Advancing Safety in Acupuncture Practice—A Collective Commitment

EDITORIAL: ADVANCING SAFETY IN ACUPUNCTURE PRACTICE—A COLLECTIVE COMMITMENT

As guest editors for this special edition of the American Academy of Medical Acupuncture Journal, we are honored to introduce a timely and essential focus: safety in acupuncture practice. With over eight decades of combined experience in integrative medicine and acupuncture, we have witnessed our profession’s remarkable growth in both clinical acceptance and scientific rigor. Yet, as acupuncture becomes further woven into the fabric of modern health care, our responsibility to ensure patient safety—while already exemplary—demands renewed attention and continuous improvement.

Why a Safety-Focused Edition Now?

Acupuncture is widely recognized as a safe, low-risk intervention for a broad spectrum of conditions—ranging from acute or chronic pain, inflammatory diseases, and anxiety to complex disorders such as polycystic ovary syndrome (PCOS). Systematic reviews and meta-analyses consistently affirm that adverse events are rare and typically minor, such as transient pain or bruising at needle sites.¹ Serious complications, including infections or organ injuries, are exceedingly uncommon, with large-scale studies estimating the incidence of significant adverse events at less than 1 per 10,000 patients.² In high-volume clinical settings, such as Singapore General Hospital, rigorous safety protocols have resulted in zero adverse events over tens of thousands of treatments.³

Despite this strong safety record, even rare complications can have profound consequences for patients and the reputation of our profession. The global expansion of acupuncture, diverse regulatory environments, and evolving patient populations introduce new challenges. As the articles submitted to this edition demonstrate, safety is not a static achievement but a dynamic process—one that requires vigilance, adaptation, and a culture of continuous learning.

What the Evidence Tells Us

The research featured in this special edition spans continents and clinical contexts, providing a comprehensive look at current safety strategies and emerging risks:

Improving Safety in Clinical Practice: This overview synthesizes best practices for risk mitigation, from rigorous patient screening and informed consent to robust documentation and adverse event monitoring. It highlights the importance of ongoing education and peer review in maintaining high standards.

Safety in Specific Populations: Systematic reviews on acupuncture for PCOS and diabetic limb conditions underscore the need for tailored risk assessments, especially in vulnerable groups. While acupuncture remains safe, practitioners must be alert to unique contraindications and comorbidities.⁴

International Perspectives: Analyses from Japan, Taiwan, and the United States reveal both commonalities and regional differences in safety promotion. For instance, Japan’s use of artificial intelligence adverse event analysis and Taiwan’s public health initiatives provide valuable models for other regions.

Risk and Professional Challenges: The U.S. perspective addresses not only clinical risks but also systemic challenges, such as variable training standards, scope-of-practice issues, and the need for unified professional advocacy.

How Can We Make Acupuncture Even Safer?

Our profession’s commitment to safety is evident, but there is always room for improvement. Here are actionable steps, distilled from both the literature and our personal experience:

• •Standardize Education and Credentialing: Ensure all practitioners meet rigorous, evidence-based training and certification standards. Ongoing professional development must be a cornerstone of practice.
• •Cultivate a Safety Culture and Implement Acupuncture Safety Content in Yearly Continuing Education (CE): Foster open communication about adverse events, near misses, and best practices. Encourage reporting and peer discussion—not as punitive measures, but as opportunities for collective learning.³ For applying for or renewing an acupuncture license in most U.S. states, a certificate from the National Certification Commission for Acupuncture and Oriental Medicine is required. This certification mandates 4 continuing education credits in acupuncture and Oriental medicine safety. These CE requirements are essential to minimize careless, reckless, or overly aggressive needling in high-risk areas of the body as well as the safe use of infrared heat devices.
• •Enhance Patient Engagement: Provide clear, accessible information about the risks and benefits of acupuncture. Informed consent should be a dialogue, not a formality, empowering patients to make confident decisions about their care.⁵
• •Implement Robust Infection Control: Adherence to Clean Needle Technique (or similar protocols) should be held as a basic requirement along with bloodborne pathogen training, especially for high-risk patients, such as those with diabetes or an immune deficit, etc. Regular audits and staff training are essential to prevent lapses.⁵
• •Leverage Data and Research: Support and participate in research that tracks outcomes and adverse events. Data-driven insights enable targeted interventions and policy development.
• •Advocate for Consistent Regulations: Work with professional organizations and policymakers to harmonize standards across states and countries, reducing variability that can compromise safety.

A Call to Action

Acupuncture’s safety record is a testament to the dedication and skill of practitioners worldwide. However, as stewards of this ancient yet evolving medicine, we must never become complacent. The articles in this special edition offer both reassurance and a roadmap: safety is not merely the absence of harm, but the presence of robust systems, compassionate care, and a relentless pursuit of excellence.

Let us embrace this opportunity to reflect, to learn, and to lead. By making safety a living value—woven into every needle insertion, every patient interaction, and every professional dialogue—we honor both our patients and the enduring legacy of acupuncture.