The last decennia the multidimensional nature of pain has been recognized and a multimodal bio-psychosocial management has been proposed. Acupuncture has progressively gained a place in this multimodal approach. The principles of traditional Chinese medicine link three major themes, nutrition and microbiome, neuroplasticity, homeostasis and the side effects of medication. For patients with chronic pain and/or chronic pain refractory to conservative medicine it is important to assess all factors involved with the chronicity. The improved biological, genetic and epigenetic knowledge has contributed to a better understanding of the mechanism of action of acupuncture and integrative medicine. Moreover neuroimaging has been able to demonstrate the brain regions activated by acupuncture and also illustrates the differences with sham or placebo. Opponents often claim an absence or weakness of evidence. These claims are based on the observations that the initial reports are predominantly case reports and studies with a poor design quality. In the last decennia well-designed randomized trials have been published, thus improving the quality of the evidence. The most important findings are summarized in this article. As with all controlled trials the inclusion and exclusion criteria as well as the standardization of the treatment do not always reflect daily practice. Therefore we report patient cases as illustration of the integrative approach.
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