Some national guidelines do recommend acupuncture/dry needling for some conditions including low back pain, while others do not. However, when you review the evidence, there is a lot of evidence that acupuncture and dry needling is helpful in a large range of musculoskeletal conditions including low back pain, neck pain and post whiplash injuries and arthritic joint pain. in the UK, National Institute for Clinical Excellence (NICE) guidelines are the go to for what does  and does not work for certain conditions. The recommendations from the last guideline for treating low back pain do not suggest acupuncture, but this was issues ten years ago and does appear to be out of date now. Some studies tlhat have been reviewed for these guidelines use what is called sham acupunture to compare to acupuncture. Unfortunately, what is called sham acupuncture is actually simply superficial acupuncture. Some of the studies using this a a control group did not find any significant differences between treatment and control groups. This is not surprising as both groups were being treated with different types of acupuncture, not a true control group, so finding a difference would be difficult. In contrast to the UK NICE guidelines, the National Institutes of Health guidelines from the United States do recommend acupuncture for low back pain in conjunction with advice on self management, specific and general exercise, manual therapy, cognitive behavioural therapy, and non-steroidal anti-inflammatory medication.

Specifically for low back pain treatment, acupuncture/dry needling was shown to be effective in reducing pain in a large meta analysis of other quality studies by Xiang in 2020. It did not show an improvement in patient’s functional ability but in real life physiotherapy, acupuncture is not give in isolation but with exercises and manual therapy. Functional improvements are unlikely without strengthening, control and flexibility exercises.

Interestingly, a randomized controlled stuldy by DeBar et.al in 2025, did show that acupuncture alone improved low back pain, reduced medication use and improved functional ability in patients over 65 years old with chronic low back pain. The effect of this lasted up to twelve months after treatment finished.

Another study by Liu et. al 2015 showed that even acupuncture in the ear lobe (auricular acupuncture) gave 51% relief of low back pain thirty days after treatment. On the day of treatment auricular acupuncture gave 80% relief of pain.

In conjunction with usual treatments for low back pain, Liu et. al 2015 showed using meta analysis of twelve other systematic review that acupuncture reduced pain and improved function in chronic low back pain sufferers more than conventional treatment alone. It also showed that compared to no treatment, acupuncture improved pain and function in low back pain patients. An earlier review by Yuan et. al 2008 showed similar results from 33 randomized controlled trials. They suggested that there was strong evidence that acupuncture plus usual treatment was more effective than usual treatment alone. They also showed, with moderate level evidence, that functional ability improved.

For neck pain post whiplash, Lee et.al’s systematic review in 2023 showed acupuncture is effective for reducing pain and movement range.

For arthritic joints, the American College of Rheumatology  in conjunction with the Arthritis Foundation recommend the use of acpunucture as part of management of arthritic joint pain.

So, overall, using acupuncture or dry needling does appear to be effective in managing a wide range of musculoskeletal problems. This is especially if it is done in conjunction with other treatments such as exercises, manual therapy and medication.

 

 

References:

DeBar LL, Wellman RD, Justice M, et al. Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348

Fox LM, Murakami M, Danesha H, Manini AF. Battlefield Acupuncture to treat low back pain in the emergency department. Am J Emerg Med. 2018;36(6):1045–1048

Kolasinski SL, Neogi T, Hochberg MC, Oatis C, Guyatt G, Block J, Callahan L, Copenhaver C, Dodge C, Felson D, Gellar K, Harvey WF, Hawker G, Herzig E, Kwoh CK, Nelson AE, Samuels J, Scanzello C, White D, Wise B, Altman RD, DiRenzo D, Fontanarosa J, Giradi G, Ishimori M, Misra D, Shah AA, Shmagel AK, Thoma LM, Turgunbaev M, Turner AS, Reston J. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Management of Osteoarthritis of the Hand, Hip, and Knee. Arthritis Rheumatol. 2020 Feb;72(2):220-233. doi: 10.1002/art.41142. Epub 2020 Jan 6. Erratum in: Arthritis Rheumatol. 2021 May;73(5):799. doi: 10.1002/art.41761. PMID: 31908163; PMCID: PMC10518852.

Lee SH, Park SY, Heo I, Hwang EH, Shin BC, Hwang MS. Efficacy of acupuncture for whiplash injury: a systematic review and meta-analysis. BMJ Open. 2024 Jan 17;14(1):e077700. doi: 10.1136/bmjopen-2023-077700. PMID: 38233056; PMCID: PMC10806823.

Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: An overview of systematic reviews. Evid-Based Complement Alternat Med. 2015;2015:328196.

Low back pain and sciatica in over 16s: assessment and management. NICE guideline. Reference number:NG59. Published: 30 November 2016 Last updated:11 December 2020

Xiang, Y., He, J., Tian, H., Cao, B., & Li, R. (2020). Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials. Acupuncture in Medicine, 38(1), 15–24. https://doi.org/10.1136/acupmed-2017-011445

Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain: A systemic review. Spine (Phila Pa 1976). 2008;33(23):E887–E900