---
title: "Pain after surgery"
url: "https://acuiq.com/wiki/evidence/postoperative-pain"
updated: 2026-10-09
last_verified: 2026-10-09
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "evidence"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-09"
reading_minutes: 8
sources: 10
---

# Pain after surgery

_What systematic reviews, three sham-controlled trials and the American Pain Society guideline report on acupuncture, electroacupuncture, ear acupuncture and acupressure for pain after surgery._

Trials of acupuncture for pain after surgery add it to the usual pain medicines and measure two things: how much pain people report on a 0 to 10 or 0 to 100 scale, and how much opioid they take, usually through a patient-controlled analgesia (PCA) pump that lets them give themselves a dose when they need it. Opioid use matters in its own right, because opioids cause nausea, drowsiness, itching and difficulty passing urine. Cochrane has not published a review of acupuncture for pain after surgery; its review of wrist-point stimulation covers nausea and vomiting, which [Nausea after surgery](/wiki/evidence/nausea-after-surgery) reports. What the reviews found depends on the control: sham acupuncture, a procedure made to resemble acupuncture without being it, or usual care alone. [Sham acupuncture](/wiki/research/sham-acupuncture) sets out the kinds in use.

## Reviews against sham

A [2008 review](https://doi.org/10.1093/bja/aen146) by Sun and colleagues at Duke University, published in the British Journal of Anaesthesia, pooled 15 randomised trials that compared acupuncture or a related technique with sham. Cumulative opioid use was lower with acupuncture by 3.1 mg at 8 hours, 8.3 mg at 24 hours and 9.1 mg at 72 hours after surgery. Pain on a 0 to 100 mm scale was lower at 8 and 72 hours. Fewer people had opioid side effects:

| Side effect | Relative risk |
| --- | --- |
| Nausea | 0.67 |
| Dizziness | 0.65 |
| Sedation | 0.78 |
| Itching | 0.75 |
| Urinary retention | 0.29 |

A relative risk of 0.67 means a third fewer people had the side effect than with sham. The authors concluded that acupuncture around the time of surgery may be a useful addition to pain management.

A [2016 review](https://doi.org/10.1371/journal.pone.0150367) by Ming-Shun Wu and colleagues at Taipei Medical University searched to September 2014 and included 13 sham- or placebo-controlled trials with 682 adults, excluding ear acupuncture. On the first day after surgery pain was 1.3 points lower with acupuncture or a related technique, on scales that were mostly visual analogue scales, and opioid use was lower. The trials disagreed with one another to an extreme degree (I² 98.6% for pain, where higher values mean more inconsistency). Split by technique, the results diverged:

- Manual acupuncture (2 trials): less pain, but no difference in opioid use.
- Electroacupuncture, in which a current runs between the needles (4 trials): no significant difference in pain or opioid use.
- Transcutaneous electrical acupoint stimulation (TEAS), current delivered through pads on the skin over the points with no needle: less pain and less opioid use.

The authors list the varied points, operations and control procedures among the review’s limitations. [Electroacupuncture](/wiki/techniques/electroacupuncture) describes how the current is applied.

## Reviews including usual care

A [2015 review](https://doi.org/10.1155/2015/657809) by Liu and colleagues in Shanghai and Hong Kong included 59 randomised trials published between 1986 and 2014, against sham, usual care or no added treatment, and searched Chinese databases as well as English ones. It found lower pain scores and lower total morphine use with acupuncture-point stimulation. The authors concluded that the evidence was insufficient to say the stimulation is an effective treatment for pain after surgery, while it did support a reduction in the painkillers people needed, with no adverse effects. They note limitations that may have led them to overestimate the effects.

A [2025 review](https://doi.org/10.1016/j.pmn.2024.12.014) by Liu and colleagues at Shenzhen Traditional Chinese Medicine Hospital searched to August 2022 and included 25 studies. Pain scores were lower with acupuncture than in control groups by a standardised mean difference of 0.38, and analgesic doses lower by 0.53, with high inconsistency between trials (I² 90%). A standardised mean difference expresses the gap between groups in units of the spread of the results, so that trials using different scales can be pooled. The authors rated the evidence with GRADE, the scale reviews use to say how far a result can be trusted, but the abstract does not give the ratings.

For ear points, a [2019 review](https://doi.org/10.1007/s11655-019-3063-1) by Zhong and colleagues at Nanjing University of Chinese Medicine pooled 26 trials with 1,682 people that compared auricular acupressure, pressure applied to ear points, with conventional care. Pain was lower by 0.85 points at 72 hours, and by 1.15 points after abdominal surgery. No serious adverse effects were recorded, and the authors called for larger and more rigorous trials. [Ear acupuncture](/wiki/techniques/ear-acupuncture) explains how the ear points are mapped.

## Knee replacement

A [2017 review](https://doi.org/10.1001/jamasurg.2017.2872) in JAMA Surgery by Tedesco and colleagues at Stanford University and the University of Bologna covered drug-free treatments after total knee replacement: 39 trials with 2,391 patients, 4 of them testing acupuncture. It graded each result with GRADE.

| Outcome | Trials (people) | Result | GRADE |
| --- | --- | --- | --- |
| Time to first PCA dose | 2 (124) | 46 minutes later | Moderate |
| Opioid use within 48 hours | 2 (123) | No significant difference | Low |
| Pain at 2 days | 2 (90) | 1.1 points lower | Low |
| Pain at 8 days | 2 (140) | No significant difference | Low |

The authors concluded that the benefit of acupuncture is concentrated in the first days after the operation.

