Chronic pain and the role of acupuncture in its management have become an important area of research as more people seek non-pharmacological approaches to persistent pain. Chronic pain can affect sleep, movement, mood, work, and overall quality of life. Acupuncture may offer a complementary approach for certain chronic pain conditions and can be incorporated into a broader, individualized pain-management plan.

Acupuncture has been practiced for thousands of years within Traditional Chinese Medicine (TCM), while modern research continues to investigate how it influences pain processing through the nervous system and other physiological pathways.

Understanding both perspectives can help explain the role acupuncture may play in managing persistent pain.

Chronic Pain and the Role of Acupuncture in Traditional Chinese Medicine

Acupuncture is a core component of Traditional Chinese Medicine, which views health through patterns of balance and imbalance within the body.

One of the foundational concepts in TCM is Qi (pronounced “chee”), traditionally described as flowing through pathways known as meridians.

From a TCM perspective, pain may occur when the normal movement of Qi and Blood becomes disrupted or when underlying patterns of Deficiency, Excess, Heat, Cold, or other imbalances affect the body.

A commonly used traditional saying is:

“Where there is stagnation, there is pain.”

Treatment therefore focuses not only on where a person experiences pain but also on the broader pattern contributing to their symptoms.

For example, two people with chronic low back pain may receive very different acupuncture treatments depending on the nature of their pain, overall health, sleep, energy, digestion, medical history, and other symptoms.

Fine, sterile needles are inserted at carefully selected acupuncture points based on the individual presentation.

Depending on the condition, acupuncture may also be combined with other treatment approaches such as electroacupuncture, cupping, Gua Sha, moxibustion, or other appropriate therapies.

Chronic Pain and the Role of Acupuncture: How Does It Work?

From a biomedical perspective, acupuncture is not thought to work through one single mechanism.

Needle stimulation activates sensory nerve fibers and generates signals that interact with the peripheral nervous system, spinal cord, and brain.

Research suggests that acupuncture may influence several interconnected processes involved in pain, including:

• Pain-processing pathways in the brain and spinal cord
• Endogenous opioid and other neurochemical systems
• Descending pain-modulation pathways
• Autonomic nervous system activity
• Local tissue and circulatory responses
• Neuroimmune and inflammatory signaling

These mechanisms are complex, and researchers continue to investigate how they interact in different pain conditions.

How Acupuncture May Influence Chronic Pain Processing

Chronic pain is more than simply a signal coming from an injured part of the body.

Pain is a complex experience produced through interactions among sensory input, the spinal cord, brain networks, emotions, memory, attention, expectations, sleep, and previous experiences.

With persistent pain, the nervous system itself can change.

Functional MRI (fMRI) and other neuroimaging studies have investigated how acupuncture may influence brain regions and networks involved in pain perception and regulation.

Research suggests that acupuncture may affect activity and connectivity within brain regions associated with sensory processing, emotion, attention, and pain modulation.

A 2022 coordinate-based meta-analysis of fMRI studies, for example, examined patterns of brain activity associated with acupuncture treatment for chronic pain.

These findings do not mean that acupuncture simply “switches off” a particular pain center in the brain. Pain processing involves complex networks, and neuroimaging research is still evolving.

How Acupuncture May Support Natural Pain Modulation

One of the best-established areas of acupuncture research involves endogenous opioids—the body’s own pain-modulating chemicals.

Acupuncture stimulation can influence endogenous opioid systems involving substances such as endorphins and enkephalins.

These substances interact with opioid receptors and participate in the body’s natural mechanisms for regulating pain.

Acupuncture may also influence other neurotransmitters and neurochemical signaling systems involved in pain modulation.

Rather than saying acupuncture simply “releases endorphins” or “increases serotonin,” it is more accurate to understand acupuncture as interacting with multiple interconnected neurochemical and neural pathways.

Acupuncture and Chronic Pain Modulation

The brain and spinal cord contain systems capable of increasing or decreasing the intensity of pain signals.

These are sometimes referred to as descending pain-modulatory pathways.

Acupuncture stimulation may activate sensory nerve fibers that communicate with the spinal cord and higher brain centers, influencing the way pain signals are processed and regulated.

This helps explain why acupuncture treatment does not necessarily need to occur directly at the location where pain is felt.

