Key messages

• Due to a lack of evidence, the benefits and harms of acupuncture for babies undergoing painful procedures are unclear.

• Well-designed and thoroughly reported studies are needed to shed light on the benefits and harms of acupuncture, also compared to medicines, or different ways of using acupuncture.

Pain in babies and acupuncture

Newborns in intensive care units experience many invasive and painful procedures (like blood tests). Newborns who undergo repetitive episodes of untreated or undertreated pain experience poor health outcomes. This is particularly concerning in preterm newborns, who are especially vulnerable to negative effects of pain due to their immature nervous systems. Assessing pain in neonates requires the use of age-appropriate scales. The Premature Infant Pain Profile (PIPP) is a scale developed to assess acute pain in preterm neonates. The Neonatal Infant Pain Scale (NIPS) is a behavioral scale and can be used with both full-term and preterm infants. The Neonatal Pain, Agitation and Sedation Scale (N-PASS) was developed to assess ongoing infant pain and also sedation in the neonatal intensive care unit.

Acupuncture is a treatment procedure in which specific points called 'meridians' are stimulated to influence the functioning of the body. It consists of different types, such as needle acupuncture with or without electrical stimulation, laser acupuncture, and non-penetrating types of manual acupressure. Moreover, the duration and frequency of acupuncture may vary.

What did we want to find out?

We wanted to find out the benefits and harms of acupuncture for babies undergoing painful procedures. Our critical outcomes were pain intensity at different time points and unwanted effects.

What did we do?

We searched for studies that compared acupuncture to: no treatment, sweet solutions, medicines, or other types of acupuncture (for example, needle acupuncture compared to laser acupuncture).

What did we find?

We found 11 studies that enrolled 852 infants. Five studies compared acupuncture with no intervention or sham treatment (dummy treatment); four studies compared acupuncture with a sweet solution; no study compared acupuncture with medicines; and two studies compared acupressure to foot massage or reflexology, which can be considered a non-invasive stimulation of acupuncture points. Six studies used the PIPP; four studies used the NIPS; and one study used the N-PASS.

Acupuncture may reduce procedural pain in newborns during and shortly after the procedure when compared to no treatment or sham treatment. However, the evidence is very uncertain about the effect of acupuncture on pain relief during the procedure when compared to sweet solution. The effectiveness of acupressure versus foot massage or reflexology remains uncertain.

Main results

• Compared to doing nothing, acupuncture may reduce pain assessed with different scales during the procedure and shortly after the procedure, resulting in little to no difference in any harms.

• The evidence is very uncertain about the effect of acupuncture on pain relief, as assessed by the PIPP or NIPS during the procedure and with the PIPP up to 10 minutes after the procedure, compared to sweet solutions. Acupuncture may result in little to no difference in any harms.

• The evidence is very uncertain about the effect of acupressure on pain assessed during the procedure or up to 10 minutes after the procedure compared to foot massage or reflexology.

We identified four ongoing studies.

What are the limitations of the evidence?

We have little to very low confidence in the evidence. All studies had some limitations in the way they were conducted, such as problems with the methods used to assign babies to one group or another and with the ways in which data were reported. Also, researchers were aware of the treatment received by the babies, which could have influenced the results.

How up-to-date is this evidence?

The evidence is current to August 2023.