Acupuncture: what a session is like, and what the evidence honestly shows

Short answer: Acupuncture has its best evidence for chronic pain (low back, neck, knee osteoarthritis) and for preventing migraine and tension-type headache. In those trials it beats no treatment by a wider margin than it beats sham needles. Guidelines disagree: the American College of Physicians lists it as a first-line option for chronic low back pain, while NICE in the UK says not to offer it for low back pain or osteoarthritis. For IVF and carpal tunnel syndrome, reviews found it did no better than sham. A session may take up to 60 minutes, with 5 to 20 needles usually left in for 10 to 15 minutes (Mayo Clinic). Check with a doctor first if you take a blood thinner, have a pacemaker or are pregnant.

We read the sources behind this guide on Oct. 29 and 30, 2026: NCCIH, Mayo Clinic, the NHS, NICE, the American College of Physicians, Medicare and the latest Cochrane reviews. Prices are as listed on each clinic’s own site or booking page on Oct. 29, 2026. Tendground does not book or sell treatments, and no clinic can pay to appear in this guide.

Acupuncture at a glance

	Acupuncture
What it is	Fine needles inserted at specific points, from traditional Chinese medicine; sometimes with small electrical currents (electroacupuncture)
Session length	Up to 60 minutes; needles usually in for 10 to 15 minutes (Mayo Clinic); first visits run longer
Needles	5 to 20 in a typical treatment; sterile and single-use under FDA rules
Best evidence	Chronic low back, neck and knee osteoarthritis pain; preventing migraine and tension-type headache
No better than sham in reviews	IVF, carpal tunnel syndrome, menopause hot flashes, irritable bowel syndrome
How you judge it	Over a course: 6 to 8 treatments, one or two a week, are common (Mayo Clinic)
Check with a doctor first if	Blood thinner or bleeding risk, pacemaker (electrical stimulation), pregnancy, skin condition or skin infection
Insurance	Some private plans; Medicare Part B only for chronic low back pain
License	State license in most states; titles such as L.Ac. vary by state

What acupuncture is

Acupuncture is a technique in which practitioners insert fine needles into the skin to treat health problems. The needles may be moved by hand or stimulated with small electrical currents, which is called electroacupuncture (NCCIH).

It has been in use in some form for at least 2,500 years and originated in traditional Chinese medicine. According to the World Health Organization, it is used in 103 of the 129 countries that reported data. In the US, use by adults rose from 1.0 percent in 2002 to 2.2 percent in 2022, most often for back, joint or neck pain.

Traditional Chinese medicine explains acupuncture as balancing the flow of energy or life force, called qi, believed to run through pathways called meridians. Many Western practitioners instead see the points as places to stimulate nerves, muscles and connective tissue (Mayo Clinic).

How it works is not fully understood. NCCIH lists three kinds of effect: on the nervous system, on the tissues where the needles are inserted, and nonspecific (placebo) effects. Mayo Clinic says each practitioner has a unique style, often blending Eastern and Western approaches.

What happens in an acupuncture session

At the first visit the practitioner asks about your symptoms, behaviors and lifestyle. They may examine the painful areas, the shape, coating and color of your tongue, the color of your face, and the strength, rhythm and quality of the pulse in your wrist (Mayo Clinic). New York’s licensing office describes the exam as looking, listening, asking questions and touching.

You lie on a padded table, with a gown, towel or sheet. The points used can be far from where it hurts. A typical treatment uses 5 to 20 needles; they are very thin, so insertion usually causes little discomfort, and people often do not feel them go in.

The practitioner may gently move or twirl the needles, or apply heat or mild electrical pulses to them. In most cases the needles stay in for 10 to 15 minutes while you lie still and relax, and there is usually no discomfort when they come out.

Mayo Clinic says a session may take up to 60 minutes, although some appointments are much shorter. First visits run longer: one Baltimore practice books 90 minutes for a new patient, and a Seattle practice books 60 minutes for a new patient and 50 for a return visit.

The needle sensation practitioners call deqi

You may feel a mild aching sensation when a needle reaches the correct depth (Mayo Clinic). In traditional practice this response is called deqi, and it is considered an important part of getting a treatment effect.