Both local and distal acupuncture points may be incorporated into a treatment depending on the condition and clinical approach.

Acupuncture, Blood Flow, and Local Tissue Effects

Acupuncture also produces local physiological responses around the area of needle insertion.

Needling can influence local blood flow and signaling molecules involved in vascular regulation. Nitric oxide has been investigated as one possible contributor to acupuncture-related changes in local circulation.

Improved local circulation may influence tissue physiology, although it would be too simplistic to say that acupuncture merely “increases blood flow and removes metabolic waste.”

The biological response to acupuncture involves interactions among sensory nerves, connective tissue, blood vessels, immune signaling, and the central nervous system.

Acupuncture and Inflammatory Signaling

Inflammation plays an important role in some—but not all—chronic pain conditions.

Research suggests that acupuncture and electroacupuncture may influence neuroimmune and inflammatory signaling pathways.

Studies have investigated effects involving cytokines and interactions between the nervous and immune systems. However, these effects vary according to the condition being studied, treatment parameters, and research model.

It is therefore more accurate to say that acupuncture may modulate inflammatory and neuroimmune pathways rather than simply claiming that it “reduces inflammation.”

If you would like to understand more about inflammation and its broader effects on the body, read about chronic inflammation and health.

💡Chronic Inflammation and Health: How It Affects the Body

Acupuncture and the Autonomic Nervous System

Chronic pain and stress frequently interact.

Living with persistent pain can increase stress, disrupt sleep, affect mood, and influence autonomic nervous system regulation. In turn, poor sleep and chronic stress can make pain more difficult to manage.

Research suggests that acupuncture may influence autonomic nervous system activity, including sympathetic and parasympathetic regulation.

This may contribute to the sense of relaxation many patients experience during treatment and may be one component of acupuncture’s broader physiological effects.

💡 Acupuncture for Stress Relief: How It Works and What to Expect

Research on Chronic Pain and the Role of Acupuncture

Among the strongest evidence supporting acupuncture for chronic pain is a large individual patient data meta-analysis published in The Journal of Pain.

Vickers and colleagues analyzed data from 20,827 patients across 39 randomized trials involving nonspecific musculoskeletal pain, osteoarthritis, chronic headache, and shoulder pain.

Acupuncture was statistically superior to both sham acupuncture and no-acupuncture control groups for each pain condition studied.

Importantly, the differences between true acupuncture and sham acupuncture were smaller than the differences between acupuncture and no-acupuncture controls. This suggests that acupuncture’s clinical effects likely involve both specific physiological effects of needling and broader contextual effects associated with treatment.

The researchers also found that the benefits of acupuncture persisted over time and concluded that acupuncture is a reasonable referral option for chronic pain.

Chronic Low Back Pain

Low back pain is one of the most common reasons people seek acupuncture.

Research suggests that acupuncture may provide improvements in pain and function for some people with chronic low back pain.

The evidence has been sufficient for acupuncture to be included as a non-pharmacological treatment option in several clinical guidelines.

Treatment may include local points around the lower back as well as distal acupuncture points selected according to the individual presentation.

As with any persistent back pain, appropriate evaluation is important to identify potential underlying causes and rule out conditions requiring additional medical investigation.

Migraines and Tension-Type Headaches

Acupuncture has also been extensively studied for headache disorders.

Evidence suggests that acupuncture may help reduce headache frequency in some people with migraine and frequent tension-type headaches.

A systematic review examining acupuncture and manual therapy for tension-type headache found evidence of potential benefit, although differences among studies mean that further high-quality research remains valuable.

For people experiencing recurrent headaches, acupuncture may be considered as one component of a broader management strategy after appropriate evaluation.

Osteoarthritis

Acupuncture has been studied extensively for osteoarthritis, particularly knee osteoarthritis.

Research suggests that acupuncture may provide modest improvements in pain and physical function for some patients.

Treatment should generally form part of a broader management plan that may include exercise, strengthening, weight management when appropriate, physical therapy, medications, and other evidence-based strategies.

Fibromyalgia

Fibromyalgia involves widespread pain and altered pain processing and is frequently accompanied by fatigue, poor sleep, cognitive symptoms, and heightened sensitivity.

Some research suggests acupuncture may help improve pain and quality of life for certain people with fibromyalgia.

