Acupuncture for Chronic Pain: What the Guidance Says

Published

NICE (the National Institute for Health and Care Excellence) says to "Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, for people aged 16 years and over to manage chronic primary pain", but only if the course meets conditions on setting, who delivers it and time, quoted below [3]. In the same section NICE says "Offer a supervised group exercise programme" and "Consider acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) for pain" [3]. For low back pain and osteoarthritis, other NICE guidelines say "Do not offer" acupuncture [16][17]. The NHS page on getting help for long-term pain does not name acupuncture. It says a GP may refer you for complementary therapy "to see if that helps with the pain" [1].

What chronic pain is

NICE defines chronic pain as "pain that persists or recurs for more than 3 months". It separates chronic primary pain, in which no underlying condition adequately accounts for the pain or its impact, from chronic secondary pain, in which an underlying condition does [3].

The NHS says that if you have been struggling with pain for more than 12 weeks, there are many services that can help. It says long-term pain has many causes, such as arthritis, back problems, an old injury, illness or nerve damage [1].

What the guidance and research say about acupuncture

NICE guidance (NG193, chronic pain in over 16s). Recommendation 1.2.5 reads: "Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, for people aged 16 years and over to manage chronic primary pain, but only if the course:" [3]

  • "is delivered in a community setting"
  • "and is delivered by a band 7 (equivalent or lower) healthcare professional with appropriate training"
  • "and is made up of no more than 5 hours of healthcare professional time (the number and length of sessions can be adapted within these boundaries)"
  • "or is delivered by another healthcare professional with appropriate training and/or in another setting for equivalent or lower cost."

In the same section NICE words other recommendations as follows: "Offer a supervised group exercise programme" (1.2.1), "Encourage people with chronic primary pain to remain physically active" (1.2.2) and "Consider acceptance and commitment therapy (ACT) or cognitive behavioural therapy (CBT) for pain" (1.2.3) [3]. Recommendation 1.2.3 uses the same verb, "Consider", as the acupuncture recommendation.

NICE says chronic primary pain is managed in line with that section, and chronic pain with an underlying condition that adequately accounts for it in line with the NICE guideline for that condition [3]. For two conditions NCCIH names below, those guidelines say: "Do not offer acupuncture for managing low back pain with or without sciatica." (NG59, 1.2.8) [16] and "Do not offer acupuncture or dry needling to manage osteoarthritis." (NG226, 1.3.8) [17].

The NHS. The NHS says your first stop should be a GP, who may carry out a physical examination, discuss your pain history and ask how your pain is affecting your life. It says painkillers may be suggested for short-term pain relief, but "painkillers are generally not considered a primary way to manage long-term pain" [1]. It lists treatments at a pain clinic as medicine, pain-relief injections, manual therapy, exercise, complementary therapy and psychological therapy. It says the aim of a pain management programme is "to improve your quality of life, despite your pain, rather than reducing your pain" [1].

The NHS also lists self-help steps for pain, including gentle exercise, slow deep breathing, talking therapies, a regular sleep routine, self-management courses and relaxation techniques [2].

NCCIH. NCCIH, part of the US National Institutes of Health, reports:

  • research has shown that acupuncture may be helpful for several pain conditions, including back or neck pain, knee pain associated with osteoarthritis, and postoperative pain [4]; NICE says "Do not offer" acupuncture for low back pain [16] and for osteoarthritis [17]
  • a growing body of evidence suggests that some complementary approaches, including acupuncture, hypnosis, massage, mindfulness meditation, music-based interventions, spinal manipulation, tai chi, qigong and yoga, "may help to manage some painful conditions" [12]
  • a 2017 review found evidence that several approaches may have some benefit for chronic pain, "but only for acupuncture was there evidence that the technique could reduce a patient's need for opioids" [12]
  • in many studies the benefit of acupuncture was greater when compared with no treatment than when compared with sham (simulated) acupuncture, which NCCIH says suggests that nonspecific effects contribute to the benefit [4]

NCCIH's findings for back pain and knee osteoarthritis sit alongside NICE's "Do not offer" for low back pain (NG59) and osteoarthritis (NG226) [16][17]. NICE's acupuncture recommendation for chronic primary pain carries conditions, and NCCIH reports a broader body of research. 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].

The NHS page on getting help for long-term pain does not list warning signs [1]. NHS pages on particular kinds of pain do. Three examples, each quoted from its own page:

Call 999 or go to A&E, back pain (NHS, UK) [13]: "You have back pain and:"

  • pain, tingling, weakness or numbness in both legs
  • a loss of feeling around your genitals or anus
  • changes in your bladder or bowels, such as difficulty peeing, or peeing or pooing yourself
  • changes in how your penis or vagina feels during sex, not being able to get or keep an erection, or not being able to orgasm
  • chest pain
  • it started after a serious accident, such as a car accident

Call 999 or go to A&E, headache (NHS, UK) [14]: "You or a child has a headache and:" includes "it started suddenly and is extremely painful".

Call 999 or go to A&E, joint pain (NHS, UK) [15]:

  • you have very bad joint pain after a fall or injury
  • you're unable to walk or put weight on a joint
  • your joint has moved out of place
  • you have any tingling or you have no feeling in the area around the joint after an injury

See a GP (NHS, UK): the NHS says your first stop for pain lasting more than 12 weeks should be a GP [1].

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 pain that has lasted more than 12 weeks is to contact a GP [1]. The clinic directory lists acupuncture and traditional Chinese medicine clinics across Malaysia by state and town.

Sources

  1. NHS. How to get NHS help for your pain. Page last reviewed 21 February 2023 (review was due 21 February 2026).
  2. NHS. 10 ways to reduce pain. Page last reviewed 2 May 2023 (review was due 2 May 2026).
  3. National Institute for Health and Care Excellence (NICE). Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). Recommendations 1.2.1 to 1.2.5. Published 7 April 2021.
  4. National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Acupuncture: Effectiveness and Safety. Last updated October 2022.
  5. 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.
  6. Federal Government Gazette P.U. (B) 118, 23 February 2021. Appointment of date of coming into operation, Traditional and Complementary Medicine Act 2016.
  7. NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026.
  8. Malaysia.gov.my (MyGovernment portal). Malaysia Emergency Response Services (MERS) 999. Page updated 25 September 2025.
  9. Malaysian Communications and Multimedia Commission. Numbering and Electronic Addressing Plan, issued 26 January 2006. Schedule D.
  10. Kuala Lumpur and Putrajaya State Health Department, Ministry of Health Malaysia. Klinik Kesihatan Kuala Lumpur.
  11. Hospital Kuala Lumpur, Ministry of Health Malaysia. Kecemasan & Trauma.
  12. National Center for Complementary and Integrative Health (NCCIH), US National Institutes of Health. Chronic Pain and Complementary Health Approaches: What You Need To Know. Last updated January 2023.
  13. NHS. Back pain. Page last reviewed 5 March 2026.
  14. NHS. Headaches. Page last reviewed 17 April 2024.
  15. NHS. Joint pain. Page last reviewed 26 February 2026.
  16. National Institute for Health and Care Excellence (NICE). Low back pain and sciatica in over 16s: assessment and management (NG59). Recommendation 1.2.8. Published 30 November 2016.
  17. National Institute for Health and Care Excellence (NICE). Osteoarthritis in over 16s: diagnosis and management (NG226). Recommendation 1.3.8. Published 19 October 2022.

Chest pain, trouble breathing, sudden weakness or another emergency: call 999 (112 from a mobile) or go to the nearest hospital emergency department.