Electroacupuncture

Our assessments of evidence for each medical benefit fall into one of these categories:

• Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
• Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
• Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
• Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
• Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
• Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)

• Less anxiety among people with breast cancer experiencing joint pain related to aromatase inhibitors treated with an eight-week course of electroacupuncture compared to controls, although no improvement was seen with sham acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁶Mao JJ, Farrar JT et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer. 2014 Dec 1;120(23):3744-51.
• Lower anxiety scores among people with breast cancer and insomnia undergoing chemotherapy treated with electroacupuncture and ear acupressure compared to controls in a small RCT⁷Zhang J, Qin Z et al. Electroacupuncture plus auricular acupressure for chemotherapy-associated insomnia in breast cancer patients: a pilot randomized controlled trial. Integrative Cancer Therapies. 2021 Jan-Dec;20:15347354211019103.
• Lower levels of worry, irritation, and tenseness among people with breast cancer during or after chemotherapy treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to In a small RCT⁸Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and  Immunity. 2020 Aug;88:88-96.

• Less depression but no evidence of an effect on depression remission rates among people with breast cancer experiencing joint pain related to aromatase inhibitors treated with an eight-week course of either electroacupuncture or sham acupuncture compared to controls in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁹Mao JJ, Farrar JT et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer. 2014 Dec 1;120(23):3744-51.

• Less fatigue among people with breast cancer experiencing joint pain related to aromatase inhibitors treated with an eight-week course of electroacupuncture compared to controls, whereas no improvement was seen with sham acupuncture in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁰Mao JJ, Farrar JT et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer. 2014 Dec 1;120(23):3744-51.

• Reduced incidence of acute vomiting among people undergoing chemotherapy and taking antiemetic medication with electroacupuncture but not manual acupuncture compared to controls in a subgroup analysis by modality in a systematic review of 11 studies¹¹Ezzo JM, Richardson MA et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews. 2006 Apr 19;(2):CD002285. Our note: acupuncture-point stimulation therapies in this meta-analysis include stimulation with needle, electroacupuncture, and acupressure
• Fewer vomiting (emesis) episodes among women with high-risk breast cancer receiving high-dose chemotherapy and treated with antiemetic medication and low-frequency electroacupuncture for 5 days compared to medication alone or minimal acupuncture stimulation (MAS) in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹²Shen J, Wenger N, et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA. 2000 Dec 6;284(21):2755-61.
• Lower incidence and severity of nausea and vomiting, and less use of rescue antiemetics among people undergoing major breast surgery under general anesthesia and treated with electroacupuncture compared to ondansetron or sham electroacupuncture in a small RCT¹³Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesthesia and Analgesia. 2004 Oct;99(4):1070-5.
• Fewer incidents of diarrhea among people with breast cancer during or after chemotherapy treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) to In a small RCT¹⁴Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and  Immunity. 2020 Aug;88:88-96.

• Fewer hot flashes among women with breast cancer treated with electroacupuncture compared to controls, but not consistently compared to sham acupuncture, in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 3 small RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁵Chen YP, Liu T et al. Acupuncture for hot flashes in women with breast cancer: asystematic review. Journal of Cancer Research and Therapeutics. 2016 Apr-Jun;12(2):535-42.
• Lower scores of hot flashes among people with breast cancer treated with electroacupuncture compared to daily gabapentin, and with fewer adverse events and longer duration of effects in a mid-sized RCT¹⁶Mao JJ, Bowman MA et al. Electroacupuncture versus gabapentin for hot flashes among breast cancer survivors: a randomized placebo-controlled trial. Journal of Clinical Oncology. 2015 Nov 1;33(31):3615-20.
• More than 50% decrease in hot flash scores during androgen deprivation therapy for prostate cancer among 9 of 22 men treated with electroacupuncture twice a week for 4 weeks then weekly for 6 weeks compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design¹⁷Beer TM, Benavides M et al. Acupuncture for hot flashes in patients with prostate cancer. Urology. Nov 2010;76(5):1182-1188.

• No benefit on symptoms among people with chemotherapy-induced peripheral neuropathy treated with electroacupuncture compared to placebo in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects¹⁸Rostock M, Jaroslawski K et al. Chemotherapy-induced peripheral neuropathy in cancer patients: a four-arm randomized trial on the effectiveness of electroacupuncture. Evidence-Based Complementary and Alternative Medicine. 2013;2013:349653.