A review of the research describes deqi as a mix of sensations: numbness, soreness, distention, heaviness, dull pain and sometimes sharp pain (Zhou and Benharash, Journal of Acupuncture and Meridian Studies, 2014). The needles are solid and do not inject any substance into the body.

Afterward, some people feel relaxed and others feel energized, and not everyone responds (Mayo Clinic). The common side effects are soreness, minor bleeding or bruising where the needles went in. One community clinic, Working Class Acupuncture in Portland, Ore., says most people are deeply relaxed or asleep once all the needles are placed.

If needles make you anxious, say so before the first one goes in, and ask how many will be used and where.

Does acupuncture work? What the evidence shows

In trials, acupuncture does better against no treatment than against sham acupuncture, such as a device that pokes the skin but does not penetrate it. NCCIH says this suggests that nonspecific effects, such as your belief in the treatment and your relationship with the practitioner, contribute to the benefit.

It is not only placebo. A pooled analysis of individual patient data from 39 trials (20,827 patients) found acupuncture beat both sham and no acupuncture for musculoskeletal pain, osteoarthritis, chronic headache and shoulder pain, with a smaller margin over sham. About 15% of the effect was lost at one year, and the margin was smaller in trials whose sham used a penetrating needle (Vickers and colleagues, Journal of Pain, 2018).

For back, neck and osteoarthritis pain, NCCIH says the pain relief was comparable to that of anti-inflammatory drugs (NSAIDs). In an analysis of data from 20 studies, the benefit lasted a year after treatment for every condition except neck pain. For headache, NCCIH adds that much of the benefit may come from expectation, beliefs and placebo responses rather than the needling itself.

Acupuncture by condition: what NCCIH, guidelines and Cochrane conclude

We read each source on Oct. 29 or 30, 2026. The NCCIH column is its acupuncture page (last updated October 2022) unless another page is named. NICE is England’s National Institute for Health and Care Excellence; each NICE cell gives the year NICE prints beside the recommendation. The Cochrane column gives the latest Cochrane review we found and its year.

Condition	NCCIH	Guidelines	Latest Cochrane review
Chronic low back pain	A 2018 review: beat no treatment and sham for back or neck pain; relief comparable to NSAIDs	American College of Physicians, 2017: a first-line option (moderate-quality evidence). NICE NG59, 2016: do not offer, with or without sciatica	2020, 33 studies (8,270 people): beat no treatment; the edge over sham was below the clinically important threshold
Neck pain	In the analysis of 20 studies, the benefit did not last a year for neck pain, unlike the other pain conditions	No neck pain recommendation in the guidelines we read; NICE NG193, 2021, allows one short course for chronic pain with no clear underlying condition	The 2016 review was withdrawn
Knee osteoarthritis	A 2018 review: beat no treatment and sham. American College of Rheumatology, 2019: conditionally recommended for the knee, hip or hand	NICE NG226, 2022: do not offer acupuncture or dry needling	2010, 16 trials (3,498 people): benefits over sham small and below clinical relevance, probably partly placebo
Migraine prevention	Moderate-quality evidence of fewer migraines (2016); may beat sham, but the difference is small	NICE CG150 (2012, amended 2025): up to 10 sessions over 5 to 8 weeks if propranolol, topiramate and amitriptyline have not worked or are unsuitable	2016, 22 trials (4,985 people): fewer headaches than no acupuncture; a small edge over sham
Tension-type headache	Moderate- to low-quality evidence it may reduce how often they come	NICE CG150, 2012: up to 10 sessions over 5 to 8 weeks to prevent chronic tension-type headache	2016, 12 trials (2,349 people): effective for frequent episodic or chronic tension-type headache
Fibromyalgia and chronic primary pain	A 2019 review of 12 studies: better than sham for pain, on low-to-moderate quality evidence	NICE NG193, 2021: one course, in a community setting with no more than 5 hours of professional time, or elsewhere at equivalent or lower cost	2013, 9 trials (395 people): no different from sham for pain or fatigue
Nausea from cancer treatment	Experts agree it helps, but the research mostly predates current anti-nausea guidelines; uncertain whether it adds to today’s treatment	None among the guidelines we read	The review was withdrawn in 2014
Nausea after surgery	Not covered on its acupuncture page	None among the guidelines we read	2025, 77 trials (9,847 people): stimulating the PC6 wrist point with anti-nausea drugs may reduce nausea and vomiting compared with sham
Anxiety	Anxiety page (September 2024): limited evidence, low-quality studies	None of the guidelines we read recommends it; NIMH names psychotherapy and medication as the two main treatments	We found none
Insomnia	Not covered on its acupuncture page	None among the guidelines we read	2012, 33 trials (2,293 people): not rigorous enough to support or refute; a new review was at the protocol stage in 2025
IVF and fertility	A 2021 review of 6 studies (2,507 people): no difference from sham in pregnancy or live birth	None among the guidelines we read	2013: no evidence it improves live birth or pregnancy rates in assisted conception
Quitting smoking	The US Preventive Services Task Force (2021) made no recommendation, as only limited evidence was available	See the NCCIH column	2014, 38 studies: no consistent, bias-free evidence of a benefit lasting six months or more
Carpal tunnel syndrome	A 2018 review of 12 studies: little or no effect compared with sham	None among the guidelines we read	2018, 12 studies (869 people): little or no short-term effect compared with sham

