According to a recent review comprising over 10,000 MS patients around the world, acupuncture is sought by approximately 14% 1. 

What is Acupuncture?

     Acupuncture is a form of alternative (or “complementary”) medicine (CAM) and a component of traditional Chinese medicine. In this practice, thin needles are inserted into the body through the skin at strategic points to balance multiple systems and relieve specific symptoms. Practitioners believe that acupuncture can restore the flow of life energy or “qi,” which must move freely through the body – through channels called “meridians” – to maintain health and prevent illness. Acupuncture can also stimulate nerves under the skin and in the muscles, resulting in production of beneficial natural substances such as pain-relieving and wellness-promoting endorphins 2.

Advantages of Acupuncture

    Some clinical studies have linked acupuncture with improvement in MS symptoms. Advantages include regulation of the neuro-immune system, increased quality of life, normalization of bladder function, delayed disease progression, and reduced fatigue, spasm and pain in limbs, and relapses 3,4. 

     Research into the specific mechanisms have suggested that the manner in which acupuncture stimulates the nervous system causes biochemical changes that balance the body and enable a return to health. Such mechanisms include reduction in inflammatory and autoimmune T-cells 5-8, associated with improvement in paralytic symptoms in animal models of MS5; promotion of NT-3, a protein growth factor that supports neuronal survival; increased number and differentiation of endogenous oligodendrocyte precursor cells, which supports remyelination and functional improvement of the demyelinated spinal cord9-11 to improve impaired motor coordination 12; reduced sensitivity to pain, stress, and anxiety; and promotion of relaxation and a sense of well-being 13. The addition of gentle electrical currents to acupuncture points – a technique known as electroacupuncture – demonstrated anti-inflammatory effects on demyelinated rats, with stimulation of the hypothalamus in the brain to increase adrenocorticotropic hormone (ACTH)/β-endorphins, which in turn regulates T helper (Th) cell responses 14.

     A small study exploring the effects of eight acupuncture treatments combined with health promotion classes on women with MS revealed significant improvements in fatigue and quality of life, including as measured by modified fatigue impact scale (MFIS), perceived stress scale (PSS), self-rated abilities for health promotion (SRA), and social functioning (SF-36)15. In a somewhat larger study on quality of life, RRMS patients who received electroacupuncture for 30 minutes/week for six months in addition to immunomodulating medications experience significantly improvement compared to sham treatment16. In another study on fatigue, 12 sessions of acupuncture reduced mean fatigue scores by nearly 30% in non-responders to the conventional antidyskinetic medication amantadine17.

     In an evaluation of disability, Wang et al. (2017) showed that 10 acupuncture treatments every two weeks for three months was associated with lower expanded disability status score (EDSS) compared to sham. This same study also showed a dramatically decreased annual relapse rate compared to no acupuncture, more so than with sham treatment 18.

    In another disability trial, MS patients receiving electroacupuncture with injection of mouse nerve growth factor in specific places on the body called “acupoints” demonstrated improved activity of daily life, EDSS, and Barthel index compared to the individual treatments 19. In a study in RRMS patients comparing true to sham electroacupuncture alone for 30 minutes once a week for six months, the EDSS score in the true group was slightly improved compared to worsening with sham, and pain as evaluated by visual analogue scale was significantly reduced for a longer period of time compared to sham 16.

     In a crossover study in RRMS patients with gait impairment – with participants receiving both true and sham interventions – acupuncture was associated with immediately and significantly improved timed 25-foot walk compared to sham 20.

    In a small group of MS patients with bladder dysfunction, electroacupuncture once a week for 10 weeks was associated with improvement: the average urge frequency decreased by more than 50%, from nearly four to less than two times per day, and the average number of daytime leaking episodes declined from more than once to nearly none per day21.

    Overall, according to the currently available evidence, acupuncture appears to help improve key symptoms of multiple sclerosis – including fatigue, neural functional, deficits, pain, gait impairments, and bladder dysfunction – and reduce relapses, and therefore may be useful as a complementary therapy in MS patients 1.

Acupuncture Treatment

     An initial acupuncture session usually lasts 20 minutes to 1 hour and involves an assessment of your general health, medical history, and a physical examination, followed by insertion of the acupuncture needles. The needles used are very fine and are usually about an inch (a few centimeters) long. They are single-use, pre-sterilized needles, disposed of after use.

     During the session, you’ll usually be asked to lie down on your belly or back. You may also be asked to remove some clothes so the practitioner can access certain parts of your body. The needles are then inserted into specific places called acupuncture points, based on the practitioner’s examination of your condition. Several points may be used during a typical session, depending on the number of symptoms you have.

