To many people, the idea of being poked with needles probably doesn’t sound appealing, which is why some avoid acupuncture. However, there are benefits to having it done. What are these? Are there any downsides?

Acupuncture, which involves inserting very thin needles through your skin at specific points on your body, has been practiced for over 2,500 years. It’s been a key component of traditional Chinese medicine (TCM) to treat many conditions, but the primary condition it focuses on is relieving pain. Increasingly, it’s being used for stress management. How it works isn’t fully agreed upon, though.

According to TCM, acupuncture is a technique used to balance a person’s flow of energy or life force, which is known as qi (“chee”). There are two opposing yet inseparable forces (yin and yang) within the body. Disruptions of the flow cause an imbalance between yin and yang, which is responsible for disease.

Energy is believed to flow through pathways (meridians) in your body, and each is associated with a different organ system. By inserting needles into specific points along these meridians, it’s believed that your energy flow will realign. There are alleged to be over 1,000 acupuncture points on the body. Sometimes the appropriate points are far removed from the area of your pain. The concept of qi isn’t as far out there as it may initially sound. Think of how you’re more prone to illness when feeling stressed or anxious. The opposite is also true—when you’re relaxed and healthy, your body physically reflects that too.

No question, the benefits of acupuncture can be felt, but efforts to understand the anatomy and physiology of how it works remain controversial. Some experts use neuroscience to explain it. Many Western practitioners feel that acupuncture points are places to stimulate nerves, muscles, and connective tissue. The stimulation triggers the body’s natural painkillers, endorphins, because each needle produces a slight injury at the insertion site.

While most people have little to no discomfort during the process, it’s enough of a signal to let the body know it needs to respond by activating the immune system, which helps with wound healing and pain modulation. Acupuncture is also said to impact the autonomic nervous system (which controls bodily functions) and the release of chemicals that regulate blood flow and pressure, reduce inflammation, and calm the brain.

Many studies, both animal and human, have demonstrated that acupuncture can cause multiple biological responses within the body; some occur locally near the insertion site or at a distance, meaning the entire body is affected. A primary focus of research has been the role of endogenous opioids in acupuncture analgesia. Considerable evidence supports the idea that opioid peptides are released during acupuncture and that this partially explains the analgesic effects that are seen. One vital piece of evidence that supports this is that opioid antagonists, like naloxone, reverse the analgesic effects of acupuncture.

There have been many studies that support the use of acupuncture to treat various conditions. In a report published in the Annals of Internal Medicine in 2017, researchers analyzed previously published trials on the use of non-pharmacologic therapies (including acupuncture) for low back pain. They discovered that acupuncture was associated with decreased pain intensity and better function immediately after treatment than individuals who didn’t have acupuncture. However, in the long term, the differences were small or not clear.

A different review published in the Cochrane Database of Systematic Reviews in 2016 looked at 22 previously published trials that involved 4985 participants. They concluded that adding acupuncture to the treatment of migraine symptoms may reduce the frequency of episodes. However, when compared to a sham acupuncture treatment, there wasn’t much of an improvement. A different 2016 review examined the impact acupuncture had on tension headaches. This evaluation involved 12 trials and 2349 participants. It suggested that at least six sessions of acupuncture did provide relief to people with frequent tension headaches.

When it comes to osteoarthritis knee pain, an analysis of previously published studies found that acupuncture improved physical function in the short and long term, but it only provided short-term pain relief (up to 13 weeks). One study published in JAMA Surgery analyzed studies on non-pharmacological interventions for pain management after a total knee replacement. It found evidence that acupuncture delayed the use of patient-controlled use of opioid medication to relieve pain.

One challenge in studying acupuncture is that it’s challenging to set up investigations using proper scientific controls due to the procedure’s invasive nature. Numerous studies show that some types of simulated acupuncture appear to work just as well as real acupuncture. There’s also evidence that indicates acupuncture works best in people who expect it to work.

Despite these caveats, the benefits of acupuncture are widespread enough that, in 2003, the World Health Organization (WHO) provided a list of conditions in which they say acupuncture has been proven effective. These include high and low blood pressure, chemotherapy-induced nausea and vomiting, some gastric conditions (ex. peptic ulcers), menstrual cramps, dysentery, allergic rhinitis, facial pain, morning sickness, rheumatoid arthritis, sprains, tennis elbow, sciatica, dental pain, reducing the risk of stroke, and inducing labor. The agency also suggests that it may help treat some infections, including urinary tract infections and epidemic hemorrhagic fever.

The National Center for Complementary and Integrative Health (NCCIH) states that acupuncture has been proven to help with low back pain, neck pain, osteoarthritis, knee pain, and headaches/migraines. According to the WHO, some conditions need more evidence as to whether or not acupuncture is helpful, like fibromyalgia, neuralgia, postoperative recovery, substance dependence (ex. tobacco and alcohol), spine pain, stiff neck, vascular dementia, whooping cough (pertussis), and Tourette syndrome. There’s also limited evidence that it helps with acne, abdominal pain, cancer pain, obesity, insomnia, infertility, diabetes, and schizophrenia.

In 1977, the U.S.’s National Institutes of Health (NIH) established the Consensus Development Program, designed to assess health technology. It arranges major conferences that create consensus and technology assessment statements on controversial medical issues and provides these to healthcare providers, patients, and the general public. In November 1997, the Program issued a statement on acupuncture:

“There have been many studies of its potential usefulness. However, many of these studies provide ambiguous results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in using appropriate controls, such as placebo and sham acupuncture groups. However, promising results have emerged, for example, the efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and postoperative dental pain.”