What the table shows: support is strongest for chronic pain and headache prevention, though the US and UK guidelines disagree on back pain and osteoarthritis. For IVF and carpal tunnel syndrome acupuncture did no better than sham, for fibromyalgia the reviews disagree, and for insomnia and anxiety the evidence is too weak to say.

Where guidelines disagree on acupuncture

For chronic low back pain, the American College of Physicians tells clinicians to start with non-drug treatment and lists exercise, multidisciplinary rehabilitation, acupuncture and mindfulness-based stress reduction among the options (Qaseem and colleagues, Annals of Internal Medicine, 2017). NICE says not to offer acupuncture for low back pain, with or without sciatica.

For osteoarthritis, the American College of Rheumatology and the Arthritis Foundation conditionally recommend acupuncture for the knee, hip or hand (2019), while NICE says not to offer acupuncture or dry needling (2022). Both put exercise first; our osteoarthritis guide covers that side.

NICE does give acupuncture a defined place elsewhere: a course of up to 10 sessions over 5 to 8 weeks to prevent chronic tension-type headache, the same course for migraine after three preventive drugs, and one short course for chronic primary pain. The NHS may offer acupuncture for people with long-term pain, migraine-type headaches, or severe hiccups.

Our acupuncture vs massage comparison sets these guidelines against the massage evidence, complaint by complaint.

Acupuncture for nausea from chemotherapy and surgery

Mayo Clinic lists chemotherapy-induced and postoperative nausea and vomiting among the conditions acupuncture is used for. The evidence is more qualified than that list suggests.

For cancer treatment, NCCIH says experts generally agree acupuncture helps, but the conclusion rests mainly on research done before current anti-nausea guidelines, and it is uncertain whether acupuncture adds anything to today’s standard treatment. The Cochrane review on chemotherapy nausea was withdrawn in 2014. Arrange acupuncture through your oncology team, alongside the anti-nausea drugs they prescribe.

After surgery, a 2025 Cochrane review of 77 trials (9,847 people) looked at stimulating the PC6 point on the wrist, with needles or with non-needle methods such as acupressure wristbands. Combined with anti-nausea drugs, it may reduce nausea and vomiting compared with sham and likely lowers the need for rescue drugs; for needles alone, the confidence in the evidence was low (Lee and colleagues, Cochrane Database of Systematic Reviews, 2025).

What acupuncture has not been shown to do

For IVF, a 2021 review of 6 studies (2,507 people) found no difference between acupuncture and sham in pregnancy or live birth rates (NCCIH). In a trial of 848 women at 16 IVF centers, live births were 18.3% with acupuncture and 17.8% with sham (Smith and colleagues, JAMA, 2018).

For quitting smoking, the US Preventive Services Task Force made no recommendation in 2021 because only limited evidence was available, and a Cochrane review found no consistent evidence of a benefit lasting six months or more (White and colleagues, Cochrane Database of Systematic Reviews, 2014).

