Acupuncture Research - Areas of High and Low Programmatic Priorities
Focus on Acupuncture for Pain Management
What is the published clinical research telling us?
- A recent, large meta-analysis of patient-level acupuncture data for the treatment of four chronic pain conditions (back and neck pain, osteoarthritis, chronic headache, and shoulder pain) found:
- Statistically significant, but small, differences between verum acupuncture (e.g., acupuncture administered according to classical Asian teachings) and “sham” acupuncture procedures (e.g., needling at non-classical acupoints, or non-penetrating needling at classical acupoints).
- The clinical relevance of these reported differences has been debated and there are remaining questions about if the difference between verum and sham acupuncture is clinically meaningful.
- Larger, statistically significant differences were found when acupuncture is compared to no acupuncture.
- These findings are generally consistent with trends across the larger body of clinical trial research examining painful conditions, which suggest:
- Benefit of acupuncture treatment when compared to standard of care with no acupuncture
- Little evidence of clinically meaningful benefit for verum acupuncture treatment when directly compared to sham acupuncture
- Little evidence for meaningful differences in analgesic effects between standardized acupuncture protocols and individualized acupuncture protocols.
- Taken together, the evidence suggests that nonspecific factors related to the patient-provider interaction such as conditioning, patient expectations, self-empowerment effects, and placebo effects, among others, likely account for most of the positive analgesic effects associated with acupuncture treatment.
- Biological effects associated with acupuncture have been reported from animal and human subject research. Examples include stimulation of local inflammatory and immune responses, fibroblast spreading and cytoskeletal remodeling, release of adenosine (antinociceptive effects), neuromodulatory mechanisms, increase of opioid peptides, and autonomic nervous system modulation. Additional research could further elucidate whether these or other potential underlying biological mechanisms have a role in analgesia, which could lead to improved understanding and treatment of pain.
- Traditional acupoint specificity does not appear to be critical for acupuncture-induced analgesia. Many sham acupuncture procedures have been shown to induce analgesia as well. What is unknown, and more research may be needed, is whether the sham approach is truly an “inert” placebo or whether these procedures are activating similar or complementary biological systems as the traditional approaches.
- The relevance of animal models and the extent to which they translate to the human condition is unclear. Many animal studies of acupuncture use electro-acupuncture to study pain and analgesia and other symptom- and disease-related biological mechanisms. Human studies appear to predominantly use acupuncture needling without electricity.
- Bodily processes are regulated through circuits of neurons communicating through electrical impulses and these circuits are thought to be excellent targets for therapeutic intervention. Electrical devices have already been developed for use in treatment (e.g., pacemakers for heart disease; deep brain stimulators for Parkinson disease). Exploratory work across many disciplines is mapping treatment- and disease-associated neural circuits and cells in order to develop additional stimulatory therapeutic devices. Studies focusing on the basic mechanisms of electro-acupuncture, particularly focusing on underlying basic mechanisms for nociception and analgesia, and their potential for informing treatment development would be aligned with this growing research trend.
Listed below are research topics that are considered by NCCIH as areas of high and low program priority for acupuncture research.
Areas of High Programmatic Priority
- Studies that address the pragmatic clinical and health care policy questions of whether acupuncture should be incorporated into clinical pain management strategies of patients with pain conditions where there is robust evidence of beneficial effects
- Large pragmatic studies for pain management addressing important clinical or policy questions, such as “Does a comprehensive pain management approach including availability of acupuncture improve pain management and reduce prescription opioid use in a clinical population?”
- Basic and clinical research to elucidate or quantify biological mechanisms of acupuncture analgesia in conditions in which beneficial effects are well-documented, and to clarify the degree to which effects are due to specific effects of needling or due to nonspecific effects related to the patient-provider interaction such as conditioning, patient expectations, self-empowerment effects, and placebo effects
- Studies to elucidate or quantify potential specific biological effects of electro-acupuncture for pain management using human experimental paradigms and quantitative sensory testing (QST) measures
- Development and testing of electro-acupuncture protocol(s) for safety and pain conditions
- Basic and clinical research on acupuncture as a model for understanding the role of nonspecific effects (e.g., expectancy, context, placebo), and whether they can be used to enhance effectiveness of pain treatment
Researchers are encouraged to conduct responder analyses in clinical studies to provide information regarding potential individual differences or sex, race, and/or ethnicity differences in response rates.
Areas of Low Programmatic Priority
NCCIH strongly discourages researchers from submitting research proposals in areas of low programmatic priority.
- Research comparing clinical outcomes of verum and sham acupuncture
- Research comparing individualized to standardized acupuncture treatment protocols
- Studies proposing use of moxibustion in the delivery of acupuncture interventions. Moxibustion may be difficult to deliver in most health care or integrative practice settings, given a variety of practical and occupational/environmental safety issues.
NCCIH Contact Information
You may find it helpful to discuss your proposed research with an NCCIH staff member prior to submitting a grant application. Each program staff member is responsible for coordinating scientific research portfolios in various scientific areas.
Review scientific portfolio areas and contact an NCCIH Program Director.
If you have general questions about acupuncture research funding, please contact Wen Chen, Ph.D.
- Avins AL. Needling the status quo. Archives of Internal Medicine. 2012; 172(19):1454–1455.
- Macpherson H, Maschino AC, Lewith G, et al. Characteristics of acupuncture treatment associated with outcome: an individual patient meta-analysis of 17,922 patients with chronic pain in randomised controlled trials. PLoS One. 2013;8(10):e77438.
- Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. 2012;172(19):1444–1453.