Acupuncture for Knee Osteoarthritis: What the Evidence Shows

Key Takeaways

Research shows acupuncture provides modest but real pain relief for knee osteoarthritis
Benefits may partly come from placebo effects, but meaningful improvement is often seen
Acupuncture is very safe when performed by qualified practitioners
Most people need 6-12 sessions to evaluate whether it’s helping
It works best as part of a comprehensive treatment plan, not as the sole treatment
Insurance coverage varies—check your plan before starting

Acupuncture has been used in traditional Chinese medicine for thousands of years. For knee osteoarthritis, it’s one of the most studied complementary therapies. But does it actually work, and is it worth trying?

This guide examines the evidence and helps you decide if acupuncture might be right for your knee pain.

What Is Acupuncture?

Traditional Understanding

In traditional Chinese medicine, acupuncture works by:

Balancing the flow of qi (vital energy) through meridians
Releasing blockages that cause pain and illness
Restoring the body’s natural healing abilities

Western Understanding

Modern research suggests acupuncture may work through:

Nervous system effects: Stimulating nerves alters pain signaling
Endorphin release: Natural painkillers produced by the body
Inflammation modulation: Changes in inflammatory responses
Connective tissue stimulation: Effects on fascia and soft tissues
Placebo response: Expectation and therapeutic relationship effects

The Procedure

During an acupuncture session:

The practitioner assesses your condition
You lie or sit in a comfortable position
Thin, sterile needles are inserted at specific points
Needles remain in place for 15-30 minutes
Some practitioners use additional techniques (electrical stimulation, heat)

What Does Research Show?

Overall Evidence

Acupuncture for knee osteoarthritis has been extensively studied:

Cochrane Review (major analysis of multiple studies):

Acupuncture provides statistically significant pain relief compared to no treatment
Benefits are modest but clinically meaningful for many patients
When compared to “sham” acupuncture (needles in non-traditional points), benefits are smaller but often still present

Key Findings

Compared to no treatment or waiting list:

Clear benefit for pain reduction
Improved physical function
Effects may last several months

Compared to sham acupuncture:

Smaller differences
Real acupuncture still tends to outperform sham
Suggests some benefit beyond just inserting needles anywhere

Compared to other treatments:

Similar effectiveness to NSAIDs for some patients
Can be used alongside other treatments safely
May allow reduction in pain medication use

What “Modest Benefit” Means

Research often describes acupuncture benefits as “modest.” In practical terms:

Not a cure for arthritis
Reduces pain by approximately 20-30% for responders
Improves function and quality of life
Some patients experience significant relief, others minimal
Benefits may be enough to make meaningful difference in daily activities

Guidelines and Recommendations

What Medical Organizations Say

American College of Rheumatology (2019 guidelines):

Conditionally recommends acupuncture for knee OA
Considered appropriate for patients who haven’t responded to or can’t take standard medications

NICE (UK guidelines):

Previously recommended acupuncture for OA
Current guidance is more cautious but doesn’t discourage

World Health Organization:

Lists knee OA as a condition for which acupuncture may be helpful

What to Expect

First Visit

Your initial appointment typically includes:

Health history review
Discussion of your knee symptoms
Physical examination
Explanation of the treatment plan
First treatment session (or this may be scheduled separately)

During Treatment

You’ll be positioned comfortably
Needles are very thin (much thinner than blood draw needles)
Insertion may cause brief pinch or pressure
Most people feel relaxed during treatment
You may notice warmth, tingling, or aching at needle sites (considered normal)

Treatment Course

Typical protocol:

1-2 sessions per week
Initial course of 6-12 sessions
Reassessment after initial course
Maintenance sessions may be recommended (monthly or as needed)

Response Time

Some people notice improvement immediately
Others need several sessions before noticing change
If no improvement after 6-8 sessions, it may not be effective for you
Benefits often increase over the first several weeks

Is Acupuncture Safe?

