Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a long-lasting pain condition in men. The Cochrane review below names its two main features as pelvic pain and urinary symptoms, and trials such as Lee 2008 admit men who have had symptoms for at least three of the previous six months. The European Association of Urology (EAU) calls the condition primary prostate pain syndrome (PPPS): persistent or recurrent pain, reproduced when the prostate is pressed, with no proven infection or other local disease. Trials measure it with the National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI), a questionnaire scored from 0 to 43 across pain, urinary symptoms and quality of life. A fall of at least 6 points is the usual threshold for a change a patient would notice, and a trial counts a man who reaches it as a responder.
The acupuncture evidence for CP/CPPS includes several trials against sham acupuncture, a control procedure built to resemble it. The reviews that pool them report lower NIH-CPSI scores with acupuncture, and the EAU and American Urological Association (AUA) guidelines both list acupuncture among the treatments to offer. Sham acupuncture covers the kinds of control in use and why none is inert.
The Cochrane review
A 2018 Cochrane review by Franco and colleagues assessed every non-drug treatment for CP/CPPS: 38 trials with 3,290 men across 23 comparisons, searched to August 2017. Three trials with 204 men, from Malaysia, Korea and Turkey, compared acupuncture with a sham procedure that placed needles away from the acupuncture points; one of the three used electroacupuncture. At short-term follow-up the NIH-CPSI score was 5.79 points lower with acupuncture (95% confidence interval 4.26 to 7.32). The Turkish trial, the one that measured the score 24 weeks after treatment, found it 7.36 points lower with acupuncture. Adverse events may have differed little or not at all (low certainty), and sexual function scores may not have differed.
Two trials with 78 men compared acupuncture with standard drug treatment and found the score 6.05 points lower with acupuncture. Certainty is rated on GRADE, the scale Cochrane uses to say how much confidence a result supports, and the review rates these two results differently in two places: against sham, high in its abstract and moderate in its summary table; against drugs, low in the abstract and moderate in the table. The same review found a reduction of similar size at short-term follow-up with extracorporeal shockwave therapy, acoustic pulses delivered from outside the body. Its search ended before the 2018 and 2021 trials below were published, and Cochrane has not updated it.
The sham-controlled trials
| Trial | Men | Treatment | Sham | Primary result |
|---|---|---|---|---|
| Lee 2008, Malaysia | 89 | 20 sessions over 10 weeks | Shallow needles 15 mm to the left of each point | Responders at week 10: 73% with acupuncture, 47% with sham |
| Qin 2018, China | 68 | 8 weeks of treatment | Non-penetrating sham | NIH-CPSI 5.7 points lower than sham at week 8 |
| Sun 2021, China | 440 | 20 sessions over 8 weeks | Shallow needles beside each point, not manipulated | Responders at week 8: 60.6% with acupuncture, 36.8% with sham |
Lee and colleagues, at hospitals in Penang with a urologist from the University of Washington, published the first randomised comparison with sham in 2008. They needled four points, without stimulating the needles, for 30 minutes twice a week: CV01 (Huiyin), CV04 (Guanyuan), SP06 (Sanyinjiao) and SP09 (Yinlingquan). The trial's table prints the names of CV1 and CV4 the other way round, and the Cochrane review copies the pairing. Twenty-four weeks after treatment ended, 14 of 44 men in the acupuncture group still met the response threshold without further treatment, against 6 of 45 with sham.
Qin and colleagues followed their 68 men for 24 weeks after treatment. The difference from sham was 6.7 points at week 20 and 7.4 at week 32.
The 2021 trial by Sun and colleagues, published in Annals of Internal Medicine, randomised 440 men with moderate to severe CP/CPPS at ten hospitals in China, 220 to each group. Its published protocol sets out the points: BL33 (Zhongliao) and BL35 (Huiyang), needled 50 to 60 mm deep, with BL23 (Shenshu) and SP06. The sham needled 2 to 3 mm deep at sites 15 mm to the side of the bladder-channel points and 10 mm from SP06, without manipulation. A man counted as a responder only if his score had fallen by 6 points or more, and the trial required the difference between groups to hold at week 8 and again at week 32, 24 weeks after the last session. At week 32 the responder rates were 61.5% with acupuncture and 38.3% with sham, an adjusted difference of 21.1 percentage points. Twenty adverse events (9.1%) were reported in the acupuncture group and 14 (6.4%) in the sham group, none serious. The authors list as a limitation that the sham may have had physiological effects of its own.
