Breast pain

Mastalgia is breast pain. In the description of Gao and colleagues’ 2023 trial protocol, cyclical mastalgia, the commoner form, usually starts one to two weeks before a period and eases once it begins; non-cyclical pain has no tie to the menstrual cycle. The literature on acupuncture for it is small: one uncontrolled pilot study from the United States, two sham-controlled trials submitted as theses in Beijing, two registered sham-controlled trials whose results have not appeared, and two reviews of Chinese trials in mammary gland hyperplasia, a diagnosis common in Chinese research on breast pain. Breast pain while breastfeeding and pain after breast-cancer surgery have their own small literatures, set out separately below.

The Cochrane review

There is none. A search of the Cochrane Database of Systematic Reviews through Europe PMC on 16 October 2026 found no Cochrane review or protocol on any treatment for mastalgia. The nearest is the 2018 Cochrane review of acupuncture and acupressure for premenstrual syndrome by Armour and colleagues: five trials with 277 women, evidence of low to very low quality, and no trial reporting specific premenstrual symptoms such as breast tenderness.

Reviews of mammary gland hyperplasia

Both reviews come from Chinese universities of traditional medicine. He and colleagues equate mammary gland hyperplasia with fibrocystic breast disease; Li and colleagues describe it as breast pain and lumps, often tied to the menstrual cycle and mood. Jifeng Li and colleagues’ 2024 review searched eight databases, four of them Chinese, and included 8 randomised trials with 573 women, keeping only trials that scored 5 or more on a modified Jadad scale, a seven-point rating of randomisation, concealment, blinding and withdrawals. The trials fall into two comparisons:

Five trials used electroacupuncture and three manual acupuncture. Points that recur across the trial groups include CV17 (Danzhong), ST15 (Wuyi), ST18 (Rugen), ST36 (Zusanli) and LV14 (Qimen). Four trials reported adverse events, five among 452 people given acupuncture: dizziness, two stuck needles, bleeding after a needle was withdrawn and one bruise under the skin. Three trials followed women after treatment, for one to three months. The authors call the evidence insufficient in quality and ask for more rigorous trials, and report no GRADE assessment.

Zhe He and colleagues’ 2024 network meta-analysis, from Yunnan University of Chinese Medicine, set a lower bar. It included 48 trials with 4,500 women, all run in China between 2008 and 2023, in which acupuncture or a related method, alone or with herbal or Western drugs, was compared with control groups that mostly took drugs. A network meta-analysis compares several treatments at once through the comparators they share. 22 trials with 2,093 women measured breast pain on a 0 to 10 visual analogue scale, and the acupuncture groups scored lower (standardised mean difference −2.97, 95% confidence interval −3.61 to −2.33) with heterogeneity, the disagreement between trials beyond chance, of 97%. Of 16 methods, warm needle acupuncture, in which burning moxa heats the needle handle, ranked first on pain with a SUCRA, a 0 to 100% score for the chance of ranking first, of 69.8%. The authors rated allocation concealment uncertain where trials did not describe it, note that few were blinded, and say they could not judge the safety of any method because adverse events were not reported in a standard way. No trial in the network used sham acupuncture. Moxibustion, Bloodletting and Thread embedding describe three of the methods it ranked.

A 2018 systematic review of the management of idiopathic mastalgia by Hafiz, Barnes and Kirwan in the UK searched PubMed, MEDLINE, the Cochrane Database and a trial registry to February 2016. It names reassurance and bra-fitting advice as the first step and topical non-steroidal anti-inflammatory drugs as the next, and groups acupuncture with relaxation therapy and kinesiology as treatments without good evidence of effectiveness.

The trials

The one mastalgia trial outside China is a 2011 pilot study by Thicke and colleagues at the Mayo Clinic in Rochester, Minnesota. It enrolled 37 women with non-cyclical breast pain between 2003 and 2009 and gave four acupuncture sessions over two weeks, with no control group; 22 completed them. On the 10-point Brief Pain Inventory, worst pain fell by an average of 3.5 points and average pain by 2.7 points by the end of treatment, and quality-of-life scores did not change. The authors present it as grounds for a randomised trial.

Yu and colleagues’ 2022 protocol cites two earlier trials of acupuncture against sham for cyclical breast pain, theses at Beijing University of Chinese Medicine by Sun in 2018 and Zhang in 2020, and reports that their conclusions diverged. Neither appears in PubMed.

