By Mr Ahmed-Ramadan Sadek, Neurosurgeon · Last reviewed October 2026 · 6 min read

What acupuncture is

Acupuncture involves placing very fine needles through the skin at chosen points on the body and leaving them in for a short time. Traditional Chinese acupuncture is based on ideas about energy flowing along channels in the body. Western medical acupuncture, which is often used by physiotherapists and doctors, explains its possible effects in terms of nerves and pain signalling instead. Dry needling is a related technique aimed at tight or tender spots in muscle.

What NICE says

NICE guidance on low back pain and sciatica (NG59) is clear: do not offer acupuncture for managing low back pain with or without sciatica.^[1] That recommendation dates from 2016 and was still in place when the guideline was last updated in 2026.

This can be confusing, because a separate NICE guideline on chronic primary pain (NG193), published in 2021, says a single, limited course of acupuncture or dry needling can be considered for chronic primary pain, meaning pain with no clear underlying cause.^[2] That guideline also says that where pain is explained by a specific condition, the NICE guideline for that condition should be followed, and it names low back pain and sciatica among them. For back pain in the NHS, NG59 takes priority, which is why your GP or physiotherapist may not offer acupuncture for it.

What the research shows

The most recent Cochrane review of acupuncture for chronic non-specific low back pain included 33 trials and over 8,000 people.^[3] Its findings were mixed:

• Compared with sham acupuncture, real acupuncture reduced pain by about 9 points on a 0 to 100 scale straight after treatment. That fell short of the 15 point threshold usually taken as a meaningful difference, and the evidence was low certainty. There was no clear improvement in function.
• Compared with no treatment, acupuncture gave a larger and clinically important reduction in pain (about 20 points) and better function in the short term, based on moderate-certainty evidence.
• Compared with usual care, acupuncture may improve function but probably does not reduce pain by a clinically important amount.

The gap between “better than nothing” and “barely better than sham” is the heart of the debate. One reasonable reading is that a good part of the benefit comes from the experience of treatment, the time with a practitioner and the expectation of relief, rather than from the needles reaching particular points. That does not make the relief you feel any less real, but it matters when deciding how to spend money and time. The Cochrane authors concluded that the decision might depend on availability, cost and personal preference.

International guidance is not unanimous. The World Health Organization’s 2023 guideline on chronic low back pain says needling therapies such as acupuncture may be offered, as a conditional recommendation based on low-certainty evidence.^[4] UK practice, though, follows NICE.

Is it safe?

In trained hands, acupuncture is generally safe. A German study of more than 229,000 patients treated by doctors found that 8.6% reported at least one side effect, most often bleeding or bruising at a needle site, followed by pain.^[5] Two patients had a pneumothorax (a punctured lung). A systematic review of earlier safety surveys reached a similar conclusion: minor problems such as needle pain, tiredness and bleeding are fairly common, while serious events are rare.^[6]

The NHS says acupuncture may not be safe for you if you take blood-thinning medicine or have an increased risk of bleeding, or if you have a skin condition or skin infection.^[7] Tell the practitioner about any medical conditions and medicines, and if you are pregnant.

What to expect at a session

The first appointment usually starts with questions about your pain and general health. You then lie or sit comfortably while the practitioner inserts a number of fine, single-use needles. Many people feel a brief prick, then a dull ache or tingling. Needles are typically left in for somewhere between a few minutes and half an hour. Some practitioners turn the needles gently or pass a weak electrical current through them. A course usually involves several sessions.

If you decide to try it

• Make sure single-use, sterile needles are used.
• Agree a short trial, for example four to six sessions, and stop if there is no clear benefit.
• Keep doing the things with stronger evidence: staying active and a regular exercise programme.
• Do not let acupuncture delay a proper assessment if your pain is severe, getting worse, or causing numbness or weakness.
• See our guides to acute back pain and sciatica for what usually helps.

References

1. National Institute for Health and Care Excellence. Low back pain and sciatica in over 16s: assessment and management (NG59). 2016, last updated 2026. Link
2. National Institute for Health and Care Excellence. Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain (NG193). 2021. Link
3. Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. Link
4. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: WHO; 2023. Link
5. Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009;16(2):91-97. Link
6. Ernst E, White AR. Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001;110(6):481-485. Link
7. NHS. Herbal medicines and complementary therapies. Page last reviewed 1 May 2026. Link

This guide is general information and is not a substitute for advice about your own situation. Please speak to your GP, physiotherapist or specialist before starting a new treatment.