Acupuncture studies usually compare real acupuncture against one of three things. The first is sham acupuncture, which is a simulated or fake procedure. The second is no treatment. The third is usual care, meaning the routine care a person would get anyway. The comparison a study uses changes what its results mean. According to the National Center for Complementary and Integrative Health (NCCIH), in many studies the benefit of acupuncture was greater when it was compared with no treatment than when it was compared with sham acupuncture.
This guide explains those comparison groups in plain language. It sorts common myths from what the evidence says and ends with a worksheet you can bring to a conversation with your health care provider. It does not tell you whether acupuncture is right for you.
Safety First: When Not to Wait
- If you have a medical emergency, call your local emergency number. Don't wait to research a treatment option first.
- New, sudden, or severe symptoms need a medical evaluation. NCCIH advises: “Don't use acupuncture to postpone seeing a health care provider about a health problem.”
- Serious complications are rare but real. NCCIH reports that relatively few complications have been reported. It also notes that nonsterile needles and improper delivery have caused infections, punctured organs, collapsed lungs, and injury to the central nervous system. If you have trouble breathing, chest pain, or any other alarming symptom during or after a session, seek emergency care right away.
Plain-Language Definitions
- Acupuncture: NCCIH defines it as “a technique in which practitioners stimulate specific points on the body, usually by inserting thin needles through the skin.” It is one of the approaches used in traditional Chinese medicine (TCM).
- Sham acupuncture: A simulated or fake procedure that looks and feels like treatment. NCCIH gives the example of “a device that pokes the skin but does not penetrate it.”
- No-treatment comparison: One group gets acupuncture and another group gets no acupuncture at all.
- Usual care (also called routine care): Everyone keeps getting their normal care. Some people also get acupuncture on top of it.
- Nonspecific effects: NCCIH describes these as “effects due to incidental aspects of a treatment rather than its main mechanism of action.” These may come from a patient's belief in the treatment, the relationship between the practitioner and the patient, or other factors not directly caused by the needles.
- Placebo effect: NCCIH uses this term when describing trials where real and sham acupuncture worked about equally well. It points to benefit tied to the experience of treatment rather than to the needling itself.
Why the Comparison Group Changes the Answer
Each comparison answers a different question. Knowing which question a study asked keeps you from reading more into a result than it shows.
- Acupuncture vs. sham: Asks whether needling specific points matters beyond the experience of being treated.
- Acupuncture vs. no treatment: Asks whether people who got acupuncture did better than people who got nothing.
- Acupuncture plus usual care vs. usual care alone: Asks whether adding acupuncture to someone's normal care was linked to better outcomes.
NCCIH says the pattern of bigger benefits against no treatment than against sham suggests that “nonspecific effects contribute to the beneficial effect of acupuncture on pain or other symptoms.” NCCIH's traditional Chinese medicine overview adds that some trials suggest real and sham acupuncture are equally effective, “indicating a placebo effect.”
Myth vs. Reality
- Myth: “If sham acupuncture works as well, the relief isn't real.”
Reality: NCCIH describes research in which patients who had felt relief during an earlier acupuncture session watched a video of that session and imagined it happening again. This “video-guided imagery technique had a significant pain-relieving effect.” In our editorial reading, a sham comparison doesn't test whether people felt better. It tests whether the needling itself explains the improvement.
- Myth: “Research shows acupuncture works for everything.”
Reality: NCCIH's overview says results from a number of studies suggest real acupuncture may help ease some types of pain that are often chronic. The examples it gives are low-back pain, neck pain, osteoarthritis/knee pain, and carpal tunnel syndrome. It also says acupuncture may help reduce how often tension headaches happen and may help prevent migraine headaches. The word “may” matters, and the list is specific.
- Myth: “Any benefit wears off right away.”
Reality: NCCIH summarizes an analysis of 20 studies (6,376 participants) of people with back pain, osteoarthritis, neck pain, or headaches. It found the beneficial effects of acupuncture continued for a year after treatment ended for all of those conditions except neck pain. That is a finding across groups of people, not a prediction for any one person.
- Myth: “Guidelines ignore acupuncture.”
Reality: NCCIH reports that a 2017 American College of Physicians guideline included acupuncture among the nondrug options recommended as first-line treatment for chronic low-back pain. It also listed acupuncture as an option for acute low-back pain. The evidence was judged moderate quality for chronic low-back pain and low quality for acute low-back pain.
