What modern research tells us about acupuncture, pain, the nervous system, inflammation and the body’s capacity to heal
Does acupuncture really work?
It is a question I have been asked many times throughout my years in clinical practice. The short answer is that there is now a substantial body of research showing that acupuncture may be beneficial for a range of health concerns, particularly several forms of acute and chronic pain.
Acupuncture is no longer a fringe or rarely used treatment. According to the US National Center for Complementary and Integrative Health (NCCIH), the proportion of American adults who reported using acupuncture within the previous year more than doubled between 2002 and 2022, increasing from 1% to 2.2%.[1]
In Australia, acupuncture appears to be even more widely used. A broadly representative national survey of 2,019 Australian adults found that 7.9% – approximately one in every 13 adults – had consulted an acupuncturist during the previous 12 months.[2]
Acupuncture is also part of Australia’s nationally regulated healthcare workforce. Chinese medicine practitioners have been registered through the Australian Health Practitioner Regulation Agency (Ahpra) since 2012. In 2024-25, there were 4,898 registered Chinese medicine practitioners in Australia, with the great majority registered to practise acupuncture.[3]
The Australian and American figures should not be treated as a direct comparison because the surveys used different methods and populations. Nevertheless, they show that acupuncture is a well-established component of contemporary healthcare, used by a significant number of people and delivered in Australia by nationally registered practitioners.
The volume of acupuncture research has also grown enormously over the past two decades. Thousands of clinical studies and hundreds of systematic reviews have examined its effectiveness, safety and possible mechanisms of action.
The strength of evidence varies considerably between conditions. It would therefore be misleading to say that acupuncture has been proven to treat every condition for which it has been studied. However, current research suggests it may be helpful for several pain conditions – including back and neck pain, osteoarthritis-related knee pain, headaches, migraines and postoperative pain – as well as some non-pain conditions.[1]
So, how does acupuncture work?
My short answer is that acupuncture stimulates the body’s own regulatory and healing responses.
From a traditional Chinese medicine perspective, acupuncture restores balance, supports the healthy movement of Qi and Blood, and helps the body return to a more harmonious state.
From a biomedical perspective, research suggests that acupuncture may influence the nervous system, local tissues, circulation, inflammatory signalling and the way the brain processes pain. Its effects are unlikely to come from one single mechanism.
Some of the principal mechanisms being investigated include:
- The release of naturally occurring biochemical messengers
- Changes in pain processing within the brain and nervous system
- Local effects on muscles, connective tissue and circulation
- Modulation of inflammatory and immune activity
- Regulation of stress and emotional responses
Let us look at each of these more closely.
Acupuncture stimulates natural biochemical responses
Scientists have been investigating acupuncture’s pain-relieving effects for more than 60 years.
When an acupuncture needle stimulates the skin, connective tissue or muscle, sensory nerve fibres send signals to the spinal cord and brain. This can influence the release and activity of several naturally occurring chemical messengers.
These include endogenous opioids – often described as the body’s natural pain-relieving chemicals – such as endorphins and enkephalins. Acupuncture may also influence neurotransmitters including serotonin, dopamine, noradrenaline and gamma-aminobutyric acid, commonly known as GABA.
These chemicals are involved in far more than pain relief. They also contribute to mood, sleep, motivation, stress responses and emotional regulation.
Researchers have additionally investigated acupuncture’s influence on purinergic signalling. This involves adenosine and related molecules that help cells communicate and participate in processes including pain perception, immune regulation and inflammation.
This does not mean that acupuncture works simply by ‘releasing endorphins’. It appears to initiate a much broader series of local and central nervous-system responses.
Acupuncture influences the nervous system and the brain
Pain is not experienced only in the part of the body that hurts. It is created through a complex interaction between the affected tissues, peripheral nerves, spinal cord and brain.
When pain continues for a long time, the nervous system can become increasingly sensitive. The brain may begin responding more strongly to signals that would not ordinarily be painful. This is sometimes referred to as central sensitisation.