     The needles may be inserted just under the skin, or deeper so they reach muscle. Because MS may make you more sensitive to their effects, the needles may be inserted very lightly. You may feel a tingling or a dull ache when the needles are inserted – some describe it as a mild electric-type sensation – but you should not experience any significant pain. If you do, let your practitioner know right away. Once the needles are in place, they may be left there for a few minutes to up to approximately 30 minutes, and may or may not be attached to a machine that provides gentle electrical stimulation to enhance the influence.

     Courses of treatment often involve several separate sessions, but this can vary. A series of acupuncture treatments is generally more therapeutic and/or preventive than when a single treatment is used.

Acupuncture Risks

     The risks of acupuncture are low if you have a competent, certified acupuncture practitioner using sterile needles. Some health authorities such as the United States Food and Drug Administration (FDA) regulate acupuncture needles as medical devices, meaning their manufacture and labeling need to meet certain standards: they must be sterile, nontoxic, and labeled “for single use only” to be applied by prescription 22.

     For some people, mild, short-term side effects may include soreness and minor bleeding or bruising where the needles were inserted, drowsiness, nausea, dizziness, or general malaise. Since single-use, disposable needles are the practice standard, the risk of infection is minimal. In rare cases, a needle may break and damage an internal organ.

     In others with specific conditions, risks may be more serious and require adjustment. Before having acupuncture treatment, be sure to tell the practitioner if you have a bleeding disorder (e.g., hemophilia) or are taking blood thinners (e.g., warfarin), which may increase chances of bleeding or bruising from the needles; have a pacemaker, as acupuncture that involves applying mild electrical pulses to the needles may potentially interfere with a pacemaker’s operation; and/or are pregnant, as some acupuncture points are thought to stimulate labor, which could result in a premature delivery.

Acupuncture is usually not advised if you have a metal allergy or an infection in the area where needles may be inserted. In cases of allergy, ask your acupuncturist if they can use coated needles.

Selecting an Acupuncturist

To choose a practitioner, take no less care than you would when considering a conventional healthcare provider.

Asking people with experience for suggestions is a good first step. It is recommended to then check the practitioner’s training and credentials. Most states in the United States require that nonphysician acupuncturists pass an examination conducted by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), an organization that can be queried for a provider’s official status.

When making a selection without suggestions, the same and similar organizations around the world can steer you in the right direction. The following are some links:

• Australia: Australian Acupuncture and Chinese Medicine Association (AACMA)

• Canada: Chinese Medicine and Acupuncture Association of Canada (CMAAC)

• Europe: European Traditional Chinese Medicine Association (ETCMA)

• New Zealand: Acupuncture NZ

• United Kingdom: Professional Standards Authority for Health and Social Care

• United States: NCCAOM Practitioner Directory

Note that acupuncture may be at least partially covered by insurance or a country’s primary healthcare service.

References

1. Khodaie F, Abbasi N, Kazemi Motlagh AH, Zhao B, Naser Moghadasi A. Acupuncture for multiple sclerosis: A literature review. Mult Scler Relat Disord. Feb 26 2022;60:103715. doi:10.1016/j.msard.2022.103715

2. Zhu J, Li J, Yang L, Liu S. Acupuncture, from the ancient to the current. Anat Rec (Hoboken). Nov 2021;304(11):2365-2371. doi:10.1002/ar.24625

3. Haider S, Fatmi W, Shoaib N, Sajjad M, Zahid M. Assessment of acupuncture’s effectiveness in mitigating fatigue among patients afflicted with multiple sclerosis: A systematic review and meta-analysis. Complement Ther Clin Pract. Sep 6 2024;57:101902. doi:10.1016/j.ctcp.2024.101902

4. Karpatkin HI, Napolione D, Siminovich-Blok B. Acupuncture and multiple sclerosis: a review of the evidence. Evid Based Complement Alternat Med. 2014;2014:972935. doi:10.1155/2014/972935

5. Kim KY, Yang WJ, Shin TK, Jeong HJ, Kim HM. Impact of acupuncture by using life-energy (qi) oriental needle on the paralysis of rats with experimental autoimmune encephalomyelitis. Am J Chin Med. 2012;40(4):769-78. doi:10.1142/S0192415X12500577

6. Li N, Guo Y, Gong Y, et al. The Anti-Inflammatory Actions and Mechanisms of Acupuncture from Acupoint to Target Organs via Neuro-Immune Regulation. J Inflamm Res. 2021;14:7191-7224. doi:10.2147/JIR.S341581

