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Does acupuncture help back pain, migraines and knee pain?

Acupuncture may ease chronic back pain and cut migraine attacks a little more than fake needling. Results for osteoarthritis and knee pain are mixed.

Published October 2026

Short answer

Acupuncture may ease chronic back pain and reduce migraine attacks, but the gain over fake needling is small and knee pain results are mixed. Evidence grade C (Limited). Several meta-analyses and sham-controlled trials; downgraded for risk of bias (needling cannot be fully blinded), small gains over sham needling, and inconsistent knee results.

Key takeaways

  • For migraine, about half of people on acupuncture had their headache frequency at least halved, against 41% given sham needling [1].
  • For chronic back pain, acupuncture gave clearly more pain relief than no treatment, but the gain over sham needling was small [2].
  • Knee and other osteoarthritis results are mixed: a pooled analysis found a modest gain over sham, while a 2021 knee trial found no advantage for superficial needling [3][4].
  • The most commonly reported side effects were needle-point pain, bruising, hematoma and bleeding [2].

The short version

Acupuncture may help with migraine and chronic back pain [1][2]. The extra benefit over fake (sham) needling is small, and results for knee pain are mixed [3][4].

What the studies show

A Cochrane review of 22 trials with 4,985 people found that acupuncture to prevent migraine attacks cut headache frequency compared with no acupuncture [1]. Against sham needling, about 50% of people on acupuncture had their headaches at least halved, against 41% on sham [1]. A later review of 20 trials also found fewer migraine episodes than with sham needling [5].

A Cochrane review of 33 trials with 8,270 people found that acupuncture gave clearly more pain relief than no treatment for chronic low back pain [2]. Against sham needling, the pain gain was small and below the amount usually considered meaningful [2].

A pooled analysis of 39 trials with about 20,800 people found that acupuncture beat sham needling for chronic pain, including osteoarthritis, by about a fifth of a standard deviation [3]. In a 2021 knee trial, 60% of people on electroacupuncture and 47% on sham reached a meaningful improvement in pain and function after 8 weeks [6]. A separate 2021 knee trial of 86 people found superficial needling no better than sham [4].

The nuances

Part of the effect may come from factors beyond the needles themselves, which the trials cannot fully separate [3]. The benefit for chronic pain appeared to last, with a drop of about 15% at one year [3]. Only one migraine trial followed people for 12 months, and it found a small benefit [1]. A 2020 sham-controlled trial of 121 adults with chronic low back pain found no significant difference in pain, but a larger improvement in disability scores [7].

What this means for you

For migraine prevention or chronic back pain, the trials suggest acupuncture may be worth considering, with modest expected gains [1][2]. Talk to a doctor first, especially if you have bleeding problems or take blood thinners, and see a doctor about any new or severe pain.

Go deeper

  • Acupuncture — Acupuncture may reduce migraine attacks and ease chronic back pain, with gains over sham (fake) needling that are real but small.

References

  1. Acupuncture for the prevention of episodic migraine.. Cochrane Database Syst Rev, 2016.
  2. Acupuncture for chronic nonspecific low back pain.. Cochrane Database Syst Rev, 2020.
  3. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis.. J Pain, 2018.
  4. Superficial Needling Acupuncture vs Sham Acupuncture for Knee Osteoarthritis: A Randomized Controlled Trial.. Am J Med, 2021.
  5. Efficacy of acupuncture for migraine prophylaxis: a trial sequential meta-analysis.. J Neurol, 2021.
  6. Efficacy of Intensive Acupuncture Versus Sham Acupuncture in Knee Osteoarthritis: A Randomized Controlled Trial.. Arthritis Rheumatol, 2021.
  7. Effect of Electroacupuncture vs Sham Treatment on Change in Pain Severity Among Adults With Chronic Low Back Pain: A Randomized Clinical Trial.. JAMA Netw Open, 2020.