Brain-imaging research suggests that acupuncture may influence areas involved in pain perception, attention, emotion and sensory processing.
One particularly interesting study examined people with carpal tunnel syndrome. Researchers used functional magnetic resonance imaging and nerve-conduction testing before and after a course of acupuncture treatment.
Following treatment, they observed changes in both nerve function at the wrist and the organisation of the area of the brain associated with sensation in the hand.[4] This suggests that acupuncture may influence pain and nerve function at more than one level.
The study was relatively small, so it should not be treated as definitive proof. However, it offers a fascinating illustration of how acupuncture may affect both local nerves and the brain’s processing of sensory information.
Acupuncture may improve local circulation
Acupuncture also produces effects in the tissues surrounding the needle.
Needle stimulation can cause small blood vessels to dilate, increasing local blood flow and oxygen delivery. Improved circulation may help bring nutrients and immune cells to the area while supporting the removal of metabolic waste products.
A study involving people with fibromyalgia examined blood flow following superficial and deeper needle stimulation. Both forms of stimulation increased local circulation, but deeper stimulation within the muscle produced a greater increase in muscle blood flow.[5]
The nervous system helps regulate this response through several chemical messengers and neuropeptides. These include calcitonin gene-related peptide and substance P, which are involved in blood-vessel regulation, pain transmission and inflammatory activity.
The relationship between these substances and acupuncture is complex. Acupuncture does not simply switch them on or off. Its effects may depend on the type of stimulation, the tissue being treated and the person’s underlying condition.
Acupuncture may modulate inflammation
Inflammation is an essential part of healing. It helps the body respond to infection and repair damaged tissue. However, when inflammatory activity becomes excessive or persistent, it may contribute to pain and chronic illness.
Research suggests that acupuncture can influence inflammatory signalling through interactions between the nervous, endocrine and immune systems. These effects may include changes in cytokines, immune-cell activity and neuropeptides involved in inflammation.
Researchers have also investigated acupuncture’s effects on biological pathways involving:
- Immunoglobulin E, or IgE, which is associated with allergic responses
- Vasoactive intestinal peptide, which contributes to intestinal and immune regulation
- Transient receptor potential vanilloid 1, or TRPV1, which is involved in pain, temperature sensation and inflammation
These findings help us understand possible mechanisms, but they do not mean acupuncture will produce the same anti-inflammatory effect in every person or every condition.
Clinical evidence is condition-specific. For example, studies suggest acupuncture may help relieve symptoms of allergic rhinitis and some inflammatory pain conditions, but results vary according to the condition, treatment protocol and quality of the research.[1]
Acupuncture may support stress and emotional regulation
Many people describe feeling calmer, more grounded or deeply relaxed during and after acupuncture.
Part of this may be explained by acupuncture’s influence on brain networks involved in emotion, threat perception and stress. Studies suggest that acupuncture may affect activity within the limbic system and other areas associated with emotional processing.
It may also influence the hypothalamic-pituitary-adrenal, or HPA, axis. This is one of the body’s major stress-response systems, linking the brain with hormonal activity in the adrenal glands.
Acupuncture has also been studied for its effects on autonomic nervous-system regulation. The autonomic nervous system coordinates involuntary functions such as heart rate, blood pressure, digestion and breathing.
In particular, acupuncture may support parasympathetic activity – the ‘rest, digest and restore’ side of the nervous system – although the response depends on the individual and the form of stimulation used.
A 2019 systematic review found that acupuncture was associated with reductions in depression severity compared with usual care, sham acupuncture and some medication comparisons. However, the authors also identified limitations in the available evidence, including variations in study quality and the risk of bias.[6]
Acupuncture should not be presented as a universal replacement for psychological therapy or prescribed medication. It may, however, form one component of a broader and appropriately supervised treatment plan for some people experiencing stress, anxiety, depression or disturbed sleep.
Are acupuncture’s benefits only temporary?
One of the most encouraging findings in acupuncture research is that the benefits may continue after a course of treatment has finished.