However, responses vary, and acupuncture should be considered one potential component of a comprehensive treatment strategy rather than a stand-alone cure.

Carpal Tunnel Syndrome

Acupuncture has also been investigated for symptoms associated with carpal tunnel syndrome, including pain, numbness, and tingling.

Some studies suggest potential benefits, but carpal tunnel symptoms should first be appropriately evaluated—particularly when numbness, weakness, muscle wasting, or progressive neurological symptoms are present.

Acupuncture should not delay necessary diagnostic testing or surgical evaluation when clinically indicated.

Cancer-Related Pain

Acupuncture is increasingly incorporated into integrative oncology and supportive cancer care.

Clinical guidelines support acupuncture for certain types of cancer-related pain and treatment-related symptoms in appropriate patients.

Treatment requires additional safety considerations depending on blood counts, surgical history, lymphedema risk, cancer location, medications, and current cancer treatments.

Acupuncture in oncology should be provided by a practitioner familiar with appropriate oncology precautions and used as an adjunct to—not a replacement for—conventional cancer care.

💡Oncology Acupuncture / Acupuncture During Cancer Treatment

The Role of Acupuncture in Chronic Pain Management

Acupuncture for chronic pain is often most effective when considered as one part of a broader, individualized treatment plan.

Chronic pain is complex and may involve multiple factors, including tissue injury, nervous system sensitization, sleep disturbance, stress, biomechanics, inflammation, physical activity, and psychological and social factors.

Depending on the individual, comprehensive pain management may include:

• Acupuncture
• Physical therapy and rehabilitation
• Appropriate strength and mobility work
• Medical management
• Sleep optimization
• Nutrition
• Stress management
• Psychological support when appropriate
• Lifestyle modifications

The goal is not simply to temporarily suppress pain but to improve function, movement, sleep, quality of life, and the person’s ability to participate in the activities that matter to them.

Chronic Pain and the Role of Acupuncture: Conclusion

Acupuncture provides an evidence-informed, non-pharmacological option for managing several chronic pain conditions.

Research suggests its effects are not explained by a single mechanism. Instead, acupuncture appears to interact with multiple systems involved in pain processing, including peripheral sensory signaling, spinal and brain pathways, endogenous pain-modulating systems, autonomic regulation, and potentially neuroimmune and inflammatory signaling.

Large-scale clinical evidence supports acupuncture as a reasonable treatment option for several types of chronic pain, particularly musculoskeletal pain, osteoarthritis, and chronic headache.

It is not a cure for every type of pain, nor should it replace appropriate medical diagnosis and treatment.

For the right patient, however, acupuncture can be a valuable component of a comprehensive approach to chronic pain—one focused not only on reducing symptoms but also on improving function and quality of life.

References

• Lai, P., Cheng, S., Chen, X., Cheng, F., Cheng, J., Xin, M. et al. (2024). The emotion regulation of acupuncture in chronic low back pain: A clinical neuroimaging protocol. Journal of Pain Research, 17, pp. 817–825.

• Turkistani, A., Shah, A., Jose, A.M., Melo, J.P., Luenam, K., Ananias, P. et al. (2021). Effectiveness of manual therapy and acupuncture in tension-type headache: A systematic review. Cureus, 13, e17601.

• Vickers, A.J., Vertosick, E.A., Lewith, G., MacPherson, H., Foster, N.E., Sherman, K.J. et al. (2018). Acupuncture for chronic pain: Update of an individual patient data meta-analysis. The Journal of Pain, 19(5), pp. 455–474.

• Yang, J., Zeng, F., Feng, Y., Fang, L., Qin, W., Liu, X. et al. (2012). A PET-CT study on the specificity of acupoints through acupuncture treatment in migraine patients. BMC Complementary and Alternative Medicine, 12, 123.

• Yuan, Q.L., Wang, P., Liu, L., Sun, F., Cai, Y.S., Wu, W.T. et al. (2016). Acupuncture for musculoskeletal pain: A meta-analysis and meta-regression of sham-controlled randomized clinical trials. Scientific Reports, 6, 30675.

• Turkeltaub, P.E., Eickhoff, S.B., Laird, A.R., Fox, M., Wiener, M. and Fox, P. (2012). Minimizing within-experiment and within-group effects in activation likelihood estimation meta-analyses. Human Brain Mapping, 33(1), pp. 1–13.