7. Liu YM, Liu XJ, Bai SS, et al. The effect of electroacupuncture on T cell responses in rats with experimental autoimmune encephalitis. J Neuroimmunol. Mar 30 2010;220(1-2):25-33. doi:10.1016/j.jneuroim.2009.12.005

8. Zhao P, Chen X, Han X, et al. Involvement of microRNA-155 in the mechanism of electroacupuncture treatment effects on experimental autoimmune encephalomyelitis. Int Immunopharmacol. Aug 2021;97:107811. doi:10.1016/j.intimp.2021.107811

9. Huang SF, Ding Y, Ruan JW, et al. An experimental electro-acupuncture study in treatment of the rat demyelinated spinal cord injury induced by ethidium bromide. Neurosci Res. Jul 2011;70(3):294-304. doi:10.1016/j.neures.2011.03.010

10. Liu Z, He B, Zhang RY, et al. Electroacupuncture Promotes the Differentiation of Transplanted Bone Marrow Mesenchymal Stem Cells Preinduced With Neurotrophin-3 and Retinoic Acid Into Oligodendrocyte-Like Cells in Demyelinated Spinal Cord of Rats. Cell Transplant. 2015;24(7):1265-81. doi:10.3727/096368914X682099

11. Zou Z, Sun J, Kang Z, et al. Tyrosine Kinase Receptors Axl and MerTK Mediate the Beneficial Effect of Electroacupuncture in a Cuprizone-Induced Demyelinating Model. Evid Based Complement Alternat Med. 2020;2020:3205176. doi:10.1155/2020/3205176

12. Zhu K, Sun J, Kang Z, Zou Z, Wu G, Wang J. Electroacupuncture Promotes Remyelination after Cuprizone Treatment by Enhancing Myelin Debris Clearance. Front Neurosci. 2016;10:613. doi:10.3389/fnins.2016.00613

13. Hui KK, Marina O, Liu J, Rosen BR, Kwong KK. Acupuncture, the limbic system, and the anticorrelated networks of the brain. Auton Neurosci. Oct 28 2010;157(1-2):81-90. doi:10.1016/j.autneu.2010.03.022

14. Liu Y, Wang H, Wang X, et al. The mechanism of effective electroacupuncture on T cell response in rats with experimental autoimmune encephalomyelitis. PLoS One. 2013;8(1):e51573. doi:10.1371/journal.pone.0051573

15. Becker H, Stuifbergen AK, Schnyer RN, Morrison JD, Henneghan A. Integrating Acupuncture Within a Wellness Intervention for Women With Multiple Sclerosis. J Holist Nurs. Mar 2017;35(1):86-96. doi:10.1177/0898010116644833

16. Quispe-Cabanillas JG, Damasceno A, von Glehn F, et al. Impact of electroacupuncture on quality of life for patients with Relapsing-Remitting Multiple Sclerosis under treatment with immunomodulators: a randomized study. BMC Complement Altern Med. Nov 5 2012;12:209. doi:10.1186/1472-6882-12-209

17. Foroughipour M, Bahrami Taghanaki HR, Saeidi M, Khazaei M, Sasannezhad P, Shoeibi A. Amantadine and the place of acupuncture in the treatment of fatigue in patients with multiple sclerosis: an observational study. Acupunct Med. Mar 2013;31(1):27-30. doi:10.1136/acupmed-2012-010199

18. Wang C, Chen Z, Wang L, et al. [Relapsing-remitting multiple sclerosis at remission stage treated with acupuncture:a randomized controlled trial]. Zhongguo Zhen Jiu. Jun 12 2017;37(6):576-580. doi:10.13703/j.0255-2930.2017.06.002

19. Ding Y, Shi X. [Controlled research on multiple sclerosis treated with electroacupuncture and acupoint injection]. Zhongguo Zhen Jiu. Sep 2013;33(9):793-5. 

20. Criado MB, Santos MJ, Machado J, Goncalves AM, Greten HJ. Effects of Acupuncture on Gait of Patients with Multiple Sclerosis. J Altern Complement Med. Nov 2017;23(11):852-857. doi:10.1089/acm.2016.0355

21. Tjon Eng Soe SH, Kopsky DJ, Jongen PJ, de Vet HC, Oei-Tan CL. Multiple sclerosis patients with bladder dysfunction have decreased symptoms after electro-acupuncture. Mult Scler. Nov 2009;15(11):1376-7. doi:10.1177/1352458509107020

22. 8 Sec. 880.5580 Acupuncture needle. (1996).