Several years ago, Susan Harrison was in so much pain that she assumed hip and knee replacement surgery was only a matter of time.
Susan, 67, was diagnosed with osteoarthritis in both hips and her left knee in 2022. The condition, often described as ‘wear-and-tear’ arthritis, occurs when the protective cartilage breaks down, allowing bones to rub against one another.
‘I was determined to keep walking every day despite the pain, but I had to change my routes to avoid high pavements and stiles in the fields, as stepping up or climbing over them hurt my hips,’ says Susan, a retired council electoral services manager who lives near Clitheroe in Lancashire with her husband David, 69.
‘At times, the pain was intense, with severe aching in my joints and a throbbing sensation.’
Although she tried to maintain her usual routine, within months Susan was waking several times each night, relying on painkillers and finding the stairs difficult to climb.
‘Being woken so often and struggling to get back to sleep had a real effect on my days,’ says Susan, who has six grandchildren.
‘I would nod off in front of the television and often needed to sleep after lunch when I was especially tired.’
Four years on, she climbs stairs comfortably, takes long walks each day and rarely reaches for pain relief.
Susan Harrison, 67, was diagnosed with osteoarthritis in 2022 after severe pain led her to believe hip and knee replacement surgery was inevitable
Four years later, Susan climbs stairs easily, enjoys long daily walks and rarely needs painkillers — and believes acupuncture made the difference
She may still need joint replacement surgery eventually, but now hopes to put it off for many years.
Her explanation for the improvement? Susan believes acupuncture has been key.
After beginning weekly 75-minute appointments, she says she noticed a change within three weeks: ‘I could walk upstairs normally, and getting around my village became easier.’
Acupuncture involves placing fine needles at particular points on the body. The technique has been practised in China for centuries and is available on the NHS in some circumstances, including for chronic pain conditions such as fibromyalgia, which causes widespread pain, and migraines. Treatment is usually limited to a maximum of ten sessions.
Western acupuncture generally uses fewer, shallower needle insertions than traditional Chinese acupuncture. The needles are placed in areas known as acupuncture points, which contain a high concentration of nerve fibres, rather than points linked to concepts of energy and blood flow.
Some research suggests the treatment can provide meaningful pain relief.
In one example, patients with knee arthritis received electro-acupuncture — in which a mild electrical current is passed through inserted needles — three times a week for six weeks. They experienced ‘significantly’ greater improvements in pain and stiffness than those given sham treatment, according to a study published in The Lancet’s eClinicalMedicine in June this year.
Follow-up MRI scans also indicated that electro-acupuncture might have anti-inflammatory effects and help protect cartilage, the researchers reported.
Recent research suggests acupuncture could have benefits beyond pain relief, including possible effects on depression and anxiety. In a review of seven studies published in the journal Medicine in August, researchers from the Beijing University of Chinese Medicine examined brain scans from about 350 people with depression who were also taking antidepressants.
Compared with participants taking antidepressants alone, those who also received acupuncture showed greater activity in brain regions involved in regulating mood.
The acupuncture group also recorded larger reductions in depression and anxiety scores than those taking antidepressants without the treatment.
The precise way acupuncture produces these effects remains uncertain, although researchers have proposed several explanations.
One theory is that inserting a needle prompts the release of adenosine, a chemical that can dampen pain signals in the surrounding tissue and reduce inflammation, explains Dr John Hughes, head of research at the Royal London Hospital for Integrated Medicine, part of University College London Hospitals NHS Foundation Trust.
The needles may also activate sensory nerve fibres, sending signals to the spinal cord and brain that encourage the release of endorphins — sometimes called ‘happy hormones’ — which act as the body’s own painkillers, he adds.
An increase in endorphins could help explain why acupuncture may ease symptoms of depression.
The treatment also stimulates the release of cortisol, the stress hormone. Although high cortisol levels can contribute to inflammation, a short-term rise may have a natural anti-inflammatory effect, potentially explaining why acupuncture may help people with arthritis and other inflammatory conditions, says Dr Hughes.
Expectation may play a part, too. People receiving acupuncture often believe it will help, and this may activate placebo processes in the brain that prompt the release of naturally occurring opioid chemicals with pain-relieving properties, says Dr Kirsty Bannister, a pain neuroscientist and associate professor of sensory neurophysiology at Imperial College London.
