Australian education providers also offer undergraduate and postgraduate programs in related fields and private health insurance companies provide rebates to patients receiving acupuncture services.

Despite its growth in Australia, critics continue to argue that there is no scientific foundation to acupuncture practice.

Dr Zhen Zheng, who was trained in China and obtained her PhD from the University of Melbourne for her pain research, is a senior lecturer and researcher at Melbourne’s RMIT University, where her research focuses on identifying the optimal acupuncture treatment protocol for pain.

A member of the Australian Pain Society, the International Association for the Study of Pain, the Australian Acupuncture and Chinese Medicine Association and the course assessment panel for the Chinese Medicine Board of Australia, Dr Zheng says the large 2012 review is one of the most clinically significant papers to be recently published.              

“This study showed acupuncture is better than sham acupuncture although the difference is small,” she says.

Dr Zheng, who practices acupuncture and Chinese Medicine at the Geelong Chinese Medicine Clinic, says the paper adds to a strong body of evidence.

She says there’s now sufficient research to show acupuncture is effective for pain and that it’s not merely a placebo.

Dr Zheng says calls for more evidence-based research into the efficacy of acupuncture detracts from a need to focus on new areas of research, particularly geared towards assisting practitioners when it comes to determining the best treatment for each patient.

“That’s the question we need to answer. We really need to move to the next stage to do more research for the practitioners to try and identify what type of pain responds to acupuncture better.”

Researchers have also struggled with comparing true and sham acupuncture, amid concerns around possible practitioner bias - as it’s not possible to prevent practitioners from knowing when they are administering sham acupuncture.

In the 2012 review, sham acupuncture included needles inserted superficially, devices with needles that retract into the handle instead of penetrating the skin, and non-needle approaches such as deactivated electrical stimulation or detuned laser.

The authors determined four randomised controlled trials had an intermediate likelihood of bias from unblinding while the 16 remaining sham trials were graded as having a low risk of bias.

Dr Zheng says there’s now a move away from research comparing acupuncture with sham acupuncture as it’s not an inert control. There’s more benefit in comparing acupuncture with other standard therapies, she adds.

While the benefits of acupuncture can be difficult to measure in research, Dr Zheng says acupuncture has a range of advantages - it has few side effects, it’s an effective non-pharmacological treatment, and it works as part of a multidisciplinary and holistic approach to health care.

“When a patient comes to see me for pain relief, I don’t just try to reduce their pain, for me it’s very important to understand how well the patient sleeps, how well they function, their diet, their lifestyle and their mental status, so it is a very holistic review of looking at what pain is and the impact on their body,” she says.

“People who have chronic pain, their main two symptoms are tiredness and sleep problems and there are other symptoms including diarrhoea, constipation and dizziness. The severity of these symptoms increase as the number of pain sites increases as well.

“We know that exercise is a wonderful intervention for pain but some people are in so much pain they can’t exercise - that’s when acupuncture is really good at helping people to reduce pain fast and then people can start exercising and start to build up their strength,” Dr Zheng says.

“Pain management is not just about pain, it’s about everything. This is where I see Chinese medicine coming in and providing a very holistic assessment of the patient. It works collaboratively with other disciplines and therapies.”