An individual-patient-data meta-analysis examined 20 trials involving 6,376 people with chronic pain. Researchers found that approximately 90% of acupuncture’s treatment benefit was sustained at 12 months when acupuncture was compared with usual care. When compared with sham acupuncture, approximately 50% of the benefit was sustained.[7]
This does not mean everyone will remain pain-free for a year. It suggests that, on average, the benefits of an appropriate course of acupuncture may not disappear as soon as treatment ends.
Acupuncture within modern healthcare
A review of clinical practice guidelines published over a 27-year period identified 2,189 positive recommendations for acupuncture across guidelines addressing 204 health conditions. Most were published in North America, Europe and Australasia.[8]
A recommendation does not prove that acupuncture will work for every person with a particular condition. Recommendations may be strong or conditional, and the evidence supporting them can range from high to low quality.
Nevertheless, these findings show that acupuncture is increasingly being evaluated and incorporated into contemporary healthcare rather than automatically dismissed as an alternative treatment.
The bigger picture
Science has not yet fully explained everything that happens during acupuncture – and it may be some time before it does.
What we do know is that acupuncture appears to work through several interconnected mechanisms. It can affect the nervous system, pain-processing pathways, local tissues, circulation, inflammatory signalling and the body’s response to stress.
For me, this is where traditional Chinese medicine and modern research meet.
Chinese medicine has always viewed the body as an interconnected whole rather than a collection of separate parts. Contemporary research is now demonstrating just how closely the brain, nervous system, immune system, hormones, circulation and emotional state communicate with one another.
Acupuncture does not force the body to behave in a particular way. Rather, it provides a carefully chosen stimulus intended to help the body regulate itself more effectively.
| That is what I mean when I say: acupuncture activates the body’s ability to heal itself. |
A final note
Acupuncture is generally considered safe when performed by a suitably qualified practitioner using sterile, single-use needles. It is important to tell your practitioner about your health history, pregnancy, medications, bleeding disorders, implanted devices and any new or unexplained symptoms.
The information in this article is general education and is not a diagnosis or a substitute for individual medical advice. If you have severe, persistent or concerning symptoms, seek assessment from an appropriately qualified healthcare professional.
References
1. National Center for Complementary and Integrative Health. Acupuncture: Effectiveness and Safety. US National Institutes of Health. https://www.nccih.nih.gov/health/acupuncture-effectiveness-and-safety
2. Steel A, McIntyre E, Harnett J, et al. Complementary medicine use in the Australian population: Results of a nationally representative cross-sectional survey. Scientific Reports. 2018;8:17325. https://doi.org/10.1038/s41598-018-35508-y
3. Chinese Medicine Board of Australia. 2024/25 Annual Report Summary. Australian Health Practitioner Regulation Agency. https://www.chinesemedicineboard.gov.au/News/Annual-report
4. Maeda Y, Kim H, Kettner N, et al. Rewiring the primary somatosensory cortex in carpal tunnel syndrome with acupuncture. Brain. 2017;140(4):914-927. https://doi.org/10.1093/brain/awx015
5. Sandberg M, Lindberg LG, Gerdle B. Peripheral effects of needle stimulation on skin and muscle blood flow in fibromyalgia. European Journal of Pain. 2004;8(2):163-171. https://doi.org/10.1016/S1090-3801(03)00090-9
6. Armour M, Smith CA, Wang LQ, et al. Acupuncture for Depression: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2019;8(8):1140. https://doi.org/10.3390/jcm8081140
7. MacPherson H, Vertosick EA, Foster NE, et al. The persistence of the effects of acupuncture after a course of treatment: A meta-analysis of patients with chronic pain. Pain. 2017;158(5):784-793. https://pubmed.ncbi.nlm.nih.gov/27764035/
8. Birch S, Lee MS, Alraek T, Kim TH. Overview of treatment guidelines and clinical practice guidelines that recommend the use of acupuncture: A bibliometric analysis. Journal of Alternative and Complementary Medicine. 2018;24(8):752-769. https://doi.org/10.1089/acm.2018.0092