Guideline bodies read overlapping sets of trials and reach opposite recommendations on acupuncture. For chronic low back pain, NICE in England says do not offer it, while the American College of Physicians’ 2017 guideline listed it among the treatments to try first and the World Health Organization says it may be offered. NICE itself says it may be considered for chronic primary pain and should not be offered for osteoarthritis. The table below sets out what national and professional bodies say, condition by condition, with the date and status of each guideline; the sections after it report how the bodies explain their different conclusions. Each condition links to the AcuiQ page that reports the reviews behind it.
Positions by condition
| Condition | Body | Published and status | Position on acupuncture |
|---|---|---|---|
| Low back pain | NICE NG59 | November 2016; last updated July 2026 | Do not offer acupuncture for low back pain with or without sciatica. |
| Low back pain | American College of Physicians | February 2017; listed by ACP as inactive | For chronic pain, one of the treatments to try first (moderate-quality evidence); for acute or subacute pain, one of several options (low-quality evidence). Strong recommendations. |
| Low back pain | US Department of Veterans Affairs and Department of Defense (VA/DoD) | 2022, version 3.0 | Suggests acupuncture for chronic low back pain (weak recommendation for); evidence insufficient for acute pain. |
| Chronic primary low back pain | World Health Organization | December 2023 | Needling therapies such as acupuncture may be offered as part of care (conditional recommendation, low-certainty evidence). |
| Chronic primary pain | NICE NG193 | April 2021 | Consider a single course of acupuncture or dry needling, only if delivered in the community, by a healthcare professional at NHS pay band 7 or below, in no more than 5 hours of their time, or at equivalent or lower cost. |
| Osteoarthritis | NICE NG226 | October 2022 | Do not offer acupuncture or dry needling. |
| Osteoarthritis of the knee, hip and hand | American College of Rheumatology | 2026 update of the 2019 guideline, summary posted September 2026 | Conditionally recommends acupuncture; moderate certainty for knee and hip, very low for hand. |
| Osteoarthritis of the hip and knee | VA/DoD | 2026, version 3.0 | Insufficient evidence to recommend for or against acupuncture, acupressure, dry needling or moxibustion. |
| Chronic tension-type headache | NICE CG150 | September 2012; last updated June 2025 | Consider up to 10 sessions over 5 to 8 weeks to prevent attacks. |
| Migraine | NICE CG150 | September 2012; last updated June 2025 | Consider up to 10 sessions over 5 to 8 weeks if propranolol, topiramate and amitriptyline have not worked or are unsuitable. |
| Headache | VA/DoD | 2023, version 2.0 | Insufficient evidence to recommend for or against acupuncture or dry needling. |
| Irritable bowel syndrome | NICE CG61 | February 2008; last updated April 2017 | “The use of acupuncture should not be encouraged.” |
| Allergic rhinitis | American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) | February 2015 | Clinicians may offer acupuncture, or refer for it, to patients interested in non-drug treatment. |
| Tinnitus | NICE NG155 | March 2020 | No recommendation on acupuncture. |
| Tinnitus | AAO-HNS | October 2014; update in development | No recommendation on acupuncture. |
| Bell’s palsy | AAO-HNS | November 2013; update in development | No recommendation on acupuncture. |
| Primary dysmenorrhoea | NICE Clinical Knowledge Summary | Last revised October 2023 | Recommends heat and high-frequency TENS as non-drug measures; acupuncture is not among them. |
| Pain in labour | NICE NG235 | September 2023; last updated June 2026 | Do not offer acupuncture or acupressure; support a woman who wants to use them. |
| Fertility problems | NICE NG257 | March 2026, replacing CG156 | Tell people that complementary therapies for fertility problems have not been properly evaluated. |
| IVF | ESHRE | 2023 | Acupuncture and other complementary therapies are not recommended as add-ons. |
| Unexplained infertility | ESHRE | 2023 | Acupuncture in women is probably not recommended (conditional, low-certainty evidence). |
| Menopausal hot flushes | NICE NG23 | November 2015; last updated April 2026 | No recommendation on acupuncture. |
| Menopausal hot flushes | North American Menopause Society | 2023, replacing its 2015 statement | Not recommended (limited or inconsistent evidence). |
| Hot flushes after breast cancer | Society for Integrative Oncology | 2017; endorsed by ASCO in 2018 | Acupuncture can be considered (grade C). |
| Nausea and vomiting from chemotherapy, breast cancer | Society for Integrative Oncology | 2017; endorsed by ASCO in 2018 | Acupressure and acupuncture recommended. |
| Cancer pain | Society for Integrative Oncology and ASCO | September 2022 | Acupuncture should be recommended for joint pain from aromatase inhibitors; acupuncture, acupressure or reflexology may be recommended for general cancer pain or musculoskeletal pain. |
| High blood pressure | American Heart Association scientific statement | 2013 | Not recommended in clinical practice to lower blood pressure (Class III, no benefit). |
| Dementia | NICE NG97 | June 2018; reviewed October 2025, recommendations unchanged | Do not offer acupuncture to treat dementia. |
| Post-traumatic stress disorder | VA/DoD | 2023, version 4.0 | Insufficient evidence to recommend for or against acupuncture. |
NICE guidelines apply in England, and the VA/DoD guidelines to the US military and veterans’ health systems. WHO’s low back pain guideline is written for primary and community care settings. ESHRE is the European Society of Human Reproduction and Embryology, and ASCO the American Society of Clinical Oncology.