The statement goes on to say that there are other situations, like addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, where acupuncture may be useful as an adjunct treatment. The Program indicates that the findings from basic research clarifying the mechanisms of action of acupuncture, including the release of opioids and other peptides in the central nervous system and the periphery and changes in neuroendocrine function, assisted in shaping their viewpoint.

When it comes to the actual practice of acupuncture, each person who performs it has their own unique style. Most blend aspects of Eastern and Western approaches. It’s important to note that acupuncture can include several different procedures and techniques. Traditionally, the acupuncturist inserts very thin needles into specific spots on your body at various depths. This is usually relatively painless. In fact, most people often don’t feel them being inserted at all. Others feel a dull ache at the needle base after it’s inserted, but this subsides.

Somewhere between five and 20 needles are used in a typical treatment. Usually, the needles remain in place for 10 to 20 minutes while you lie still and relax. There is usually no discomfort when the needles are removed. Some acupuncturists manipulate the needles after they’ve been placed. This can involve gently moving or twirling the needles after placement. It can also include moxa, or moxibustion, which uses heated sticks (made from dried herbs) held near the needles to warm and stimulate the points.

An additional technique is to connect an electrical device to a few of the needles and provide a weak electrical current that stimulates the needles. The resulting tingling, numbness, heavy sensation, or ache is often considered the desired therapeutic effect. Additional treatment options are Chinese herbs (given in the form of teas, pills, and capsules), laser acupuncture (stimulates acupuncture points without the use of needles), and cupping (involves heating glass or silicone cups and applying them to the skin for several minutes, so it creates a suction effect—this leaves a bright red, circular welt).

It’s vital to note to never try acupuncture on your own!

If you’re looking for ways to gain similar benefits at home, you should look into acupressure. This involves pressing on specific points on your body. If you’re unsure of how or where to start, consult with a certified reflexologist or acupuncturist who can demonstrate where and how to apply pressure properly.

The risks associated with acupuncture are low, especially if you have a competent, certified acupuncture practitioner using sterile needles. The U.S. Food and Drug Administration (FDA) regulates acupuncture needles as medical devices, meaning they must be manufactured and labeled to meet specific standards. The needles must be sterile, nontoxic, and single-use, which significantly reduces the risk of infection.

The most common side effects include soreness and minor bleeding or bruising where the needles were inserted. Other side effects are skin rashes, allergic reactions, nausea, dizziness, or fainting. You may be at risk for complications if you have a bleeding disorder, have a pacemaker, or are pregnant. In rare cases, a needle may break, damage an internal organ, cause internal bleeding, or injure the spinal cord. If a needle is inserted deeply into the chest or upper back, there is a risk of a collapsed lung.

Before your first session, you need to talk to your primary care doctor to ensure that it’s safe for you to get acupuncture. The NCCIH advises people not to use acupuncture instead of conventional healthcare techniques. Instead, they should be complementary to each other. You also need to prepare a comprehensive list of your medical conditions, any treatments you’re receiving, and medications you’re taking to give to the acupuncturist.

To determine the type of acupuncture that will help you the most, the practitioner may ask you about your symptoms, behaviors, and lifestyle (ex. diet, sleep, stress level, and other habits). Don’t be surprised if these questions range far beyond the specific symptoms for which you are seeking treatment. You may be asked about your emotions, food likes and dislikes, and your response to changes in temperature and seasons. They will also closely examine the parts of your body that are painful.

The acupuncturist will examine your complexion carefully, note the quality of your voice, look at the shape/coating/color of your tongue, and determine the strength/rhythm/quality of the pulse in your wrist. In TCM, the tongue and pulses are considered to reflect the health of your organ systems and meridians. This initial evaluation and treatment may take up to 60 minutes. Subsequent appointments take about 30 minutes.

The number of acupuncture treatments you’ll need depends on the condition being treated and its severity. Typically, if you have a single complaint, you need one or two treatments a week for a few weeks. It’s common to receive six to eight treatments. Most people feel happy, content, and energetic after acupuncture. However, it’s not uncommon to feel tired after treatment and see changes in your eating, sleeping, or bowel habits. Some individuals don’t experience any changes. If your symptoms don’t begin to improve within a few weeks, acupuncture may not be right for you.

If you’re considering acupuncture, it’s essential to select a qualified practitioner. One way is to ask people you trust for recommendations. Visit the National Certification Commission in Acupuncture and Oriental Medicine (NCCAOM) website because this will allow you to check a practitioner’s training and credentials (they should have LAc after their name). Most states require practitioners to be licensed by this board. Some certification requirements differ slightly by state.

The next step is to see if your health insurance covers an acupuncturist because this will determine your out-of-pocket costs. Typically, without insurance, the initial session and medical consultation will cost from $75 to $95, and a routine visit will cost between $50 and $70. During this first meeting, it’s essential to ask the practitioner about their experience and training.

Acupuncture is beneficial and safe when it’s performed correctly. Since there are very few side effects and it can be effectively combined with other treatments, acupuncture might be a good option to help you become well if conventional methods alone aren’t working. Take your time in selecting a practitioner, so you’ll get the best possible result, which means you’ll be feeling better in no time!