• Less dry mouth among people who had completed radiotherapy with or without chemotherapy for head and neck squamous cell carcinoma treated with acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) compared to baseline in a small trial¹⁹Iovoli AJ, Ostrowski A et al. Two- versus four-times weekly acupuncture-like transcutaneous electrical nerve stimulation for treatment of radiation-induced xerostomia: a pilot study. Journal of Alternative and Complementary Medicine. 2020;26(4):323-328.
• Fewer dry mouth symptoms among people who had previously been treated with radiotherapy treated with acupuncture‐like electrostimulation of different sets of points compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design of low quality²⁰Wong RK, Jones GW, Sagar SM, Babjak AF, Whelan T. A phase I-II study in the use of acupuncture-like transcutaneous nerve stimulation in the treatment of radiation-induced xerostomia in head-and-neck cancer patients treated with radical radiotherapy. International Journal of Radiation Oncology Biology Physics. 2003 Oct 1;57(2):472-80.

General cancer pain

Preliminary evidence of less pain among people treated with electroacupuncture and analgesic compared to analgesic alone

Preliminary evidence of no difference regarding pain among people treated with electroacupuncture compared to sham

• Less cancer pain among people with cancer treated with electroacupuncture plus conventional analgesia compared to analgesic alone (3 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects), but no benefit with electroacupuncture compared to sham (2 RCTs) in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of RCTs²¹He Y, Guo X et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncology. 2020 Feb 1;6(2):271-278.
• Less pain intensity among people with breast cancer with electroacupuncture compared to usual care or waitlist controls in a subgroup analysis of a meta-analysis of 20 RCTs²²Li H, Schlaeger JM, et al. Acupuncture improves multiple treatment-related symptoms in breast cancer survivors: a systematic review and meta-analysis. Journal of Alternative and  Complementary Medicine. 2021 Dec;27(12):1084-1097.
• No difference for pain among women with newly diagnosed or recurrent primary ovarian or peritoneal cancer, cancer of the uterus, or tumors of the fallopian tubes treated with electroacupuncture compared to sham in a small RCT²³Lu W, Matulonis UA et al. The feasibility and effects of acupuncture on quality of life scores during chemotherapy in ovarian cancer: results from a pilot, randomized sham-controlled trial. Medical Acupuncture 2012;24(4):233-40.

Pain related to surgery: preliminary evidence of less surgery-related pain among people treated with electroacupuncture

• Less reported pain (better analgesia rates) and less use of sufentanil among people with esophageal cancer undergoing elective radical surgery (resection) and treated with general anesthesia, sufentanil administered for patient-controlled intravenous analgesia, and electroacupuncture compared to the anesthesia/analgesia regimen alone in small RCT²⁴Zhou M, Li Y et al. [Clinical research of electroacupuncture on the analgesic effect of thoracic perioperative stage]. [Article in Chinese] Zhongguo Zhen Jiu. 2017 Jul 12;37(7):705-709.
• Less pain among people undergoing major breast surgery under general anesthesia and taking ondansetron to manage nausea and vomiting and treated with electroacupuncture compared to sham electroacupuncture in a small RCT²⁵Gan TJ, Jiao KR, Zenn M, Georgiade G. A randomized controlled comparison of electro-acupoint stimulation or ondansetron versus placebo for the prevention of postoperative nausea and vomiting. Anesthesia and Analgesia. 2004 Oct;99(4):1070-5.

Headache: preliminary evidence of fewer headaches among people with breast cancer treated with electroacupuncture during or after chemotherapy

• Fewer headaches among people with breast cancer during or after chemotherapy treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) in a small RCT²⁶Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and  Immunity. 2020 Aug;88:88-96.

Musculoskeletal pain: preliminary evidence of less chronic musculoskeletal pain among people with cancer treated with electroacupuncture compared to usual care

• Less chronic musculoskeletal pain among people with cancer treated with electroacupuncture compared to usual care in a mid-sized RCT²⁷Mao JJ, Liou KT et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial. JAMA Oncology. 2021 Mar 18.

• A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward less stiffness and better physical function among women with early breast cancer with joint pain (arthralgia) due to aromatase inhibitor therapy treated with six weeks of electroacupuncture compared to sham treatment in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁸Oh B, Kimble B et al. Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: pilot study. Acupuncture in Medicine. 2013 Sep;31(3):264-71.