In reviews reported by NCCIH, acupuncture was no better than sham for carpal tunnel syndrome, menopause hot flashes or irritable bowel syndrome, although it beat no acupuncture for hot flashes and may help irritable bowel syndrome as an add-on to other treatment. We found no good evidence that acupuncture clears toxins or treats organ disease, and NCCIH says not to use it to put off seeing a health care provider.

Acupuncture for stress, anxiety and sleep

If you are struggling to cope, or stress or anxiety will not go away, talk to a doctor or mental health professional; NIMH names psychotherapy and medication as the two main treatments for anxiety (NIMH). If you are in crisis or thinking about suicide, call or text 988; in a life-threatening situation, call 911 or go to the nearest emergency room (NIMH).

Mayo Clinic says acupuncture is increasingly used for overall wellness, including stress management. For anxiety, NCCIH calls the evidence limited and the studies low quality (NCCIH). A 2022 review of 27 trials (1,782 people with generalized anxiety disorder) found acupuncture relieved symptoms with fewer side effects than the comparison treatments, and its authors called for larger, high-quality trials (Li and colleagues, Medicine, 2022).

For sleep, a Cochrane review of 33 trials found the evidence not rigorous enough to support or refute acupuncture for insomnia (Cheuk and colleagues, Cochrane Database of Systematic Reviews, 2012). A new Cochrane review was at the protocol stage in 2025 (Ang and colleagues, Cochrane Database of Systematic Reviews, 2025).

Is acupuncture safe?

Mayo Clinic says the risks are low if you have a competent, certified practitioner using sterile needles. The common side effects are soreness and minor bleeding or bruising where the needles were inserted.

The FDA requires acupuncture needles to be sterile and labeled for single use, and single-use, disposable needles are now the practice standard, so the risk of infection is minimal. Serious complications are rare, but done improperly, acupuncture can cause infections, punctured organs, collapsed lungs and injury to the central nervous system (NCCIH).

Who should check with a doctor before acupuncture

• Blood thinner or bleeding risk. The NHS says “Acupuncture may not be safe for you if” you take blood thinning medicine or are at increased risk of bleeding, or have a skin condition or skin infection (NHS). Check with your doctor first. Our guide to wellness on blood thinners covers the rest of the spa menu.
• Pacemaker. Tell the practitioner, and ask your cardiologist before any acupuncture with electrical stimulation. Mayo Clinic says electrical pulses on the needles “may potentially interfere with a pacemaker’s operation”.
• Pregnancy. Tell the practitioner and your prenatal care team before you book. Mayo Clinic says some acupuncture points are thought to stimulate labor, which could lead to premature delivery.
• A new or worsening problem. Get it diagnosed first: NCCIH says not to use acupuncture to put off seeing a health care provider. Tell your doctor you are considering acupuncture, and do not stop a prescribed medicine without talking to them first (NHS).

What acupuncture costs

Prices as listed on each clinic’s own site or booking page on Oct. 29, 2026. Prices change; confirm before you book.

• The Point Acupuncture, Seattle (a private practice run by an L.Ac.): $220 for a new patient appointment (60 minutes), $165 for a return visit (50 minutes).
• Lillie Stewart, L.Ac., Baltimore: $200 for a new patient intake and treatment (90 minutes), $115 for an established patient.
• Harlem Chi Community Acupuncture: $115 for a new patient, $75 for a returning patient, $60 for seniors and students, $130 for a private room.
• Oakland Acupuncture Project, Oakland, Calif.: a sliding scale of $20 to 40 for follow-up visits (as the clinic prints it) and $45 for a new patient, with no proof of income asked.
• Working Class Acupuncture, Portland, Ore.: $25 to $45 per treatment on a sliding scale, in recliners in a group setting.

First visits cost more than return visits at the four clinics that list both. Working Class Acupuncture says acupuncture in a private room typically costs $75 to $150 per treatment; the two private practices above list more than that for a first visit. Our acupuncture vs massage comparison puts these next to massage prices.

