Acupuncture

Acupuncture treats certain medical conditions by putting fine needles just under the skin at particular points on the body. The needles are left in place for a short time and then removed. Acupuncture can help with some physical problems such as pain and feeling sick. It can also help to reduce symptoms such as anxiety.

Traditional Chinese acupuncture is based on the theory that vital energy called Qi circulates around the body along channels called meridians. Blockages in the flow of Qi are thought to cause ill health. Blockages may occur when we are

• Anxious or stressed
• Angry
• Frightened
• Not eating properly
• Suffering from an infection
• In poor health due to illness or disease
• Exposed to substances that might harm our health

Traditional acupuncture aims to correct the flow of Qi. In traditional Chinese medicine acupuncture is used alongside diet and herbal medicine.

Western medical acupuncture is a modern interpretation of acupuncture based on scientific theory. Treatments are given alongside conventional medical treatments and are based on usual medical diagnosis. Acupuncture is used to treat a wide range of conditions, including pain and addiction (for example, smoking). Many medical doctors are trained in acupuncture and some health professionals are also trained to use acupuncture alongside cancer treatment.

Medical research has shown that acupuncture works by stimulating nerves to release the body’s own natural chemicals. The chemicals help to relieve symptoms. For example, a number of our own natural morphine like substances (endorphins) are released in the spinal cord and brain to relieve pain. Serotonin can be released by acupuncture to help make you feel more relaxed and give a feeling of well being.

Traditional Chinese acupuncturists believe that Qi flows through the body along channels, called meridians. The therapist puts acupuncture needles into certain points along the meridians to free the flow of Qi. This is thought to stimulate the body to heal itself.

People who use acupuncture often say that it helps them to feel relaxed and improves their overall feeling of well being. One of the main reasons people with cancer use acupuncture is to help relieve sickness (nausea) caused by chemotherapy. Seabands (acubands) are bracelets that apply pressure to acupuncture points on the wrist and can help to reduce sickness due to chemotherapy or travel. Acupuncture is widely used in hospitals, hospices and clinics to relieve pain. Some people like to use it because it helps them to sleep better and feel generally more healthy. It can reduce anxiety which can also help to reduce pain.

Some people use acupuncture reduce hot flushes caused by cancer or its treatment.

We have general information about why people with cancer use complementary therapies in our about complementary therapy section.

On your first visit the acupuncturist will ask general questions about your health, lifestyle and medical history. This can include sleep patterns, diet, and how you feel emotionally. You will be asked about any symptoms or side effects and about any medicines you are taking. A traditional acupuncturist may also look at your tongue and feel your wrists to help them to decide where to put the needles.

Always tell your acupuncturist about any health problems or medicines you take. Acupuncture may not be suitable for you, or your acupuncturist may need to avoid certain acupuncture points.

How many treatments you need will vary. Discuss this with your acupuncturist before you start your treatment. They may recommend that you have treatments once or twice a week at first. If acupuncture is going to help you, you are likely to see an improvement in about 5 to 6 sessions. If you have a chronic condition, you might need to go back every few weeks for a top up treatment.

You have fine, stainless steel needles put into pressure points just below your skin. Most acupuncturists use between 4 and 10 points during a session. They use new, sterile needles for every patient.

The needles shouldn’t cause pain, although you might feel a tingling sensation. They are usually left in place for about 20 to 30 minutes. The acupuncturist may turn or flick the needles while they are in place to help the treatment to work.

Many acupuncturists now use a technique called electroacupuncture. They attach a very weak electrical current to the needles once they are in. This small amount of electricity moves the needles so they don’t have to be moved by hand.

There is a particular type of acupuncture called ear acupuncture, or auricular acupuncture, where the needles may be left in place for a few days. Another type of acupuncture called acupressure uses pressure on acupuncture points.

There is no evidence to show that acupuncture helps in any way with treating or curing cancer. But research suggests that it is helpful in relieving some symptoms of cancer or the side effects of cancer treatment. The main areas of research into acupuncture for cancer are chemotherapy related sickness and cancer pain. 

You can find out about current UK research into complementary and alternative therapies on our complementary therapy research page. The NHS specialist library for complementary and alternative medicine website gives information about current research into acupuncture. For any symptom where there is evidence that acupuncture may help, we need to compare it with standard treatment to get an overall view of how it can help alongside current conventional treatment options. Most studies show acupuncture to be better than no treatment and as good as or better than current standard treatment. 