Two larger sham-controlled trials were registered in 2022, both in Beijing:

• Yu, Guo and colleagues at Beijing Hospital of Traditional Chinese Medicine planned 108 women with cyclical mastalgia, given 18 sessions over three menstrual cycles of manual acupuncture or a non-penetrating sham at 14 non-points on the back, with change in breast pain on a visual analogue scale as the main outcome. Their points include the most tender spot on the breast (an ashi point), CV17, ST15, ST18, SI11 (Tianzong), LI04 (Hegu), SP06 (Sanyinjiao) and LV03 (Taichong). The registry entry gives an estimated completion of December 2024, an unknown status and no results.
• Gao, Liu and colleagues at Guang’anmen Hospital planned 60 women with moderate to severe cyclical pain across three hospitals, given 16 sessions over three cycles of acupuncture or a sham whose needles go into adhesive pads over the same points without piercing the skin, and followed for six cycles. Their protocol says earlier trials lacked an appropriate comparison and could not show whether acupuncture works for cyclical mastalgia. The registry entry gives an estimated completion of September 2024, an unknown status and no results.

A search of Europe PMC and PubMed on 16 October 2026 found no published result from either trial. Sham acupuncture describes the two kinds of control they chose. CV17, ST15 and ST18 lie over the chest wall, and Needling over the chest covers the risks of needling there.

Breast pain while breastfeeding

Pain from engorgement, the overfilling of the breasts with milk in the first days after birth, is a different condition with its own review. The 2020 Cochrane review of treatments for breast engorgement by Zakarija-Grkovic and Stewart included 21 trials with 2,170 women, among them trials of acupuncture and acupressure. The trials were too varied to pool, and the authors found the certainty of evidence too low for robust conclusions about any treatment. In a 2024 Korean trial by Han, Kim and Park, 52 breastfeeding mothers with breast pain, all also given a gentle hand massage technique, had four weeks of ear acupressure at points including Shenmen and Breast or at points unrelated to the breast. Pain on a 0 to 10 rating did not change significantly; pressure pain thresholds rose in two areas of one breast in the acupressure group. Ear acupuncture describes the method.

Pain after breast-cancer surgery

Pain in the chest, armpit or arm after breast-cancer surgery is a separate condition, and its acupuncture literature is also small. In a 2025 pilot trial by Ilfeld and colleagues in the United States, 30 adults going home on the day of breast surgery wore a device that stimulates the ear through electrodes placed around it, switched on or sham, for five days. Median pain was 0 with stimulation and 1.5 with sham, a difference that missed statistical significance (P = 0.084), and the authors say the pilot was too small to settle it. For chronic post-mastectomy pain, a 2026 protocol by Kawasaki and colleagues in Japan describes a single-arm study of 12 weekly acupuncture-based sessions, running to March 2027. A 2002 case report by Jenner and Filshie describes a woman given acupuncture for pain after mastectomy and reconstruction who had milk discharge from her other breast, four years after she had last lactated. Pain after surgery, Cancer pain and Acupuncture in cancer care cover the wider literature.

What guidelines say

No guideline on breast pain recommends for or against acupuncture. NICE’s Clinical Knowledge Summary on cyclical breast pain, last revised in April 2026, advises reassurance that the pain is not linked to breast cancer, a well-fitted bra, over-the-counter topical anti-inflammatory gel and a pain diary. It lists evening primrose oil, flaxseed, low-fat or low-caffeine diets, vitamins B6 and E and changing contraceptives as not recommended for want of evidence, names danazol and tamoxifen as specialist options, and advises referral to a breast clinic if pain persists for three months despite these measures. It does not mention acupuncture. Clinical guidelines lists the guidelines the evidence pages cite.

What the reviews could not settle

No trial published in a journal has compared acupuncture with sham for cyclical or non-cyclical mastalgia; the two registered to do so have not reported, and the two thesis trials disagree. The pooled results come from trials in mammary gland hyperplasia, a Chinese diagnosis that overlaps with cyclical breast pain without matching it, and they compare acupuncture with other acupuncture or with drugs, which cannot separate the needling from the attention and expectation around it. The 97% heterogeneity in He’s analysis means the trials disagree on the size of any difference. The one study of non-cyclical pain had no control group, and NICE’s guidance does not mention acupuncture.

AcuiQ’s breast pain, breast tenderness and breast hyperplasia pages list the protocols individual studies prescribed, each with its citation. Period pain and Endometriosis cover other pain tied to the menstrual cycle.