Clinical Practice Guidelines That Mention Acupuncture: ACP, NICE and Others
What the American College of Physicians, NICE and the American College of Rheumatology say about acupuncture in their guidelines, side by side, and why they do not all agree.
Content last updated . This page has not been medically reviewed.
Guidelines side by side
| Guideline | Condition | What it says about acupuncture |
|---|---|---|
| ACP (United States), 2017 | Low back pain, acute, subacute and chronic | Acupuncture is one of several nonpharmacologic options to select first; recommendation graded strong [1] |
| NICE NG59 (England) | Low back pain with or without sciatica | "Do not offer acupuncture" [2] |
| NICE NG193 (England) | Chronic primary pain (pain with no clear underlying condition) | Consider a single course, with limits on setting, practitioner and time [3] |
| NICE CG150 (England) | Tension-type headache and migraine prevention | Consider a course of up to 10 sessions over 5 to 8 weeks [4] |
| ACR and Arthritis Foundation (United States), 2019 | Osteoarthritis of the hand, hip and knee | Conditional recommendation, in a list with other approaches [5] |
What each guideline actually said
ACP (low back pain). The panel based its advice on trials and reviews published through April 2015, with updated searches through November 2016. [1] For acute or subacute pain, it advised choosing nonpharmacologic treatment such as heat, massage, acupuncture or spinal manipulation, and rated the evidence for acupuncture as low quality. [1] For chronic pain, it listed acupuncture among options with moderate-quality evidence, alongside exercise, multidisciplinary rehabilitation and mindfulness-based stress reduction. [1]NICE (low back pain). The NG59 page we read (published November 2016, last updated July 2026) still carries the 2016 instruction not to offer acupuncture for low back pain with or without sciatica. [2]
NICE (chronic primary pain). NG193 says to consider a single course of acupuncture or dry needling for people aged 16 and over. [3] The recommendation applies only if the course is delivered in a community setting and fits within no more than 5 hours of healthcare professional time, or is delivered in another way at equal or lower cost. [3] In practice this is a cost-conscious, limited offer, not a general endorsement.
NICE (headaches). For prevention of chronic tension-type headache, CG150 says to consider up to 10 sessions over 5 to 8 weeks. [4] For migraine prevention, it applies this only if propranolol, topiramate and amitriptyline have not worked or are unsuitable, and it takes the person's preference into account. [4]
ACR and Arthritis Foundation (osteoarthritis). Acupuncture was among the approaches given a conditional recommendation, a weaker level than the strong recommendations given to exercise and other options. [5] The abstract we read does not say which joint the acupuncture recommendation applies to, so we do not state that. See acupuncture for knee osteoarthritis.
Why guidelines differ
The ACP's evidence searches ran through 2015 and 2016, and NICE published NG59 in November 2016, so the two looked at a similar period yet reached opposite conclusions on low back pain. We did not read NICE's full evidence review, so we cannot say exactly why. In general, panels can weigh the same trials differently, for example how much a gap between real and sham acupuncture matters, how they judge cost, and which outcomes count most. That is our general explanation, not a reason either group gave in the pages we read. Evidence label for acupuncture across guidelines: mixed. Trial-quality issues that matter here are in quality and bias in acupuncture trials.How to use this page
- A guideline is advice for groups of patients, not a prediction for you.
- A "consider" or "conditional" recommendation means reasonable people may choose differently.
- Guidelines change; check the date and the current version.
- Never stop a prescribed treatment because of what a guideline says. Talk to the clinician who knows your health history.
- For safety questions, see side effects and precautions.
Frequently asked questions
Do medical guidelines recommend acupuncture?
Some do for some conditions. The ACP lists it as an option for low back pain, [1] and NICE says to consider it for chronic primary pain and some headaches, [3][4] but NICE advises against it for low back pain. [2]
Why does NICE say no for back pain but yes for chronic pain?
They are separate NICE guidelines about different conditions. The NG59 page we read says not to offer acupuncture for low back pain, [2] while NG193 says to consider a limited course for chronic primary pain. [3] We did not read the committees' reasoning.
Is a "conditional" recommendation a strong endorsement?
No. The ACR gave acupuncture a conditional recommendation for osteoarthritis, while exercise and some other approaches received strong ones. [5]
Are there guidelines from outside the United States and England?
Likely yes, but we have not read them for this page. Proper evidence not found here for guidelines from other countries.
Can I use a guideline to decide on my own?
It can help you ask better questions, but it is not personal advice. Discuss options with your clinician, who knows your health history and medicines.
References
- Qaseem A et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017. Read 2026-10-22.
- NICE. Low back pain and sciatica in over 16s: assessment and management (NG59), Recommendations. Read 2026-10-22.
- NICE. Chronic pain (primary and secondary) in over 16s (NG193), Recommendations. Read 2026-10-22.
- NICE. Headaches in over 12s: diagnosis and management (CG150), Recommendations. Read 2026-10-22.
- Kolasinski SL et al. 2019 American College of Rheumatology/Arthritis Foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis Care Res 2020. Read 2026-10-22.