Acupuncture for Chronic Low Back Pain and Neck Pain

Summary

For chronic low back pain and neck pain, reviews find acupuncture eases pain a little more than sham acupuncture and more than no treatment, but the sham-controlled gain is small and sometimes below the level researchers call clinically important. Guidelines disagree, so the answer depends on which one you read. Evidence labels used here: promising but limited and mixed. See what is acupuncture for how to read sham-controlled trials.

Chronic low back pain

• American College of Physicians (2017). For chronic low back pain, clinicians and patients should initially choose nondrug treatment, with acupuncture among the options rated moderate-quality evidence, alongside exercise, multidisciplinary rehabilitation and mindfulness-based stress reduction. It was a strong recommendation. For acute and subacute pain, acupuncture was listed among options with low-quality evidence. [1]
• NICE, England (updated July 2026). NICE says: do not offer acupuncture for managing low back pain with or without sciatica. [2]
• Cochrane review (2020). 33 trials, 8,270 people. Compared with sham, acupuncture may relieve pain in the immediate term (low-certainty evidence), but the difference did not meet the threshold for a clinically important change (15 points on a 100-point scale or 30 percent). It found no better function than sham (very low certainty). Compared with no treatment, pain relief was larger and clinically important (moderate-certainty evidence). Most trials could not blind the acupuncturist. [3]
• NCCIH. The 2018 review it describes found the pain-relieving effect comparable to that of nonsteroidal anti-inflammatory drugs (NSAIDs), and benefits lasting a year after treatment for the painful conditions studied, except neck pain. [4]

Why the disagreement? The ACP and NICE weigh the same kinds of trials differently, in particular whether a small sham-controlled difference justifies offering a treatment. We did not read NICE's reasoning in full; read the guideline itself if you want that.

Neck pain

• Cochrane (2016). In 27 trials, moderate-quality evidence suggested acupuncture relieves pain better than sham at the end of treatment and short term, and better than waiting list or inactive treatment. The effect did not appear to last over the long term. Adverse effects were minor, including increased pain, bruising, fainting and dizziness. [5]
• 2024 meta-analysis. Of 18 trials, acupuncture added to other care gave relief lasting at least 3 months, but compared with sham there was no statistically significant difference in pain, though function scores improved. Nine studies reported adverse events in 8.5 to 13.8 percent, mild and short-lived. [6]

What it means in practice

Acupuncture is one of several options for chronic back or neck pain, usually with exercise and self-care. Benefit over sham is small, so context and expectation probably contribute. A pooled analysis of 39 trials said those factors, as well as needling at specific points, add to the effect. [7] In the United States, Medicare covers acupuncture only for chronic low back pain, up to 12 visits, with 8 more if the first 12 help. [4] Check current coverage with your plan.

Safety and when to get urgent care

Side effects are covered on side effects and precautions. NICE tells clinicians to think about other causes, such as cancer, spinal injury and infection, when someone has back pain, particularly if new or changed symptoms develop. [2] So get medical assessment for back pain that follows a serious injury, comes with new symptoms, or changes, rather than trying acupuncture first.