What are the potential adverse events of acupuncture?

Potential Adverse Events of Acupuncture

Acupuncture is generally a safe procedure when performed by trained practitioners using clean needle techniques, with serious adverse events being rare (occurring at approximately 0.04-0.08 per 10,000 treatments). 1

Common Minor Adverse Events

• Needle site reactions: Bruising, hematoma, or bleeding at the needling site are among the most frequently reported minor adverse events 1, 2
• Vasovagal reactions: Including tiredness, dizziness, fainting, or residual pain at insertion points 1, 3
• Discomfort and pain: Approximately 1-45% of patients may experience needle pain during treatment 4
• Minor bleeding: Reported in 0.03% to 38% of treatments 4
• Feelings of faintness and syncope: Occurring in 0% to 0.3% of treatments 4
• Cutaneous disorders: Including suspected contact dermatitis 2
• Gastrointestinal symptoms: Nausea or vomiting has been reported in some cases 2

Serious Adverse Events (Rare)

• Pneumothorax: This is the most frequently reported serious complication, typically resulting from deep needle penetration in the thoracic region 1, 5
• Infections: Including hepatitis and other transmissible diseases, primarily from inadequate sterilization techniques 1, 6
• Nerve injuries: Both central and peripheral nerve damage can occur 1, 3
• Organ injuries: Including heart and abdominal organ injuries 1, 3
• Needle breakage: Fragments can potentially migrate to distant organs 1, 5
• Seizures: Rare but reported in case studies 3
• Burns: Particularly with electroacupuncture or moxibustion techniques 1, 2

Risk Factors for Adverse Events

• Practitioner factors: Inadequate training, incorrect acupoint selection, and improper needle manipulation are major contributors to serious adverse events 1, 5
• Technical factors: Deep needle penetration, aggressive manipulation, and repeated reheating of needles increase risk 1
• Hygiene factors: Contaminated needles, inadequate skin disinfection, and poor environmental controls can lead to infections 1
• Patient factors: Certain conditions may increase risk, including frailty, febrile illness, skin infections, and pregnancy (particularly first trimester) 3

Risk Prevention Strategies

• Proper training: Ensure acupuncturists have appropriate education and adhere to standard operating procedures 1, 6
• Clean needle technique: Use of sterile, disposable needles and proper skin disinfection 1, 6
• Anatomical knowledge: Careful selection of needling areas with awareness of underlying structures 1
• Appropriate depth: Avoiding excessive depth of needle insertion, particularly in high-risk areas 1
• Patient screening: Identifying contraindications and high-risk patients before treatment 3

Trends in Safety

• There has been a trend toward fewer reported serious complications since the late 1980s, likely due to improved clean needle techniques and more rigorous training requirements 6
• A six-year survey at a national clinic in Japan found only 94 adverse events (0.14%) in 65,482 treatments, with no serious or severe cases reported 2
• Most severe adverse events reported in medical literature appear to be cases of negligence rather than inherent risks of properly performed acupuncture 2

While acupuncture has demonstrated effectiveness for certain conditions like chronic back pain and osteoarthritis-related knee pain 3, practitioners and patients should be aware of these potential adverse events and take appropriate precautions to minimize risks.