Acupuncture Methods: Manual, Electro- and Auricular Acupuncture and Acupressure

Four methods, two kinds of stimulation

Manual, electro- and auricular acupuncture all use needles that go through the skin. Acupressure uses pressure only and does not break the skin, so its risks and evidence are different. Keep the two groups apart when reading claims. [1] The page what is acupuncture explains the overall approach.

Manual acupuncture

This is the form most studies describe: fine needles are inserted and may be moved by hand. [1] Most of the evidence on back and neck pain and headache comes from trials of needling. Needles must be sterile and single-use. In the United States the FDA regulates acupuncture needles as medical devices and requires them to be sterile and labeled for single use only. [1]

Electroacupuncture

Here the needles are connected to a device that passes a small electrical current. [1]

• Evidence: NCCIH describes a 2017 study of about 500 women with stress urinary incontinence. Those given electroacupuncture (18 sessions over 6 weeks) had less leakage, with about two-thirds having a drop of 50 percent or more. NCCIH called it a rigorous study. [1] Evidence for other conditions is on the use pages. In a 2024 review of knee osteoarthritis trials, electroacupuncture appeared to work better than manual acupuncture, but the evidence overall was rated very low certainty. [2]
• Precaution: A study of current paths concluded electroacupuncture should not be applied so that the current is likely to cross the heart. [3] People with a pacemaker or other implanted device should say so before any session. [4] More on side effects and precautions.

Auricular (ear) acupuncture

Auricular acupuncture stimulates specific areas of the ear. NCCIH reports promising results for chronic back pain and cancer pain: a 2019 review of 15 studies (930 people) of auricular acupuncture or auricular acupressure found reduced pain, and a 2020 review of nine studies (783 people) found better cancer pain relief than sham ear acupuncture. [1]

One simple ear technique called "battlefield acupuncture" has been used by U.S. military and veterans' services. A 2021 review of nine studies (692 people) found no significant improvement in pain compared with no treatment, usual care, delayed treatment or sham. [1] Label: promising but limited for ear methods in general, no good evidence of benefit for battlefield acupuncture in that review.

Acupressure

Acupressure presses on the same traditional points with fingers or a device, with no needles. It is covered on acupressure. Wrist stimulation at the point called PC6 was part of a large Cochrane review of postoperative nausea; that review included acupuncture, electrical stimulation and acupressure. [5]

Choosing between methods

Method matters less than the reason you are seeking care. Ask the practitioner why they suggest a method, what the evidence is for your problem, and how many sessions they expect before judging results. See acupuncture licensing and training.