Insurance and Medicare for acupuncture

Some health insurance policies cover acupuncture and others do not, and coverage is often limited to certain conditions. In 2018 and 2019, 50.2 percent of adult visits to acupuncturists had some insurance coverage, up from 41.1 percent in 2010 and 2011, and Medicaid coverage varies by state (NCCIH).

Medicare Part B covers acupuncture, including dry needling, only for chronic low back pain: pain lasting 12 weeks or longer with no known cause that is not linked to surgery or pregnancy. It covers up to 12 treatments in 90 days, 8 more if you are improving, and no more than 20 in 12 months; after the Part B deductible you pay 20% of the Medicare-approved amount (Medicare.gov). The rule is CMS national coverage determination 30.3.3, in effect since January 21, 2020 (CMS).

Medicare cannot pay a licensed acupuncturist directly. Under the CMS rule, a doctor can give the treatment under state requirements; a nurse practitioner, physician assistant or other staff member needs a master’s or doctoral degree in acupuncture or Oriental Medicine and a current state license, and other staff must work under the supervision of a doctor, physician assistant or nurse practitioner. Ask about this before you book.

How to choose an acupuncturist and check a license

Most states license acupuncturists, and the requirements vary by state (NCCIH). A majority of states require the national board’s examination or certification, and its state licensure map also shows the states with no acupuncture practice act. The board was renamed in January 2026, from NCCAOM to NCBAHM, the National Certification Board for Acupuncture and Herbal Medicine.

Titles are set by each state. In New York, only a licensed acupuncturist may use the initials L.Ac., after a three-year professional training program that follows at least two years of college, and a state-approved licensing exam; New Mexico licenses Doctors of Oriental Medicine (DOM). Doctors can practice acupuncture too: in New York, a physician or dentist must be certified, with at least 200 hours of instruction and 100 hours of supervised experience (New York State Education Department).

Before you book, ask whether the clinic uses disposable needles, what the treatment involves, how likely it is to help your condition and what it will cost (Mayo Clinic). Be wary of anyone who tells you to skip or delay a doctor’s visit; New York requires acupuncturists to advise patients of the importance of seeing a physician. Our guide to checking a practitioner’s credentials shows how to look up a license.

How many acupuncture sessions to try

Acupuncture is tried as a course. Mayo Clinic says a plan for one complaint usually involves one or two treatments a week, that 6 to 8 treatments are common, and that if your symptoms do not begin to improve within a few weeks, acupuncture may not be right for you.

NICE’s headache course is up to 10 sessions over 5 to 8 weeks, and Medicare covers 8 sessions beyond the first 12 only if you are improving. One community clinic, Working Class Acupuncture, usually starts people at 2 times a week for 3 weeks and reassesses after 6 treatments.

Pay per visit, or buy a short package at first, until you know whether it helps.

Community acupuncture vs a private session

Community clinics such as Working Class Acupuncture treat people in recliners in a shared room and charge on a sliding scale. Two randomized trials have compared group and individual treatment.

In 779 low-income primary care patients with chronic back, neck or osteoarthritis pain, both settings reduced pain and improved function over 12 weeks of weekly sessions, but the trial could not show that group treatment was as good: 37.5% of the individual arm and 30.3% of the group arm had more than a 30% improvement in pain interference (McKee and colleagues, Journal of General Internal Medicine, 2020).

In 74 people with cancer pain, group treatment was noninferior to individual treatment (Reed and colleagues, Evidence-Based Complementary and Alternative Medicine, 2020). The trials do not settle which is better, but a community clinic is the cheaper way to find out whether acupuncture helps you.

Cupping, gua sha, shiatsu, ear seeding and dry needling

Cupping uses suction cups on the skin and is a practice from traditional medicine in China and the Middle East. NCCIH says it may help reduce pain but the evidence is not very strong, and it can cause persistent skin discoloration, scars, burns and infections (NCCIH). Our cupping explainer covers the marks; on a blood thinner, our blood thinners guide says to decline cupping and gua sha.

Gua sha is a scraping technique from traditional Chinese medicine. Shiatsu is Japanese finger-pressure bodywork, with no needles. Ear seeding uses small beads taped to points on the outer ear and comes from auricular acupuncture.