Later reviews
A 2022 review by Qin and colleagues, searched to November 2021, pooled 12 trials with 1,188 men, six published in English and six in Chinese, and rated each result with GRADE. Against sham, in six trials with 769 men, the standardised mean difference in NIH-CPSI score was 1.20 in acupuncture's favour, moderate certainty; a standardised mean difference expresses an effect in standard deviations so that trials using different scales can be pooled. Against drugs, in six trials with 357 men, it was 1.01, low certainty. The review found no serious adverse effects. Two of its four authors, Qin and Wu, were also authors of the 2018 and 2021 trials.
A 2023 review by Pan and colleagues, searched to March 2022, included only trials scoring 4 or more on the Jadad scale, a short checklist of randomisation, blinding and dropouts: ten trials with 798 men. In six sham-controlled trials the NIH-CPSI score was 6.41 points lower with acupuncture (95% confidence interval 5.29 to 7.53).
Network meta-analyses rank several treatments at once through their shared comparisons. Three have covered acupuncture for CP/CPPS.
| Review | Trials (men) | Comparisons | Finding |
|---|---|---|---|
| Qin 2016 | 12 (1,203) | Acupuncture, electroacupuncture, alpha-blockers, antibiotics, the two drugs together, and placebo | All five treatments ahead of placebo on NIH-CPSI; electroacupuncture also ahead of alpha-blockers |
| Qin 2025 | 67 (5,961) | Eight kinds of acupuncture against a single “usual treatment” group that combined drugs, sham, other physical therapies and no treatment | Every kind of acupuncture ahead of drugs on clinical efficacy; long-needle acupuncture ranked first |
| Liu 2026 | 45 (3,534) | Kinds of acupuncture, alone or with drugs or Chinese herbal medicine, against drugs, herbal medicine or another kind of acupuncture; sham-controlled trials excluded | Warm needle acupuncture ranked first on NIH-CPSI; certainty mostly low to moderate |
Liu and colleagues, searching to October 2025, write that most of their trials were conducted in China and compared acupuncture with drugs rather than sham, which makes a specific effect of treatment hard to separate from contextual effects, and that long-term data were limited. Qin and colleagues in 2025 rated no result with GRADE. Where the trials come from sets out what the share of positive results by country shows across acupuncture research.
What guidelines say
The EAU's chronic pelvic pain guideline, in the 2026 compilation of the EAU guidelines and next due for update in 2027, rates at level of evidence 1a the statement that acupuncture is superior to sham in improving symptoms and quality of life. Its recommendation, “Offer acupuncture in PPPS”, carries a strong rating. The same table strongly recommends alpha-blockers, and at least six weeks of antibiotics for men not treated before, when the condition has lasted less than a year.
The AUA published its guideline on male chronic pelvic pain in 2025, from a literature search updated in June 2024. Statement 28 says clinicians may offer acupuncture to patients with CP/CPPS, a conditional recommendation on grade B evidence. Its discussion cites the 2021 trial and Pan's review, and notes that a sham procedure is hard to design, that the sham may have had physiological effects, and that a trial run in China, where acupuncture is mainstream and experienced acupuncturists are easy to find, may not reflect patients in the United States. Clinical guidelines compares how guideline bodies treat acupuncture across conditions.
What the evidence could not settle
In a sham-controlled trial the acupuncturist knows which procedure is being given, and the NIH-CPSI is a score the men report themselves. None of the three sham-controlled trials above followed men for more than 24 weeks after treatment, so they cannot say whether the difference lasts longer. Lee's and Sun's trials each used one fixed set of points; Qin and colleagues in 2022 called for future trials to fit treatment to each man's symptoms, which neither design tests. The network meta-analyses rank kinds of acupuncture mostly through comparisons with drugs given openly, which carry the limitation Liu and colleagues describe. Chronic pain reports the evidence across other long-lasting pain conditions.
AcuiQ's chronic prostatitis page lists the protocols individual studies prescribed, each with its citation.