Acupuncture is a popular alternative medicine approach with origins in Chinese medicine. It is mainly used for treatment of a variety of pain and pain syndromes. Acupuncture involves the placement of fine needles in strategic positions. The working principles of acupuncture remain shrouded in mystery but it has been pointed out that there are some vague similarities with transcutaneous electrical nerve stimulation, TENS. TENS is assumed (not proven) to work by exerting stimulus to peripheral nerves by applying small currents via electrodes through the skin. It is thought that acupuncture may achieve similar nerve stimulation effects by piercing the skin with fine needles.

There is a large body of literature on acupuncture and it is highly controversial if acupuncture has any clinical benefits beyond a placebo effect (some have branded acupuncture as ‘theatrical placebo’). The debate depends on a large number of poor-quality studies that do not provide any reliable evidence. Further there is nothing close to agreement as to how clinical effects of acupuncture should be assessed and validated.

Some studies employ sham needling and compare the outcomes in trial-like manner to the outcomes for standard acupuncture treatments. The majority of these studies do not demonstrate any effect of acupuncture that would be significantly different from / better than that of the sham procedures. Critics take this as strong evidence to dismiss any benefits of acupuncture. Only small observational studies without comparison with sham needle procedures report better outcomes than other (or no) treatment. Perhaps the only significant and reliable piece of information in the debate about acupuncture actually is this difference in reported results.

Those in favour of acupuncture question the merits of comparing sham and real procedures, claiming that acupuncture cannot be assessed in this way (a questionable argument), given that such acupuncture assessment schemes still amount to essentially comparing ‘apples and pears’. Those in favour of acupuncture take fMRI effects observed after needle placement as evidence that acupuncture works – but forget to mention that sham needling and/or other placebo experiments also produce measurable fMRI effects. Some of those in favour of acupuncture take a pragmatic view and promote it as a relatively safe, though only moderately effective intervention. In short, the whole debate lacks rigour and depth, and there is no robust and convincing evidence that acupuncture is clinically effective because of the mediocre quality of publications on this topic.

Regarding maxillofacial pain syndromes, acupuncture applications mainly in the management of temporomandibular (jaw) joint disorders, myofascial (muscle) facial pain and spasms and several other facial pain syndromes have been reported, including migraines and other headaches and anxiety in dental patients.

So, what should one conclude at this point? If somebody believes that acupuncture helps them, perhaps they should use it – keeping in mind that there may be other, free of cost, ways to achieve similar results, by placebo effects or otherwise. When deciding for or against acupuncture it may be a good idea to remember that although acupuncture is nearly always portrayed as harmless, it does carry some small risks for minor and serious adverse effects including injuries, bleeding, fainting and infections.