How the bodies reached different conclusions
The guidelines that explain themselves turn on three choices: which comparison counts, whether cost is weighed, and how large a difference has to be to matter.
Which comparison counts
A sham comparison asks whether needling does something beyond the attention, expectation and ritual of treatment; a usual-care comparison asks whether adding acupuncture changes how people fare. The full NICE low back pain guideline of 2016 records that its committee agreed sham-controlled evidence should inform decisions first, and that effects against usual care would count only once an effect against sham had been shown. Against sham, it found no clinical benefit for pain or function, and it recommended against acupuncture. Five years later, the committee for NICE’s chronic pain guideline found 27 studies showing less pain and better quality of life over three months against usual care or sham, agreed that the benefit over sham indicated a specific effect, and built its cost model on the usual-care trials because they better reflect real-world benefit. NG193 is used alongside NG59 rather than in place of it, so in England acupuncture can be considered for chronic primary pain but not for low back pain.
WHO’s guideline development group weighed both comparisons for chronic primary low back pain: a trivial benefit over sham in the immediate term, and low-certainty evidence of a small benefit to pain and a moderate to large benefit to function against no intervention. It judged the net benefit small and made a conditional recommendation in favour, with a remark that needling should form part of a broader package of care rather than stand alone. Sham acupuncture explains why no sham is inert, and why the bodies can disagree on how to read sham trials.
Whether cost is weighed
NICE weighs cost to the NHS. NG193’s recommendation is hedged by its own economic model: acupuncture was likely to be cost-effective only if delivered in the community, by staff at or below a set pay band, within five hours of their time. For osteoarthritis, the NG226 committee found the evidence, mostly from knee osteoarthritis, showed a lack of benefit and some evidence of harm, and that acupuncture was not cost-effective. It noted low-quality evidence that electroacupuncture beat sham, and asked for more research on it rather than recommending it. WHO judged the resource implications of acupuncture moderate to large, while noting that in China most people can get it cheaply through insurance subsidies.
How large a difference has to be
The American College of Rheumatology explains its conditional recommendation for osteoarthritis by the size of the difference and the size of the risk. Its 2019 guideline describes acupuncture’s benefit as a large contextual effect plus a small difference between real and sham acupuncture, of the same size as the difference between full-dose paracetamol and placebo, and judged the risk of harm minor. The ACR’s 2026 update kept the conditional recommendation and rated the evidence moderate in certainty for the knee and hip. The VA/DoD osteoarthritis guideline, published the same year, found the evidence insufficient to recommend acupuncture for or against.
Reading a guideline’s date
A guideline’s publication date and its evidence date can differ by years. NICE tags each recommendation with the year its evidence was last reviewed: the labour recommendation in NG235 is marked [2007, amended 2023], meaning its wording changed in 2023 without a new evidence review, and the complementary therapy advice in NG257 is marked [2004] in a guideline published in 2026. The AAO-HNS list of guidelines shows updates of its tinnitus and Bell’s palsy guidelines in development, and the VA/DoD numbers each version of a guideline. The American College of Physicians treats any of its guidelines five or more years old as no longer active, and lists its 2017 low back pain guideline among them. The table records the status shown by each body’s own site or journal in October 2026.
What guidelines do not cover
A guideline says whether a treatment should be offered within a health system. It does not say which points, how many sessions or which style of acupuncture, and the trials behind these guidelines varied: WHO’s ranged from one to 40 sessions, and NICE’s chronic pain committee noted wide variation in the type and intensity of acupuncture. AcuiQ indexes the protocols individual studies prescribed, each with its citation, and does not recommend any of them; What AcuiQ does not do sets out that limit.