Dry needling uses the same type of needles as acupuncture, but the points are chosen in a different way (NCCIH), and Medicare counts it as acupuncture.

FAQ: acupuncture

Does acupuncture hurt?

The needles are very thin, so insertion usually causes little discomfort, and many people do not feel them go in. You may feel a mild ache when a needle reaches the correct depth; the deqi sensation can include soreness, heaviness or dull pain. Soreness, minor bleeding or bruising at the needle sites are the common side effects.

How long does an acupuncture session take?

Up to 60 minutes, with the needles usually in for 10 to 15 minutes (Mayo Clinic). New-patient visits can run longer: one Baltimore practice books 90 minutes.

How long does acupuncture take to work?

Mayo Clinic says 6 to 8 treatments are common, and that if your symptoms do not begin to improve within a few weeks, acupuncture may not be right for you. One community clinic reassesses after 6 treatments.

Is acupuncture safe?

With a competent practitioner and sterile, single-use needles, the risks are low; the common side effects are soreness, minor bleeding and bruising. Done improperly, it can cause infections, punctured organs or collapsed lungs. Check with a doctor first if you take a blood thinner, have a pacemaker, are pregnant or have a skin infection.

Is acupuncture just a placebo?

Not entirely. Part of the benefit comes from nonspecific effects such as your belief in the treatment and your relationship with the practitioner, which is why acupuncture beats sham by less than it beats no treatment. But a pooled analysis of 39 trials concluded that its effect on chronic pain cannot be explained by placebo alone.

Does insurance or Medicare cover acupuncture?

Some private plans do, often only for certain conditions. Medicare Part B covers it only for chronic low back pain: up to 12 treatments in 90 days, 8 more if you are improving, and no more than 20 in 12 months, with 20% coinsurance after the Part B deductible. Medicare cannot pay a licensed acupuncturist directly.

Can acupuncture help with fertility or IVF?

Not in the trials we found. A 2021 review of 6 sham-controlled studies and the 2013 Cochrane review found no improvement in pregnancy or live birth rates, and in a trial of 848 women undergoing IVF, live births were 18.3% with acupuncture and 17.8% with sham.

Does acupuncture help you quit smoking?

Not reliably. A 2014 Cochrane review found no consistent evidence of a benefit lasting six months or more, and the US Preventive Services Task Force made no recommendation in 2021.

Is community acupuncture as good as a private session?

It costs less, and the trials are mixed. In a trial of 779 people with chronic pain, both group and individual treatment helped, but group treatment was not shown to be as good; in a smaller trial in cancer pain, group treatment was noninferior.

Can I have acupuncture alongside regular medical treatment?

Yes. Tell your doctor you are considering it, and do not stop a prescribed medicine without talking to them. For chronic low back pain, the American College of Physicians lists acupuncture as a first-line option; for nausea, the Cochrane evidence is for wrist-point stimulation combined with anti-nausea drugs, not instead of them.

What is acupuncture with electrical stimulation?

In electroacupuncture, the needles are stimulated with small electrical currents (NCCIH). If you have a pacemaker, tell the practitioner and ask your cardiologist first: Mayo Clinic says the pulses may interfere with it.

The bottom line on acupuncture

Acupuncture has real but modest effects on chronic pain and headache, and part of that effect is nonspecific. Guidelines disagree on back pain and osteoarthritis, and for IVF, quitting smoking and carpal tunnel syndrome the reviews found no clear benefit.

Try it for what it has been shown to help, judge it over a few weeks rather than one visit, check the license, and talk to a doctor first if you take a blood thinner, have a pacemaker, are pregnant, or have pain that is new, severe or getting worse.

Related reading on acupuncture

• Acupuncture vs massage: which for back pain, neck pain, headaches or stress?
• Cupping Therapy Explained: What the Marks Actually Mean
• What is ear seeding? Auricular acupressure, explained
• How to check a wellness practitioner’s credentials
• Wellness on blood thinners: massage pressure, cupping, wet floors and what is actually safe
• Which bodywork for which complaint: a decision guide