Editor—A discussion of the adverse effects of acupuncture has led to considerable anxiety among those who practise this treatment.1 Many have claimed that serious complications are avoidable and therefore do not occur in countries where acupuncturists are adequately trained. It has also been stated that causality is often inadequately established in case reports. Moreover, it has also been said that doctor-acupuncturists are just as likely to cause complications.
In an attempt to respond to these issues we systematically searched the literature available on Medline, Embase, and the Cochrane Library, for all reports of serious adverse effects resulting from acupuncture and published in 1997, the year not covered by our review. The results are summarised in the table. (A complete list of references is available on the BMJ’s website.2)
Eight adverse effects were reported. The most common was pneumothorax. Five reports originated in the United States, and one each in Japan, Taiwan, and Brazil. One complication was caused by an acupuncturist who was not medically qualified.3 No information on qualifications was given in the other cases, but it was implied that treatment was carried out by non-medically trained acupuncturists. The use of indwelling needles seems to carry greater risks than the use of conventional acupuncture techniques.
Acupuncture is not free of risks. All adverse events reported in 1997 would have been avoidable. The absolute number of cases is small, but the degree of underreporting remains unknown.
Table.
Summary of eight adverse effects of acupuncture reported in 19972
| Condition | How causality established | Outcome | Risk factor identified |
|---|---|---|---|
| Auricular perichondritis | Clinical symptoms | Disfigurement | Indwelling needle |
| Bacterial meningitis | Analysis of cerebrospinal fluid | Full recovery | Needle inserted through clothing |
| Cardiac tamponade | Dislodged needle seen in right ventricle | Full recovery after surgery | Indwelling needle |
| Foot drop | Clinically (nerve conduction studies) | Physiotherapy with residual weakness after 6 years | None identified |
| Pneumothorax | Chest x ray | Full recovery | Elderly patient, chronic bronchitis |
| Pneumothorax | Chest x ray | Full recovery | Cystic fibrosis |
| Pneumothorax | Chest x ray | Full recovery | None identified |
| Pyarthrosis | Analysis of joint fluid | Full recovery | None identified |
References
- 1.Ernst E, White A. Acupuncture: safety first. BMJ. 1997;314:1362. doi: 10.1136/bmj.314.7091.1362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.www.bmj.com/cgi/eletters/314/7091/1362.
- 3.Vilke GM, Wulfert EA. Case reports of two patients with pneumothorax following acupuncture. J Emerg Med. 1997;15:155–157. doi: 10.1016/s0736-4679(96)00313-7. [DOI] [PubMed] [Google Scholar]