What effect does acupuncture have on cortisol levels?

By Mel Koppelman



Cortisol is a biological marker of stress and has been measured in acupuncture research covering a wide variety of clinical areas. As of yet, a systematic review of this literature has not been performed.


To assess the effect of acupuncture on cortisol levels in the short- and long term.

Search methods I searched Embase, Medline, AMED, CAMBase, CENTRAL, CINAHL, PsychINFO, ElectroAcupuncture and reference lists of articles. I also contacted key researchers in the field.

Selection criteria RCTs comparing acupuncture to sham acupuncture, waitlist, or other treatment that measured cortisol at least once before and after the intervention.

Data collection I independently assessed trial quality and extracted data into EPPI Reviewer and Excel.

Main results Nineteen trials involving 1,269 people were included. Seven trials involving 663 people measured cortisol before and after a single treatment.

Compared to controls, an overall standardised mean difference of -0.51 was observed (95% CI -1.15 to 0.13), with acupuncture reducing cortisol levels more than controls, and this effect was not significant. Two trials involving 29 people measured mean daily cortisol output over five weeks of treatment. An overall standardised mean difference of 0.93 was observed (CI -1.83 to 3.70), with controls reducing cortisol more than acupuncture, and this effect was not significant.

Author’s conclusions The included studies suffered from methodological weaknesses that made it difficult to draw conclusions from the pooled estimates of effect. Future studies would benefit from using a more nuanced cortisol measuring strategy in order to improve robustness of the outcome.