Acupuncture is a traditional alternative medicine of China, being practiced for thousands of years in the country. Recently, many western countries have also started making use of the treatment for various conditions. It is chosen by many since it is known to be less invasive, more natural, and less liable to adverse events as compared to orthodox forms of treatment (Vincent, 2001). However, critics of complementary medicine have criticized it as being dangerous (Vincent, 2001). This has prompted to growing demand for evidence of its efficacy and safety. In addition, there is also some evidence in the literature about adverse events associated with it. In the article below, we will review the literature primarily focused on safety of acupuncture therapy.
A decade ago, a review by Lao and colleagues (2003) reported declines in adverse event reports, especially after 1988 with few reported serious complications after this period. The authors attributed the decline to recent practices of clean needle technique and more rigorous acupuncturist training requirements. Therefore, the review concludes that if acupuncture is performed by trained practitioners using clean needle techniques, it is a safe procedure (Lao, 2003).
A survey by MacPherson and colleagues interviewed 574 professional acupuncturist and recorded details of adverse events to acupuncture therapy performed on patients to a total number of 34,407 treatments. No serious adverse events were reported. Serious adverse events meant events requiring admission to hospitals, prolonged days of hospitalization, permanently disability, or resulting in mortality (MacPherson, 2001). The rate of significant minor adverse events was only 1.3 per 1000 treatments. The practitioners also recorded just 15% mild transient reactions. The survey suggested that acupuncture can be considered to be a relatively safe treatment modality (MacPherson, 2001).
Again, MacPherson conducted a similar survey on patients who have received acupuncture therapy and published it in 2004, with an aim of establishing the type and frequency of adverse events the acupuncture patients experienced (MacPherson, 2004). Of the 6348 patients completing the survey questionnaire, 682 patients reported at least one adverse event over three months. There were only 107 patients per 1000 who reported adverse events. Three patients reported a serious adverse event. Severe tiredness and exhaustion, pain at the site of needle insertion, and headache were the most common events reported (MacPherson, 2004). The survey concluded that though patients reported a range of adverse events these did not stop them from seeking further acupuncture treatment. It is a safe intervention when practiced by trained professionals (MacPherson, 2004).
Another survey in the same year by White and colleagues also showed acupuncture to be a safe treatment, provided it is done by skilled professionals. The incidence of adverse events was only 684 per 10,000 consultations of the therapy. The survey concluded the incidence of adverse events following acupuncture to be minimal (White, 2001).
An observational study was conducted to evaluate the safety of acupuncture in China that included patients who had received acupuncture for conditions like migraine, Bell’s palsy, and functional dyspepsia (Zhao, 2011). A total of 1968 patients who have or had received acupuncture treatment documented adverse events. Among them, only 74 (3.76%) patients suffered at least one adverse event throughout the treatment period. There were no serious adverse events reported (Zhao, 2011). Of the 74 patients reporting adverse events, 73 of them recovered within two weeks through the use of physiotherapy or self-medication. One observation of the study was, the risk of adverse events was higher in older people and especially in males. The Chinese study proved that acupuncture is safe with low risk of adverse events in clinical practice (Zhao, 2011).
A very recent systematic review of case reports found mycobacterial and staphylococcal infections to be the main complication of acupuncture. The infections were caused by skin contact at acupoint sites and were the major complications of acupuncture (Xu, 2013). The authors recommend following guidelines such as Clean Needle Technique in order to minimize acupuncture - related adverse events. Hygienic clinical settings, sterilized equipments, and clean supplies are essential for preventing infections. There were a few organ injuries, but these were found to be associated with faulty needle insertion (Xu, 2013). The review also showed that adverse event cases due to acupuncture are rare in the US. The authors conclude that along with safe and clean practice guidelines, required is also a sound understanding of biomedical knowledge such as anatomy and physiology (Xu, 2013).
Another review of reviews and Meta analyses focuses on the general conclusions of these reviews. According to the review, general international agreement has emerged that acupuncture appears to be effective for most of the disorders including postoperative dental pain, postoperative nausea and vomiting, or chemotherapy-related nausea and vomiting etc (Birch, 2004). Reviews discussed in this review by Birch have concluded that while not free from serious adverse events, adverse events are rare and that acupuncture is a relatively safe procedure (Birch, 2004).
In contrast to a lot of literature discussed above, a review of all systematic reviews that critically evaluated acupuncture as a treatment of pain and at summarized reports of serious adverse effects was done in which numerous contraindications and caveats emerged. The review suggests that numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Pneumothorax and infections were the most frequently reported adverse effects. Serious adverse effects including deaths, continued to be reported, according to the review (Ernst 2011).
Overall, a lot of literature in the form of systematic reviews and reviews of reviews conclude that acupuncture is a safe treatment provided it is carried out by trained professionals using safe and clean techniques and following clean practice guidelines.
References:
Vincent C. (2001) The safety of acupuncture. Acupuncture is safe in the hands of competent practitioners. BMJ, 1; 323 (7311): 467–468.
Lao, L., Hamilton, G.R., Fu, J., Berman, B.M., (2003) Is acupuncture safe? A systematic review of case reports. Altern Ther Health Med, 9 (1), 72-83.
MacPherson, H., Thomas, K., Walters, S., Filter, M. (2001) A prospective survey of adverse events and treatment reactions following 34,000 consultations with professional acupuncturists. Acupunct Med, 19 (2), 93-102.
MacPherson, H., Scullion, A., Thomas, K.J., Walters, S. (2004) Patient reports of adverse events associated with acupuncture treatment: a prospective national survey. Qual Saf Health Care, 13, 349–355.
White, A., Hayhoe, S., Hart, A., Ernst, E. (2001) Survey of adverse events following acupuncture (SAFA): a prospective study of 32,000 consultations. Acupunct Med, 19 (2), 84-92.
Zhao, L., Zhang, F., Li, Y., et al. (2011) Adverse events associated with acupuncture: three multicentre randomized controlled trials of 1968 cases in China. 12, 87.
Xu, S., Wang, L., Cooper, E., et al. (2013) Adverse Events of Acupuncture: A Systematic Review of Case Reports. Evid Based Complement Alternat Med, 581203.
Birch, S., Hesselink, J., Jonkman, F.A., Hekker, T., Bos, A. (2004) Clinical research on acupuncture. Part 1. What have reviews of the efficacy and safety of acupuncture told us so far? J Altern Complement Med, 10 (3), 468-80.
Ernst, L., Lee, M.S., Choi, T.Y. (2011) Acupuncture: does it alleviate pain and are there serious risks? A review of reviews. Pain, 152(4), 755-64.