Here we discuss research into

• Acupuncture and pain control
• Acupuncture for nausea and vomiting due to chemo
• Acupuncture for nerve changes due to chemo
• Acupuncture for hot flushes
• Acupuncture for cancer related tiredness
• Acupuncture for a dry mouth
• Acupuncture for breathlessness
• Sham acupuncture

Acupuncture and pain control

In April 2009, researchers looked at 15 randomised controlled trials that have been carried out into acupuncture and related techniques for pain control after surgery. The related techniques included

• Electro acupuncture
• Auricular acupuncture
• Acupressure and capsicum plasters
• Moxibustion
• Transcutaneous electrical nerve stimulation (TENS) on acupoints. 

Patients in the studies had a variety of surgical operations. Most operations were abdominal surgery and some trials included face reconstruction surgery, knee surgery, haemorrhoidectomy, back surgery, chest surgery, hip replacement and molar tooth extraction.

The reviewers found that acupuncture and related techniques can work well for some people to reduce pain after surgery, especially when used alongside conventional painkillers. In some people, acupuncture techniques reduced the need for strong painkillers and so reduced the risk of side effects such as feeling sick, itching, dizziness and drowsiness. But the researchers say that these results need to be confirmed by larger studies. There is not yet enough evidence to show for sure that acupuncture can relieve cancer pain but many studies show it can reduce some types of pain. 

An American study reported in 2010 about acupuncture for pain and dry mouth after neck surgery. The study of 58 patients divided them into 2 groups. One group had acupuncture and the other group had standard care after surgery. The group of patients having acupuncture had less pain and needed fewer painkillers than the group who had standard care. We need more large scale research into the use of the different types of acupuncture for cancer pain.

A small study has shown that acupuncture can help to reduce the joint pain caused by hormone treatment for breast cancer. Joint pain is sometimes a side effect of a type of hormone treatment called aromatase inhibitors, which include anastrozole, exemestane and letrozole.

Acupuncture for nausea and vomiting due to chemo

There is a large UK trial looking at acupressure for nausea due to chemotherapy (chemotherapy induced nausea and vomiting – CINV). The trial wants to find out how well acupressure works and is also looking at how cost effective the treatment is.

Past research has given some information about acupuncture and acupressure for CINV. In 2006 experts looked at all the trials that have researched whether acupuncture can reduce nausea and vomiting after chemotherapy. The trials used various methods of acupuncture

• Acupuncture applied with electricity (electroacupuncture)
• Acupuncture without electricity (manual acupuncture)
• Acupressure (pressing on the points usually with fingertip)
• Electrical stimulation on the skin surface such as with wristwatch like devices.

There were 11 trials and the analysis found that electroacupuncture reduced vomiting in the first day after chemotherapy, but manual acupuncture did not. Acupressure reduced first day nausea, but was not effective on later days. Acupressure did not reduce vomiting. Electrical stimulation on the skin also showed no benefit. All the trials gave anti sickness drugs, but the drugs used in the electroacupuncture trials were not the most modern ones. So, it is not known if electroacupuncture gives more benefit than modern anti sickness drugs. The researchers recommended that trials of electroacupuncture with modern drugs should be carried out. You can see the review into acupuncture for nausea and vomiting on the Cochrane Library website. 

A UK study in 2007 in Manchester of 36 patients looked at whether acupressure bands (Sea bands) could reduce nausea and vomiting after chemotherapy. Patients in one group wore the wristbands for 5 days. In another group, patients did not wear the wristbands. Both groups took the usual anti sickness medicines. In the group wearing the Sea bands patients had significantly less nausea, retching, and distress. A US study in 2007 of 160 women also found that acupressure wrist bands can help to reduce delayed nausea and vomiting due to breast cancer chemotherapy.

Acupuncture for nerve changes due to chemo

In one study, acupuncture was used to try to reduce numbness, tingling and sensation changes in the hands and feet after chemotherapy treatment. These symptoms are known as peripheral neuropathy. 21 patients had acupuncture therapy according to classical Chinese Medicine, while 26 patients had the best medical care but no specific treatment for peripheral neuropathy. Sixteen patients (76%) in the acupuncture group had an improvement of their symptoms, while only four patients in the control group (15%) did so. Three patients in the acupuncture group (14%) showed no change and two patients' symptoms got worse (10%). In the group that had no acupuncture seven showed no change (27%) and 15 got worse (58%). The researchers suggest that acupuncture can have a positive effect on peripheral neuropathy symptoms.