Safety Profile

Acupuncture is considered very safe when performed by qualified practitioners:

Common minor effects:

Slight bleeding or bruising at needle sites
Temporary soreness
Brief lightheadedness
Relaxation or fatigue after treatment

Rare serious complications:

Infection (very rare with proper technique)
Organ puncture (extremely rare with qualified practitioners)
Nerve damage (very rare)

Who Should Be Cautious

Talk to your doctor before starting acupuncture if you:

Take blood thinners
Have a bleeding disorder
Have a pacemaker (if electrical stimulation will be used)
Are pregnant
Have compromised immune system
Have skin conditions at treatment areas

Finding a Qualified Practitioner

Credentials to Look For

In the US:

Licensed Acupuncturist (L.Ac., Lic.Ac., or similar)
Certification from NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine)
Master’s or Doctorate in acupuncture or Oriental medicine

Medical acupuncturists:

MDs or DOs with additional acupuncture training
May have certification from ABMA (American Board of Medical Acupuncture)

Questions to Ask

What is your training and certification?
How many years have you been practicing?
Do you have experience treating knee osteoarthritis?
What should I expect from treatment?
How many sessions do you typically recommend?
What are your fees, and do you accept insurance?

Red Flags

Be cautious of practitioners who:

Guarantee results
Recommend extremely long treatment courses upfront
Don’t use single-use, sterile needles
Can’t explain their qualifications
Discourage you from seeing your regular doctor

Cost and Insurance

Typical Costs

Per session: $75-$150 (varies by location and practitioner)
Initial course (6-12 sessions): $450-$1,800
Maintenance: Varies based on frequency

Insurance Coverage

Some private insurance: May cover a limited number of sessions
Medicare: Generally does not cover acupuncture for OA
Check your specific plan: Coverage varies widely
HSA/FSA: Often can be used for acupuncture

Cost-Effectiveness

Consider:

How does cost compare to other treatments you’re considering?
Will it allow you to reduce other healthcare costs (medications, doctor visits)?
What is the value of potential quality of life improvement?

Combining Acupuncture with Other Treatments

Works Well With

Exercise and physical therapy
Weight management
Standard medications (NSAIDs, acetaminophen)
Other injections (hyaluronic acid, corticosteroids)
Heat and cold therapy

Important Considerations

Tell your acupuncturist about all medications and treatments
Tell your regular doctor about acupuncture
Don’t stop other treatments without discussing with your healthcare team
Acupuncture is complementary, not replacement for standard care

Who Is Most Likely to Benefit?

Good Candidates

People who want to try non-drug approaches
Those who can’t take or haven’t responded well to NSAIDs
Patients looking to reduce medication use
People with mild to moderate knee OA
Those open to the treatment approach

May Be Less Effective For

Severe, end-stage knee OA
People with strong skepticism (mindset matters for pain treatment)
Those unable to commit to a course of treatment
Patients expecting a cure rather than management

Frequently Asked Questions

Does acupuncture hurt?

Most people experience minimal discomfort. The needles are very thin, and insertion typically causes only a brief sensation. Some points may be more sensitive than others. Most people find sessions relaxing.

How is “real” acupuncture different from “sham”?

Sham acupuncture in studies uses needles at non-traditional points, superficial insertion, or non-penetrating placebo devices. The fact that sham acupuncture often also helps suggests that some benefits come from the ritual and expectation, but real acupuncture typically outperforms sham.

Can acupuncture make arthritis worse?

Acupuncture doesn’t worsen the underlying arthritis. Some people experience temporary increased soreness after sessions, but this typically resolves quickly. There’s no evidence it accelerates joint damage.

How long do the benefits last?

Benefits from a course of acupuncture may last several months. Many people benefit from periodic maintenance sessions. The duration of relief varies between individuals.

Should I try acupuncture before other treatments?

Generally, acupuncture is considered complementary to standard treatments, not a replacement. Most guidelines suggest trying established treatments (exercise, physical therapy, appropriate medications) alongside or before acupuncture. However, if you prefer non-drug approaches, acupuncture is a reasonable early option.

Exploring treatment options for knee pain? Learn about hyaluronic acid injections or read about exercises for knee arthritis.

Last medically reviewed: February 2025

Medical Disclaimer: This article is for informational purposes only and is not a substitute for professional medical advice. Discuss acupuncture and all treatment options with your healthcare provider.