Acupuncture for Stroke Recovery: Evidence

Stroke is an emergency: act first

A stroke needs urgent medical help in hospital because it can be life-threatening. The NHS (UK) uses the word FAST: face, arms, speech and time to call 999. [1] It adds that symptoms can stop after a short time, and that you should still get medical help straight away. [1] In the United States, call 911. Do not wait to see whether symptoms pass, and do not book acupuncture instead of emergency care.

This page is about recovery after stroke has been treated, and about Bell's palsy. Acupuncture is explained on What Is Acupuncture?.

Rehabilitation comes first

The NHS says recovery depends on how much a stroke has affected you physically and mentally, and on your rehabilitation plan, with exercises, activities and therapy sessions that are often difficult but help progress. [2] Acupuncture, if used, sits beside rehabilitation, not in place of it.

Evidence after stroke

Labels: established, promising but limited, mixed, insufficient evidence, no good evidence of benefit.

1. Recovery stage (subacute and chronic), Cochrane 2016: 31 trials, 2,257 people

   Insufficient evidence

   Two sham trials found no difference in motor function or quality of life. Against usual care alone, 29 trials favored acupuncture on daily living, neurological deficit and other measures, but quality was low or very low. The authors said evidence was inadequate to conclude routine use is justified. [3]

2. First 30 days (acute stroke), Cochrane 2018: 33 trials, 3,946 people

   No good evidence of benefit

   Apparent benefit on death or dependency against any control was uncertain and was not confirmed in the 6 sham trials (odds ratio 0.71, 95% CI 0.43 to 1.18). [4]

3. Swallowing problems after acute ischemic stroke, 2026 trial: 300 people, 23 hospitals in China

   Promising but limited

   At day 14, 78.0% of the acupuncture group vs 57.0% of the sham group reached the target eating level (relative risk 1.37). Adverse events were mild and transient. [5]

Most of the older evidence comes from comparisons with no sham, so patients and assessors knew who got acupuncture. The 2018 Cochrane authors said apparent benefits in acute stroke were confounded by risk of bias from open controls. [4] The swallowing result is a single trial, run in China, with 10 sessions over 14 days; it needs repeating elsewhere. In the 2016 review, sickness and intolerance of pain at acupuncture points were reported in a few people. [3]

For acute stroke, adverse events such as pain, dizziness or fainting were recorded in 6.2% of people in the acupuncture arms. [4]

Bell's palsy

Bell's palsy is sudden weakness on one side of the face. The NHS says most people get better within 6 months, that steroids can help, and that a drooping face with an arm that cannot be raised or with slurred speech can be signs of stroke, which is a medical emergency. [6]

The Cochrane review of acupuncture for Bell's palsy (2010) found 6 trials (537 people). Study design flaws prevented reliable conclusions; none reported the outcomes the reviewers wanted, and harmful side effects were not reported. [7] A 2019 review of 11 trials (1,258 people) compared acupuncture with drug treatment and found higher cure and effective rates with acupuncture, but with substantial heterogeneity, poor-quality studies and not enough evidence on safety; the authors said to interpret results cautiously. [8] Label: insufficient evidence. I found no sham-controlled review of acupuncture for Bell's palsy in the sources read: proper evidence not found for that comparison.

Related reading

TCM for Stroke Recovery and Dementia, Scalp Acupuncture and Coordinating Acupuncture With Your Medical Care.