- Myth: “Acupuncture is natural, so it has no risks.”
Reality: NCCIH says relatively few complications have been reported. It also says improper delivery and nonsterile needles have caused serious harm. The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices and requires them to be sterile and labeled for single use only.
What “Usual Care” Studies Can and Cannot Tell You
A usual-care study reflects real life more closely: people keep their normal care and some add acupuncture. NCCIH describes one such study from Germany in 2017. In it, 357 people getting routine asthma care were randomly assigned to receive or not receive acupuncture, and another 1,088 people who got acupuncture for asthma were also studied. Adding acupuncture to routine care was associated with better quality of life than routine care alone.
In our editorial reading, this design has a limit. NCCIH notes that nonspecific effects can come from belief in the treatment and the practitioner relationship. A comparison with routine care alone doesn't separate those factors from the needling. That is why sham-controlled studies answer a different question, and neither design gives the whole picture by itself.
Evidence Limits to Keep in Mind
- Study results describe groups, not individuals. An average result can't tell you how your body will respond.
- Findings are condition-specific. Evidence for low-back pain doesn't carry over to a different condition.
- Evidence quality varies. As the guideline example shows, reviewers can rate evidence for one use as moderate quality and another as low quality.
- Source pages age. NCCIH's traditional Chinese medicine overview was last updated in April 2019, and its acupuncture effectiveness page in October 2022. Newer research may exist, so ask your provider what has changed.
- Herbs are a separate question. Acupuncture evidence says nothing about herbal products you may be offered with it. NCCIH notes that because many studies of Chinese herbal products have been of poor quality, no firm conclusions can be made about their effectiveness. It also reports that some products have been contaminated with undeclared drugs, heavy metals, or incorrect herbs. NCCIH's Herbs at a Glance fact sheets cover what the science says and safety cautions for specific herbs. Our guide to reading herbal supplement research explains how to use them.
Conversation Worksheet: Questions to Bring
Use these questions with your primary care provider or specialist, and with any acupuncture practitioner you are considering. Write down the answers so you can compare them.
About the evidence for your situation
- What does current research say about acupuncture for my specific condition, not for pain or wellness in general?
- Did those studies compare acupuncture with sham acupuncture, with no treatment, or with usual care? What does that mean for how I should read the results?
- How strong is that evidence rated, and is there newer research than what I have read?
About how it fits with your current care
- Would this be added to my current care rather than replacing it? NCCIH advises not using TCM “to replace or delay seeking conventional care.”
- Is there anything about my health history, medicines, pregnancy, or nursing status that I should discuss before trying acupuncture?
- What change would tell us whether it's worth continuing, and when should we check?
About safety and the practitioner
- What training and experience does the practitioner have? NCCIH notes that most states and the District of Columbia have laws regulating acupuncture practice.
- Are sterile, single-use needles used for every session?
- What should I do if I have unusual symptoms after a session?
- Will the practitioner share information with my other health care providers if I ask?
For more questions to ask before booking, see our guide to verifying a complementary care practitioner. If a practitioner uses terms you don't recognize, our guide to traditional medicine terms can help you ask what a practice involves.
Quick Checklist Before You Read the Next Headline
- What was acupuncture compared with: sham, no treatment, or usual care?
- Which specific condition was studied?
- How many people took part, and how long were they followed?
- Does the headline say “may help” or does it overstate a “cure”?
- Is the source an authoritative health organization or a seller?
- Have you told all your health care providers about any complementary approaches you use, as NCCIH recommends?
Sources and Editorial Notes
- National Center for Complementary and Integrative Health. Traditional Chinese Medicine: What You Need To Know. Last updated April 2019.
- National Center for Complementary and Integrative Health. Acupuncture: Effectiveness and Safety. Last updated October 2022.
- National Center for Complementary and Integrative Health. Herbs at a Glance.
This article was prepared by the NewEasternHealth.com Research Team using the sources above. Read how we select and check sources in Our Standards and our Editorial Policy.
Medical information disclaimer: This article is general educational information. It is not medical advice, diagnosis, or treatment, and it does not recommend any therapy. Talk with a qualified health care provider about your own situation, and don't start, stop, or change any treatment or medicine based on this article. See our full Medical Disclaimer.
Independence notice: NewEasternHealth.com is an independent educational publication. It is not affiliated with any clinic or practice that previously used this domain. It does not provide acupuncture or other health services and does not employ licensed clinicians. See our Non-Affiliation Notice.