How Does Acupuncture Actually Work? What the Research Is Starting to Show

For a long time, acupuncture had a bit of a strange position in healthcare.

Clinically, many of us saw patients respond to it.

But when somebody asked, “How does sticking a needle in someone actually change pain or function?” the explanation was often much less satisfying.

That is changing.

The more we understand the nervous system, immune system and mechanisms of tissue repair, the easier it becomes to view acupuncture not simply as “putting needles into muscles,” but as a form of targeted sensory and neuromodulatory input.

And some of the research coming out is pretty fascinating.

A needle is an input into the nervous system

The first concept is probably the most important.

When we insert and manipulate a needle, we aren't doing nothing.

We are mechanically stimulating tissue containing sensory nerve endings, connective tissue, immune cells and blood vessels. That stimulation generates neural and biochemical signals that can be processed locally, through the spinal cord, and eventually through higher centres of the nervous system.

A 2024 clinical review of acupuncture for pain described several interacting mechanisms, including local physiological responses around the needle, modulation of nociceptive signalling at the spinal and supraspinal levels, endogenous opioid signalling, and changes within brain networks involved in sensory, emotional and cognitive aspects of pain.

So instead of thinking:

Needle → muscle relaxes

a better model may be:

Needle → sensory input → nervous system response → altered physiology

And that response could occur at several levels.

There are local biochemical effects

Needling creates a small, controlled mechanical stimulus in tissue.

One pathway receiving significant attention is purinergic signalling.

Mechanical stimulation can influence extracellular ATP and its breakdown product, adenosine. Adenosine can interact with receptors such as the A1 receptor on sensory afferents, potentially reducing nociceptive signalling locally. More recent reviews continue to identify ATP, adenosine, P2X receptors and inflammatory signalling as important candidates in acupuncture-induced analgesia.

That means the area surrounding a needle isn't simply being “released.”

There is an actual biological response occurring in and around the tissue.

Acupuncture may change how nociceptive information is processed

This is where it becomes particularly relevant to how we think about our patients.

Pain isn't simply information coming from damaged tissue.

It is an output created through processing across the peripheral nervous system, spinal cord and brain.

Acupuncture appears capable of influencing several parts of that system.

Recent reviews describe effects on peripheral afferent input, spinal nociceptive processing, descending pain-modulatory pathways and higher brain networks involved in pain perception.

Endogenous opioid systems, GABAergic signalling, glutamatergic signalling, neuropeptides and multiple receptor systems have all been implicated.

This is one reason I think the term neuromodulation is much more useful than simply saying acupuncture “releases a tight muscle.”

We are giving the nervous system an input and potentially changing how it responds to subsequent input.

Then there is the neuroimmune system

This area may become one of the more interesting pieces of the acupuncture story.

We increasingly understand that pain, inflammation and nervous-system function cannot really be separated into independent systems.

Sensory neurons communicate with immune cells.

The autonomic nervous system influences immune activity.

Glial cells influence nociceptive processing.

And inflammatory mediators can change neuronal excitability.

Recent mechanistic reviews suggest acupuncture and electroacupuncture can influence this neuroimmune interaction through sensory-afferent stimulation, autonomic pathways and signalling cascades associated with inflammatory regulation.

Again, that doesn't mean acupuncture simply “turns inflammation off.”

Biology is rarely that simple.

It suggests that the stimulation may influence the systems regulating the inflammatory environment.

And this brings us to nerve repair

One paper I recently went back through made this even more interesting.

Researchers created a peripheral sciatic nerve injury and treated it with electroacupuncture.

They found that electroacupuncture decreased expression of a microRNA called miR-1b. That mattered because miR-1b negatively regulates brain-derived neurotrophic factor, or BDNF.

BDNF is an important neurotrophic factor involved in neuronal survival and regeneration.

When the researchers reduced miR-1b, BDNF increased. Schwann-cell proliferation and migration increased as well, and functional measures including nerve conduction and sciatic nerve recovery improved.

When they experimentally increased miR-1b, some of the benefits of electroacupuncture were reduced.

In other words, their results suggested a potential pathway:

Electroacupuncture → ↓ miR-1b → ↑ BDNF → improved Schwann-cell activity → enhanced peripheral nerve repair.

This is an animal study, so we cannot automatically translate that pathway into a claim that acupuncture regenerates injured human nerves. But it gives us something incredibly valuable: a plausible biological mechanism worth continuing to investigate.

That fits into a larger body of research showing how important Schwann cells, neurotrophic factors and activity-dependent stimulation are to peripheral nerve regeneration. Current nerve-regeneration literature continues to examine electrical stimulation as a way of promoting the regenerative response following peripheral nerve injury.

So why do we use acupuncture?

Not because every mechanism has been completely solved.

It hasn't.

And not because a needle magically “fixes” whatever structure hurts.

What we have instead is an increasingly sophisticated picture of acupuncture as a neuro-modulatory intervention capable of interacting with peripheral nerves, spinal processing, brain networks, local biochemical signalling, autonomic regulation and neuroimmune processes.

That model makes a lot more sense to me clinically.

We assess the patient.

We determine what part of the system we think needs to change.

Then we use acupuncture as one potential input into that system.

As I always say, the needle itself isn't the knowledge.

Knowing why you're putting it there is where the value is.

References / Further Reading

Liu YP et al. Electroacupuncture Promoted Nerve Repair After Peripheral Nerve Injury by Regulating miR-1b and Its Target Brain-Derived Neurotrophic Factor. Front Neurosci. 2020.

Chiu HY et al. Recent advances in acupuncture for pain relief. Pain. 2024.

Liu Y, Fox MP. The Role of Electrical Stimulation in Peripheral Nerve Regeneration: Current Evidence and Future Directions. J Hand Surg Glob Online. 2024.

Recent reviews of acupuncture mechanisms also describe purinergic, neuroimmune, autonomic and central nervous-system mechanisms involved in its effects.