## Three sham-controlled trials

A [2001 trial](https://doi.org/10.1097/00000542-200108000-00015) at Hirosaki University in Japan randomised 175 people having upper or lower abdominal surgery to small intradermal needles or a control before anaesthesia. The needles went either side of the spine on the bladder channel, from [`BL18`](/points/BL18) (Ganshu) to [`BL24`](/points/BL24) (Qihaishu) for upper abdominal surgery and from [`BL20`](/points/BL20) (Pishu) to [`BL26`](/points/BL26) (Guanyuanshu) for lower. More people had good pain relief, extra intravenous morphine fell by half, and nausea fell by 20% to 30% in the needled groups.

A [2005 trial](https://doi.org/10.1016/j.pain.2004.08.021) at the University of Greifswald in Germany randomised people having a hip replacement to press needles at four ear points (lung, shenmen, thalamus and hip) or to sham needles on the rim of the ear, left in for three days. Among the 54 who completed it, the needled group used 37 mg of the opioid piritramide over 36 hours against 54 mg with sham. Pain scores and side effects did not differ, and patients’ guesses about which group they were in did not differ significantly between the groups.

A [2015 trial](https://doi.org/10.1097/aap.0000000000000138) at Chang Gung Memorial Hospital in Taiwan randomised 60 people having a knee replacement to needling at the knee, scalp and ear, or to sham ear acupuncture, all under general anaesthesia. Fentanyl use through the PCA pump was 621 micrograms against 869 with sham, pain was lower over the first 24 hours, and nausea and vomiting were less common.

## What guidelines say

The [postoperative pain guideline](https://doi.org/10.1016/j.jpain.2015.12.008) of the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, published in February 2016, can neither recommend nor discourage acupuncture as an addition to other pain treatment after surgery, on insufficient evidence. It describes the evidence on needle acupuncture in adults as mixed, and the evidence on acupressure, ear acupuncture and electroacupuncture as limited. In the same section it makes a weak recommendation, on moderate-quality evidence, for transcutaneous electrical nerve stimulation (TENS), and notes that some TENS trials placed the pads on acupoints away from the incision with similar effects. No later version had been published by October 2026.

## What the reviews could not settle

The pooled trials differ in operation, technique, points, timing and control, and the reviews report inconsistency between them high enough that a single pooled figure says little about any one operation. Pain and opioid use do not always move together: in the 2016 review and the knee replacement review, some comparisons lowered one without the other. The outcomes these reviews pooled run from the first hours to three days after surgery, and the knee replacement review found no difference by day 8. The comparisons with usual care cannot be blinded, and the three sham-controlled trials above enrolled 60 to 175 people each. None of the reviews on this page compares acupuncture with a nerve block or another established pain technique for the same operation.

AcuiQ’s [postoperative pain page](/symptoms/postoperative-pain), with the related [perioperative pain](/symptoms/perioperative-pain) page, lists the protocols individual studies prescribed, each with its citation.

### Sources

1. Sun Y, Gan TJ, Dubose JW, Habib AS, Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials, British Journal of Anaesthesia 2008 — https://doi.org/10.1093/bja/aen146
2. Wu MS, Chen KH, Chen IF, Huang SK, et al., The efficacy of acupuncture in post-operative pain management: a systematic review and meta-analysis, PLoS One 2016 — https://doi.org/10.1371/journal.pone.0150367
3. Liu XL, Tan JY, Molassiotis A, Suen LK, Shi Y, Acupuncture-point stimulation for postoperative pain control: a systematic review and meta-analysis of randomized controlled trials, Evidence-Based Complementary and Alternative Medicine 2015 — https://doi.org/10.1155/2015/657809
4. Liu J, Li Y, Liu J, Zhang X, Efficacy of acupuncture in postoperative pain-relieving: a systematic review and meta-analysis, Pain Management Nursing 2025 — https://doi.org/10.1016/j.pmn.2024.12.014
5. Zhong Q, Wang D, Bai YM, Du SZ, et al., Effectiveness of auricular acupressure for acute postoperative pain after surgery: a systematic review and meta-analysis, Chinese Journal of Integrative Medicine 2019 — https://doi.org/10.1007/s11655-019-3063-1
6. Tedesco D, Gori D, Desai KR, Asch S, et al., Drug-free interventions to reduce pain or opioid consumption after total knee arthroplasty: a systematic review and meta-analysis, JAMA Surgery 2017 — https://doi.org/10.1001/jamasurg.2017.2872
7. Kotani N, Hashimoto H, Sato Y, Sessler DI, et al., Preoperative intradermal acupuncture reduces postoperative pain, nausea and vomiting, analgesic requirement, and sympathoadrenal responses, Anesthesiology 2001 — https://doi.org/10.1097/00000542-200108000-00015
8. Usichenko TI, Dinse M, Hermsen M, Witstruck T, et al., Auricular acupuncture for pain relief after total hip arthroplasty: a randomized controlled study, Pain 2005 — https://doi.org/10.1016/j.pain.2004.08.021
9. Chen CC, Yang CC, Hu CC, Shih HN, et al., Acupuncture for pain relief after total knee arthroplasty: a randomized controlled trial, Regional Anesthesia and Pain Medicine 2015 — https://doi.org/10.1097/aap.0000000000000138
10. Chou R, Gordon DB, de Leon-Casasola OA, Rosenberg JM, et al., Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists' Committee on Regional Anesthesia, Executive Committee, and Administrative Council, Journal of Pain 2016 — https://doi.org/10.1016/j.jpain.2015.12.008