Acupuncture for hot flushes

A 2005 study of 194 patients with breast or prostate cancer who had hot flushes due to their cancer treatment showed that acupuncture or self acupuncture gave long term relief of vasomotor symptoms associated with acupuncture and self acupuncture. Several smaller studies also support this finding, including a Swedish study in 2006 of 38 women having hormone therapy for breast cancer. The study found that as well as reducing the number and intensity of the hot flushes, women who had acupuncture felt better psychologically.

A 2009 Korean study looked at trials that used acupuncture for hot flushes in women with breast cancer. Six randomised controlled trials were included in the review. 281 people took part in the trials. They included patients with breast cancer who had needle acupuncture with or without electrical stimulation to treat hot flashes. Three trials of manual versus sham acupuncture were combined in an overall analysis. There was a suggestion that acupuncture did reduce the frequency of hot flashes after treatment compared with sham acupuncture.

One trial compared electroacupuncture to HRT and found that HRT was more effective at reducing hot flashes than electroacupuncture. Another trial compared acupuncture with the drug venlafaxine and another compared acupuncture to applied relaxation. These trials found that there was no difference between acupuncture and the other treatments. The authors of this review felt that the trials failed to show that acupuncture works for the treatment of hot flashes.

You can read the report about acupuncture for hot flushes on the Database of abstracts and reviews website. 

Acupuncture for cancer related tiredness

Tiredness (fatigue) after chemotherapy is a difficult symptom to manage in practice and has a big effect on patient's lives. A small UK trial of 47 patients in 2007 looked at acupuncture, acupressure and sham acupuncture for moderate to severe chemotherapy related fatigue. The trial showed that acupuncture and acupressure treatments helped people feel less tired and reduced physical tiredness. It also improved activity. At the end of the treatments, the acupuncture group had a 36% improvement in fatigue levels, while the acupressure group improved by 19% and the sham acupressure by 0.6%.

The ACU.FATIGUE trial is a big study currently looking at acupuncture to help women with severe tiredness (fatigue) following chemotherapy treatment for breast cancer. Up to 40 out of every 100 women (40%) have moderate to severe levels of fatigue which can sometimes last for years. The trial is looking at acupuncture carried out by a therapist and by women themselves (self acupuncture). 

Acupuncture for a dry mouth

A 2010 systematic review was carried out in Ireland into trials using acupuncture for dry mouth in people having radiotherapy for head and neck cancers. The reviewers looked at 3 trials and found that they suggested that acupuncture can help to reduce a dry mouth. They said that there is not enough evidence to recommend it as a treatment. They also said that we need more research to know how helpful acupuncture can be for a dry mouth due to cancer or its treatment.

An American study also reported in 2010 about acupuncture for pain and dry mouth after neck surgery. The study of 58 patients divided them into 2 groups. One group had acupuncture and the other group had standard care after surgery. The group of patients having acupuncture had fewer problems with a dry mouth than the group who had standard care.

One small Swedish study looked at whether acupuncture can help to reduce a dry mouth (xerostomia) in people with advanced cancer. There were 8 people in the study and they had 10 acupuncture treatments during a 5 week period. The researchers found that all the patients had reduced dryness of the mouth. 

In 2002, a US study of 50 patients showed that acupuncture helped to reduce a dry mouth after radiotherapy to the head and neck. Acupuncture even helped some patients where standard medicines had not worked. For some people the effect lasted more than 3 months.

Acupuncture for breathlessness

Several studies have used acupuncture or acupressure for cancer related breathlessness. The results are conflicting. Some studies showed that acupuncture or acupressure can reduce breathlessness and other studies showed no benefit. We need more research to help us know whether acupuncture is helpful for people who are breathless due to their cancer or treatment. 

Sham acupuncture

Some people think that acupuncture may work because of a placebo effect. For example, the benefits might be due to the attention of the therapist, being listened to, or just having the chance to lie down and relax. To try to account for the placebo effect, some studies compare true acupuncture with sham acupuncture. Sham acupuncture uses a special needle that does not actually penetrate the skin. Some studies have shown that the real acupuncture worked better than the sham acupuncture for some symptoms. For others, there was no difference.