‘Together with its demonstrated anti-inflammatory and pain-relieving effects, this may allow acupuncture to reduce pain,’ she says.
The National Institute for Health and Care Excellence (NICE), the healthcare treatment watchdog, recommends acupuncture ‘where there is evidence it can help certain groups of patients… for example, in the management of chronic pain’.
However, the criteria are limited, and NHS funding does not generally cover people with arthritis, lower back pain or cancer-related pain, who may need to pay privately. In London, an individual session can cost as much as £150.
A lack of UK-based research is one reason the treatment is not recommended more widely. Most acupuncture studies take place in China, says Ian Appleyard, research and policy manager at the British Acupuncture Council.
‘People in China are more familiar with acupuncture and are often more comfortable lying still while the needles are manipulated more strongly. Many Western patients need longer to get used to that sensation,’ he says.
‘To change NHS guidance, we need evidence showing that it works in the British population.’
Another challenge in acupuncture research is the use of ‘sham’ treatment as a comparison. Sham acupuncture is not necessarily inactive, because it still involves inserting a needle, says Dr Bannister.
‘NICE requires a treatment to show a particular degree of benefit over a placebo before recommending it. Acupuncture often does not reach that threshold when compared with sham acupuncture, because the sham procedure can still stimulate nerves to some extent,’ adds Ian Appleyard.
When carried out by a properly trained practitioner, acupuncture is generally considered low risk, although it may not be suitable for some people, including certain pregnant women. It is not a cure, stresses Dr Bannister.
Research suggests arthritis patients receiving electro-acupuncture (pictured) achieved ‘significantly’ greater improvements in pain and stiffness than those given sham treatment
‘Acupuncture may ease symptoms, but it does not address the underlying cause of a disease,’ she says.
‘It would be dangerous to stop medicines such as antidepressants or immune-suppressing drugs, which are prescribed for some forms of arthritis, and rely on acupuncture instead.’
For people like Susan who want to limit their use of painkillers, however, acupuncture can seem like an appealing additional option.
Susan was distressed when an X-ray in 2022 showed that osteoarthritis affected several of her joints.
‘When I read about the condition, I worried that it could seriously affect my quality of life,’ she says.
‘I was told it was not yet severe enough for joint replacements and that I would have to live with it. But I wondered whether I might eventually need surgery and, if so, how long replacement joints would last.’
Doctors recommended painkillers and prescribed daily exercises, including leg raises, to strengthen her muscles and maintain mobility.
‘I dislike taking painkillers unless they are absolutely necessary, but I knew the condition was likely to get worse,’ says Susan.
Her pain soon intensified. Sleep became so disrupted that she sometimes needed painkillers several times during the night, her hips throbbed on the stairs and her knee was swollen by the end of the day.
‘Because osteoarthritis has no cure, I wanted to find another way to control it and hopefully avoid surgery,’ says Susan.
She had previously found acupuncture helpful for tennis elbow. So, in August 2023, she decided to try the treatment for her hips and knee.
Acupuncture is not regulated in the UK, meaning the standard of care can differ between practitioners.
‘Most acupuncture clinics operate privately, and anyone can establish an organisation without formal qualifications,’ explains Ian Appleyard. ‘To find a qualified practitioner, check that they are registered with the British Acupuncture Council.’
In the future, patients may even be able to administer a form of acupuncture themselves.
A team led by Dr Hughes at University College London recently completed an early trial examining whether cancer patients undergoing chemotherapy could safely insert needles into their lower legs.
The 40 participants said they were able to carry out the treatment themselves, and reported improvements in cancer symptoms and treatment side effects, including pain, nausea and poor sleep.
Susan now has a maintenance acupuncture session every five or six weeks, paying £60 per appointment.
‘Acupuncture has transformed my life — it has given me a new lease of life,’ she says.
‘It is not a cure, and I still experience symptoms occasionally, but they are nowhere near as severe as before. I cannot remember the last time I needed painkillers.
‘I can walk more freely instead of feeling so stiff, and I am able to enjoy being active again.
‘It is reassuring to know that I can manage the condition with acupuncture and may be able to avoid joint replacements. If the pain becomes worse, though, I will speak to my GP again.
‘I would recommend acupuncture to anyone.’