• Less self-reported sleep disturbance among people with cancer treated with electroacupuncture compared to enhanced supportive care in a network meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 24 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects²⁹Cheung DST, Xu X et al. Invasive or noninvasive? A systematic review and network meta-analysis of acupuncture and acupressure to treat sleep disturbance in cancer patients. Worldviews on Evidence-Based Nursing. 2022 Dec 21.
• Less sleep disruption, continuing for 24 weeks of follow up, among people with cancer with clinically significant sleep disturbance and chronic musculoskeletal pain treated with electroacupuncture for 10 weeks compared to usual care in a mid-sized RCT³⁰Yang M, Baser RE et al. Effect of acupuncture versus usual care on sleep quality in cancer survivors with chronic pain: secondary analysis of a randomized clinical trial. Cancer. 2023 Mar 29.
• Better measures of sleep and sleep quality among people with breast cancer experiencing daily hot flashes treated with electroacupuncture compared to gabapentin in a small RCT³¹Garland SN, Xie SX et al. Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial. Menopause. 2017 May;24(5):517-523.
• A weak trend toward less sleep disturbance among people with breast cancer experiencing joint pain related to aromatase inhibitors and treated with an eight-week course of electroacupuncture compared to controls, whereas no improvement was seen with sham acupuncture in a small RCT³²Mao JJ, Farrar JT et al. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer. 2014 Dec 1;120(23):3744-51.

• Fewer incidents of postoperative pneumonia and acute pulmonary injury among senile people undergoing radical surgery (resection) of pulmonary carcinoma treated with electroacupuncture 30 minutes before and throughout the surgery compared to controls in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects³³Liu T, Ma F et al. [Impacts of electroacupucnture at Zusanli (ST 36) and Feishu (BL 13) on the postoperative inflammatory reaction and pulmonary complications in senile patients after radical resection of pulmonary carcinoma]. Zhongguo Zhen Jiu. 2016 Nov 12;36(11):1135-1138. Chinese.
• Fewer incidents of tinnitus during or after chemotherapy among people with breast cancer treated with 2 sessions per week for 8 consecutive weeks of electroacupuncture plus manual acupuncture compared to minimal acupuncture stimulation (MAS) in a small RCT³⁴Zhang ZJ, Man SC et al. Electroacupuncture trigeminal nerve stimulation plus body acupuncture for chemotherapy-induced cognitive impairment in breast cancer patients: An assessor-participant blinded, randomized controlled trial. Brain, Behavior, and  Immunity. 2020 Aug;88:88-96.

• Less severe depression but no evidence of an effect on depression remission rates among people with clinical depression treated with electroacupuncture compared to antidepressant medications in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality³⁵Haller H, Anheyer D, Cramer H, Dobos G. Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open. 2019 Aug 5;9(8):e028527.
• Less severe depression among people with clinical depression treated with electroacupuncture compared to usual care (1 RCT) but not to sham treatment (5 RCTs) in a meta-analysis of 10 RCTs of low quality³⁶Haller H, Anheyer D, Cramer H, Dobos G. Complementary therapies for clinical depression: an overview of systematic reviews. BMJ Open. 2019 Aug 5;9(8):e028527.
• Less pain and use of analgesic medication among people with chronic low back pain with insufficient pain relief (not specific to people with cancer) and treated with auricular electroacupuncture compared to conventional manual auricular acupuncture in a small RCT³⁷Sator-Katzenschlager SM, Scharbert G et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia. 2004 May;98(5):1359-64, table of contents.
• Better sleep among people with chronic low back pain with insufficient pain relief treated with auricular electroacupuncture compared to conventional manual auricular acupuncture in a small RCT³⁸Sator-Katzenschlager SM, Scharbert G et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia. 2004 May;98(5):1359-64, table of contents.
• Better psychological well-being and activity among people with chronic low back pain with insufficient pain relief treated with auricular electroacupuncture compared to conventional manual auricular acupuncture in a small RCT³⁹Sator-Katzenschlager SM, Scharbert G et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia. 2004 May;98(5):1359-64, table of contents.

• Fewer symptoms of depression and diarrhea among people with depression and chronic diarrhea treated with electroacupuncture combined with 1.5 g viable bifidobacterium tablets with warm water 3 times a day after meals compared to conventional drugs for depression and chronic diarrhea in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects⁴⁰Huang W, Gan W et al. Efficacy of electroacupuncture combined with probiotics for depression and chronic diarrhea in patients and effect on serum inflammatory cytokines, NE and BDNF. Experimental and Therapeutic Medicine. 2019 Nov;18(5):3470-3474.