Acupuncture given by professionally qualified therapists is generally very safe and doesn’t usually have side effects. One large Japanese study showed that of 65,000 people having treatments, very few had any problems. Sometimes people faint or feel dizzy. This is most common with your first treatment. It is best not to do anything too energetic straight after a treatment. It is important not to be left alone during treatment and not to drive immediately afterwards. If you carry on feeling dizzy, contact your acupuncturist for advice.

You may have

• Pain or bleeding at the needle sites but this is rare
• Bruising around the punctured point

Very rarely, acupuncture can have a serious side effect, such as infection or heart damage. These effects are generally the result of poor practice.

Acupuncture is not recommended if you

• Have a low platelet count because your risk of bleeding is higher
• Have a low white blood cell count because your risk of infection is higher
• Have heart valve problems
• Are pregnant because some acupoints can make the womb contract
• Have lymphoedema because putting needles into limbs that have poor lymph drainage increases the risk of infection
• Wear a pacemaker or have a heart murmur

Always check with your doctor before you start using any type of complementary or alternative treatment. Look in our complementary therapy section for more information about telling your doctor if you are using CAM therapy. Always make sure your acupuncturist knows your full medical and drug history at every visit, especially if anything has changed.

Most people who have acupuncture have to pay for it themselves. But acupuncture is being used more and more within the NHS. There are more than 7,000 nurses, GPs, physiotherapists and hospital doctors who have training in acupuncture. In fact 1 in 3 GP surgeries are making acupuncture available to their patients. There are also about 5,500 traditional acupuncturists practicing throughout the UK.

There is information about finding an acupuncturist further down this page. If you go for private treatment, your first consultation will usually be longer than normal treatment sessions. Roughly you should expect to pay between £40 and £80 for your first consultation and between £30 and £70 for following treatments. If you have private healthcare it is always worth asking the company if they cover acupuncture, as some do.

Acupuncture is widely used in many cancer hospitals and clinics, hospices and GP practices. It's vital that the person who treats you is properly trained. They should also be qualified to use acupuncture for people with cancer. It is best not to go for treatment at acupuncturists on the high street because these practitioners may not be familiar with treating cancer. Many Chinese medicine practitioners use herbs alongside acupuncture and some of the herbs can interact with cancer treatments and stop them working so well.

The best way to find a reliable acupuncturist in the UK is to

• Contact one of the acupuncture organisations listed below and ask them for a list of acupuncturists in your area
• Check if the organisation has a code of practice and ethics and a disciplinary and complaints procedure (the better complementary organisations do)
• Ask the acupuncturist how many years of training they've had and how long they've been practising
• Ask them if they have treated many people with cancer before
• Ask if they have indemnity insurance (in case of negligence)

There is no single professional UK organisation that regulates acupuncturists. There are several associations but there is no law that says acupuncturists have to join them.

Most reputable acupuncturists belong to one of the organisations listed below. These organisations are working together and have made proposals to the Government about legal regulation of acupuncturists. The Government have published a consultation document about regulating the practice of acupuncture and herbal medicine. You can look at this document on the Department of Health website. Type ‘acupuncture’ into the search box.

For more information about finding a reliable therapist, and the questions you should ask, look in our complementary therapies section.

There are a number of different organisations that acupuncturists can join. These are listed here, with details of how you can contact them.

Acupuncture Association of Chartered Physiotherapists (AACP)
(for physiotherapists who use acupuncture as part of their treatment)
AACP Limited
Southgate House
Southgate Park
Bakewell Road
Orton Southgate
Peterborough
PE2 6YS
Email: sec@aacp.uk.com
Website: www.aacp.uk.com
Phone: 01733 390012

British Academy of Western Medical Acupuncture (BAWMA)
(for nurses, doctors and physiotherapists who use acupuncture)
76 Langdale Road
Bebington
Wirral CH63 3AW
Phone: 0151 3439168
Email: info@bawa-hq.freeserve.co.uk
Website: www.bawma.co.uk

British Acupuncture Council (BAcC)
(practitioners of traditional acupuncture)
63 Jeddo Road
London W12 9HQ
Tel: 020 8735 0400
Fax: 020 8735 0404
Email: info@acupuncture.org.uk
Website: www.acupuncture.org.uk

British Medical Acupuncture Society (BMAS)
(for medical practitioners who practise acupuncture)
BMAS House
3 Winnington Court
Northwich
Cheshire
CW8 1AQ
Phone: 01606 786 782
Fax: 01606 786 783
Email: admin@medical-acupuncture.org.uk
Website: www.medical-acupuncture.co.uk