Safety and adverse reactions

According to the scientific literature, acupuncture is one of the safest therapies in the hands of well-trained health care professionals. Occasionally, adverse reactions have been described after acupuncture therapy. An adverse reaction event is “any ill-effect, no matter how small, that is unintended and non-therapeutic”.

The number of these adverse reactions is very small in comparison to other medical interventions used to treat the same conditions, such as the administration of anti-inflammatory medications or the injections of corticosteroids.

In the last few years, twelve prospective studies surveying more than a million acupuncture treatments estimated the risk of a serious adverse event to be 0.05 per 10,000 treatments or 0.55 per 10,000 individual patients.

The most common adverse reactions attributable to acupuncture, reported in the medical literature include:

• 1 Minor reactions: small bleeding at insertion site, pain or tenderness at administration site, bruising, transient aggravation of symptoms, transient headache, nausea, vomiting, local numbness, anxiety, dizziness, and occasional fainting (vaso-vagal reaction)
• 2 Significant reactions: pneumothorax, peripheral nerve injury, vascular injuries, seizures, and miscellaneous infections such as endocarditis, skin, auricular chondritis, epidural abscess, etc.

Pneumothorax is the most commonly reported of the significant adverse reactions, although still only a few hundred have been described in the millions of acupuncture treatments reported in the medical literature. The vast majority of these reported pneumothoraxes resolved in days without treatment. Few required medical intervention, and even fewer had some long-term complications.

Based on this evidence, there are no absolute contraindications to acupuncture other than a patient unwilling to receive this treatment, but certain situations require special precautions, such as patients with:

• Valvular heart disease
• Pacemakers
• Blood dyscrasia
• Compromised immune system
• History of major seizures induced by an invasive medical procedure
• Prior history of adverse reactions to acupuncture

Through proper technique and with a thorough practical knowledge of human anatomy, the majority of possible adverse reactions described above can be avoided.

A full review of the literature on adverse reactions to acupuncture is beyond the scope of this commentary, however further reading on the topic is encouraged to add clarity to commonly raised questions such as acupuncture and pregnancy, treatment of obesity, addictions, etc., which are addressed during the McMaster Contemporary Medical Acupuncture Program.

Safe practice for all graduates is the most important focus of the McMaster Contemporary Medical Acupuncture Program, and is achieved by the following supervised hands-on activities and use of supporting materials all throughout the program:

• Lecture-workshops anatomy review
• Anatomy lab sessions
• Palpation skills workshops
• Single needle insertion workshops (precedes all other needling workshops)
• Blueprint treatment workshops
• Use of original visual materials: Atlas of Surface Anatomy