NICE (the National Institute for Health and Care Excellence) says: "Do not offer acupuncture for managing low back pain with or without sciatica." [3] A 2017 American College of Physicians guideline, as reported by NCCIH, reaches a different conclusion, set out below. The NHS lists some back pain symptoms as reasons to call 999 (see below).
What lower back pain is
The NHS says back pain, particularly lower back pain, is very common. It usually improves within a few weeks but can sometimes last longer or keep coming back [1].
A common cause is an injury such as a pulled muscle. Sometimes a medical condition such as a slipped disc, sciatica or ankylosing spondylitis is the cause. The NHS says it is not always obvious what causes back pain, and that it often gets better on its own. Very rarely it is a sign of a serious problem such as a broken bone, cancer or an infection [1].
The NHS describes sciatica as pain, tingling, numbness or weakness that usually affects the bottom and the back of one leg. It happens when the sciatic nerve is irritated or compressed. It usually gets better in a few weeks to a few months but can last longer [2].
What the guidance and research say about acupuncture
NICE guidance (NG59, last updated July 2026). NICE's recommendation 1.2.8 reads: "Do not offer acupuncture for managing low back pain with or without sciatica." [3] This guideline covers people over 16. NICE does recommend considering manual therapy (spinal manipulation, mobilisation or soft tissue techniques such as massage), but only as part of a treatment package that includes exercise [3].
The NHS. The NHS says other treatments may be recommended if back pain does not get better after a few weeks. It lists group exercise sessions and physiotherapy, manual therapy, and CBT. It also lists a procedure to seal off some nerves, for long-term lower back pain only. Its back pain page does not list acupuncture [1].
NCCIH. NCCIH, part of the US National Institutes of Health, reports [4]:
- a 2018 review of 12 studies (8,003 participants) found acupuncture more effective than no treatment for back or neck pain
- the same review's analysis of 10 studies (1,963 participants) found acupuncture more effective than sham acupuncture
- the difference from no treatment was greater than the difference from sham acupuncture
- a 2017 American College of Physicians guideline, as reported by NCCIH, included acupuncture among the nondrug options recommended as first-line treatment for chronic low-back pain
- that guideline judged the evidence for acute low-back pain to be of low quality, and for chronic low-back pain of moderate quality
The NICE and American College of Physicians guidelines were produced by different bodies and reach different conclusions on acupuncture. This page does not decide between them.
Acupuncture in Malaysia
What acupuncture is. NCCIH, part of the US National Institutes of Health, describes acupuncture as a technique in which practitioners insert fine needles into the skin. The needles may be manipulated by hand or stimulated with small electrical currents (electroacupuncture). Acupuncture originated from traditional Chinese medicine [4].
Registration. Malaysia's Traditional and Complementary Medicine Act 2016 (Act 775) defines traditional and complementary medicine to include traditional Chinese medicine [5]. Under section 25 of the Act, in force since 1 March 2021, a person who is not a registered practitioner shall not practise traditional and complementary medicine services [5][6]. A registered practitioner must hold a valid practising certificate, which is valid for not more than twelve months and must be displayed at the place of practice (section 26) [5].
Referral. Section 30 of the Act requires a registered practitioner to refer a patient to a medical or dental practitioner if the patient has an acute medical emergency, or if the condition is beyond the practitioner's skill, competency or expertise [5]. Under section 30(3) the practitioner must explain this duty to the patient, or the patient's guardian or representative, so that they can make an informed decision about whether to refuse being referred. Section 30(4) says that if the patient, guardian or representative gives written notice consenting not to be referred, the practitioner is not obliged to refer [5].
NCCIH's guidance is not to use acupuncture to postpone seeing a health care provider about a health problem [4].
Safety. According to NCCIH, relatively few complications from acupuncture have been reported, but complications have resulted from nonsterile needles and improper delivery. When not delivered properly, acupuncture can cause serious adverse effects, including infections, punctured organs and injury to the central nervous system [4]. The NHS lists two situations in which acupuncture may not be safe: taking blood-thinning medicine or being at increased risk of bleeding, and having a skin condition or skin infection [7].
When the sources say to get medical help
Each source below sets its own level of urgency. Malaysia's emergency line is 999 [8]. The regulator's numbering plan also lists 112 as the code for mobile phones routed to emergency services [9].
Emergency. The NHS (UK) lists these as reasons to call 999 or go to A&E, for someone with back pain and any of [1]:
- pain, tingling, weakness or numbness in both legs
- a loss of feeling around the genitals or anus
- changes in bladder or bowels, such as difficulty peeing, or peeing or pooing yourself
- changes in how the penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm
- chest pain
- back pain that started after a serious accident, such as a car accident
For sciatica, the NHS adds sciatica on both sides, and severe or worsening weakness or numbness in both legs [2]. It says not to drive to A&E, and to ask someone to drive you or call 999 and ask for an ambulance [1].
Urgent GP appointment or NHS 111 (NHS, UK) [1], for someone with back pain who:
- feels hot, cold, shivery or generally unwell
- has severe pain that starts suddenly or is getting worse quickly
See a GP (NHS, UK) [1], for someone with back pain who:
- has not improved after treating it at home for a few weeks
- is worried about the pain or is struggling to cope
- is stopped from doing day-to-day activities
- has lost weight without trying to
- has a lump or swelling in the back, or a back that has changed shape
- has pain that does not improve after resting or is worse at night
- has pain that is worse when sneezing, coughing or pooing
- has pain coming from the top of the back, between the shoulders
In Malaysia (Ministry of Health portals). Klinik Kesihatan Kuala Lumpur, a government health clinic, lists outpatient (Pesakit Luar) services. It lists its service hours as 8.00am to 5.00pm Monday to Friday, with extended hours on weekday evenings and on weekends and public holidays, and says it is closed on some festival days [10]. Hospital Kuala Lumpur's emergency department says it provides 24-hour emergency medical services to people in Kuala Lumpur [11].
Find a clinic
The NHS's suggested next step for back pain that has not improved after treating it at home for a few weeks is to see a GP [1]. The clinic directory lists acupuncture and traditional Chinese medicine clinics across Malaysia by state and town.
Sources
- NHS. Back pain. Page last reviewed 5 March 2026.
- NHS. Sciatica. Page last reviewed 3 December 2024.
- National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). Recommendations 1.2.7 and 1.2.8. Last updated 29 July 2026.
- National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Acupuncture: Effectiveness and Safety. Last updated October 2022.
- Laws of Malaysia. Traditional and Complementary Medicine Act 2016 (Act 775), English text published by the Ministry of Health Malaysia. Sections 3, 25, 26 and 30.
- Federal Government Gazette P.U. (B) 118, 23 February 2021. Appointment of date of coming into operation, Traditional and Complementary Medicine Act 2016.
- NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026.
- Malaysia.gov.my (MyGovernment portal). Malaysia Emergency Response Services (MERS) 999. Page updated 25 September 2025.
- Malaysian Communications and Multimedia Commission. Numbering and Electronic Addressing Plan, issued 26 January 2006. Schedule D.
- Kuala Lumpur and Putrajaya State Health Department, Ministry of Health Malaysia. Klinik Kesihatan Kuala Lumpur.
- Hospital Kuala Lumpur, Ministry of Health Malaysia. Kecemasan & Trauma.