Acupuncture appears to be a legitimate treatment option for knee osteoarthritis pain, with a large body of clinical evidence now supporting its use as a complementary therapy alongside conventional care. A 2024 systematic review and network meta-analysis published in BMJ Evidence-Based Medicine pooled data from 80 randomized controlled trials involving 9,933 participants with knee osteoarthritis (KOA), comparing acupuncture against sham acupuncture, nonsteroidal anti-inflammatory drugs (NSAIDs), usual care, waiting-list controls, and steroid injections .

Osteoarthritis affects more than 32.5 million adults in the United States, particularly after age 45, and over 600 million people worldwide . The condition is characterized by structural changes in the joint rather than systemic inflammation, making it distinct from autoimmune forms of arthritis like rheumatoid arthritis. As a leading cause of physical disability in adults, osteoarthritis has prompted many patients to explore complementary treatments when conventional options fall short or cause side effects.

What Does the Clinical Evidence Actually Show?

The landmark 2004 multicenter randomized controlled trial at the University of Maryland School of Medicine's Center for Integrative Medicine enrolled 570 adults with knee osteoarthritis and assigned them to receive true acupuncture, sham acupuncture (using non-penetrating needles or needling at incorrect points), or a self-management education program, while continuing their usual medical care . Participants in the true acupuncture group received 23 treatment sessions over 26 weeks. By the end of the study, they experienced an average reduction in knee pain of about 40 percent and nearly a 40 percent improvement in physical function compared with their baseline scores, with improvements in the sham acupuncture and education groups being smaller .

The 2024 analysis drawing on this much larger evidence base represents one of the most comprehensive evaluations of acupuncture's effectiveness for knee pain. The sheer volume of research, spanning 295 publications across 26 countries, 133 institutions, and 107 journals according to a 2025 bibliometric analysis published in Frontiers in Medicine, demonstrates that acupuncture has moved from the margins of medical practice into mainstream clinical investigation .

"There's an explosion of credible, peer-reviewed medical journal citations, the literature is very robust," said Woodson Merrell, M.D., assistant professor of medicine at the Icahn School of Medicine at Mount Sinai in New York and a New York State licensed physician acupuncturist.

Woodson Merrell, M.D., Assistant Professor of Medicine at Icahn School of Medicine at Mount Sinai

How Does Acupuncture Work for Pain Relief?

While acupuncture is rooted in traditional Chinese medicine, which describes the treatment in terms of restoring the flow of qi (vital energy) through pathways called meridians, Western biomedical research has identified several plausible biological mechanisms . These proposed pathways include:

• Endorphin Activation: Acupuncture may stimulate the release of endorphins, the body's natural pain-relieving chemicals that reduce the perception of pain signals.
• Nervous System Calming: The treatment appears to have a regulatory effect on the nervous system, potentially reducing stress responses and pain sensitivity.
• Improved Blood Flow: Acupuncture may enhance circulation to affected joints, delivering more oxygen and nutrients to support healing.
• Inflammation Reduction: Research suggests acupuncture can help reduce inflammatory markers in the joint and surrounding tissues.
• Brain Pathway Modulation: The treatment may alter how the brain processes and interprets pain signals, particularly through emotional and cognitive pathways.

The actual mechanism likely involves a combination of these pathways working together, though researchers acknowledge that fully understanding how different physiological systems interact during acupuncture treatment remains an ongoing challenge .

How Is Acupuncture Actually Administered?

In clinical practice, acupuncture involves inserting sterile, disposable, hair-thin needles into the skin at specific points called acupoints . The needles may be manipulated by hand or stimulated with small electrical currents, a technique known as electroacupuncture. Treatment typically involves multiple sessions over several weeks, often alongside conventional medical care. A typical course, as demonstrated in the landmark 2004 trial, involved 23 sessions spread over 26 weeks, though treatment protocols vary across studies and practitioners.

What Do Official Medical Guidelines Recommend?

The American College of Rheumatology (ACR) and Arthritis Foundation guidelines conditionally recommend acupuncture for osteoarthritis of the knee, hip, or hand, meaning it may be appropriate for some patients, but the evidence of benefits is not strong or consistent enough to recommend it for everyone . The evidence base is most extensive for knee osteoarthritis, more limited for hip osteoarthritis, and sparse for hand osteoarthritis.

First-line treatment for osteoarthritis still includes exercise and weight management, along with topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen for pain relief . For more severe or localized symptoms, corticosteroid injections into the joint may help, and joint replacement surgery is typically reserved for advanced disease. Acupuncture is increasingly viewed as a valuable complementary option, particularly when symptoms persist or medications are not well tolerated.

"Acupuncture was considered for some time a fringe treatment and not part of legitimate medical care, but that perspective is at least 10 years old. There is now a vast body of quality, scientifically rigorous research being conducted showing its benefits, particularly around pain management. The evidence has evolved, and acupuncture is increasingly viewed as a legitimate intervention worth understanding," explained Belinda Anderson, Ph.D., associate dean and professor at Pace University in the College of Health Professions and associate clinical professor at Albert Einstein College of Medicine in New York.

Belinda Anderson, Ph.D., Associate Dean and Professor at Pace University

Why Are More Americans Turning to Acupuncture?

According to national survey data summarized in a 2024 update from the National Institute of Health's National Center for Complementary and Integrative Health (NCCIH), the percentage of U.S. adults reporting acupuncture use more than doubled between 2002 and 2022, rising from 1.0 percent to 2.2 percent, or approximately 7.3 million adults who used it for pain . This dramatic increase reflects both growing awareness of the treatment's potential benefits and a shift in how the medical establishment views complementary therapies.

The growing adoption is also driven by practical concerns. Many patients with chronic osteoarthritis experience side effects from long-term NSAID use, including gastrointestinal problems and increased cardiovascular risk. For these individuals, acupuncture offers an alternative that may provide meaningful pain relief without the same medication-related risks.

What Are the Limitations of Current Research?

Despite the growing evidence base, important limitations remain. Differences in treatment protocols, comparison groups, and practitioner technique complicate comparisons across studies, even for knee osteoarthritis where the evidence base is most extensive . Some studies use sham acupuncture as a control, which itself may have therapeutic effects, making it difficult to isolate acupuncture's true benefit. Additionally, many studies involve relatively small sample sizes and short follow-up periods, leaving questions about long-term effectiveness and optimal treatment duration.

The research landscape is also evolving rapidly, with new studies being published regularly. This means clinical guidelines and expert recommendations may shift as additional evidence accumulates. Patients considering acupuncture should discuss it with their healthcare provider to determine whether it's appropriate for their specific situation and how it might fit into their overall treatment plan.