How Safe is Acupuncture?

The evidence for acupuncture as one of the safest forms of treatment available is overwhelming. Many millions of acupuncture treatments are given across the globe every year.  9-12 million acupuncture treatments are reported in the US alone every year.  Millions upon millions of treatments are provided in China, Japan and throughout Asia, Europe, Africa, and the rest of the world.  Out of the millions of treatments given each year, very few severe adverse effects are ever reported.

The probability of causing any lasting or significant harm with acupuncture is extremely small when performed by someone well-schooled in anatomy, who follows a clean needle technique protocol.

If you search the literature, you’ll find that frequency of adverse effects from acupuncture range from less than 0.006% (very safe) to as much as 10% (not safe at all), depending on the study, its authors, and who is interpreting or commenting on it.

Many of the studies, comments, and articles on the subject seem to be written either by avid acupuncture supporters or acupuncture naysayers.  I’m sure some have been authored by individuals with no biases, however I haven’t come across very many of them.  I suggest all acupuncture safety studies, comments, and conclusions—including my own—are best taken with a grain of salt.  Consider who the author is, in what field of science or healthcare is the author’s primary training, what is the author’s reputation for reviewing acupuncture and CAM procedures in general, and how the comments compare with the actual results of the study.  Authors who decry acupuncture as being dangerous are, with very few exceptions, the same authors who claim most other CAM therapies to be dangerous, hoaxes, or placebos.

When searching the literature, you’re likely to find a few authors of acupuncture studies, who are referenced over and over again in articles by many other writers and researchers.  MacPhearson & White are some of the more prominent names you’ll come across.   While MacPheason & White present balanced interpretations of their work, writers who cite MacPheason & White often come to conclusions that seem to be based more on their biases than the actual results of the study.  One prominent author who seems to be relentless in his attempts to make acupuncture appear dangerous, claims that even negligible risks outweigh acupuncture’s benefits, which he describes as nonexistent.  Needless to say, I disagree.

Naysayers point out that up to 10% of acupuncture treatments cause harm.  This would be a problem if it were true.  However, when you look at they are calling “harms,” they include side effects, like temporary soreness at an acupuncture point after treatment, a few drops of blood or a small bruise at a point upon needle removal, or a patient feeling tired after a treatment.  I doubt any of these authors would consider a few drops of blood, small bruise, or temporary soreness at the injection site, to be adverse side effects of an injected drug.

Acupuncture supporters on the other hand, tend to cite studies that show almost no, or very few mild side effects.  Many of these authors, however, qualify their endorsement of acupuncture with reference to treatment by “qualified professionals” or “standard treatment.”  Opinions of who is a “qualified professional” or what makes for “standard treatment” seems to vary with the authors’ credentials and biases.

Medical doctors usually claim that acupuncture is perfectly safe, but only if performed by medical doctors.  Licensed acupuncturists generally claim that acupuncture is perfectly safe, but only if performed by licensed acupuncturists.

Studies on the adverse effects of acupuncture treatments administered by licensed acupuncturists, and studies on the adverse effects of acupuncture treatments administered by medical doctors and physiotherapists are remarkably similar in their results, despite vastly differing levels of acupuncture training between the providers.

Both supporters and critics alike point to pneumothorax as the main severe adverse effect of acupuncture to beware of.  A bit of searching will also turn up the occasional reference to an acupuncture needle being inserted into someone’s heart, or a very long needle breaking of inside someone’s abdomen.  There are also a few reported cases of cross infection, which usually involve an infected practitioners failing to follow universal precautions or standard clean needle technique.   All of these incidents, including pneumothorax are extremely rare. While hearsay incidents may be less rare, verified reports are hard to come by.  Those that are verified are often the result of negligence or incompetence on the part of the practitioner.   These incidents are less side effects of acupuncture than they are side effects of individual healthcare providers not complying with basic standards of care.

Comparing the possible adverse effects of acupuncture and their frequency to the documented adverse effects of just about any other medical,  physical, or surgical intervention,  places acupuncture squarely in the generally safe category.

For example, an abstract in Pubmed cites a study in which adhesive bandages caused significant allergic reactions in 6.5% (4 out of 26) of the participants.  A partial list of  the side effects of aspirin include, rupture in the wall of the stomach or intestines, anemia, bleeding of the stomach or intestines, blood coming from anus, bronchospasm, decrease in the ability of platelet cells to clot, decreased white blood cells, drowsiness, giant hives, hemolytic anemia, hemorrhage within the skull, hepatitis caused by drugs, interstitial nephritis, large purple or brown skin blotches, life threatening allergic reaction, ringing in the ears, seizures, and the list goes on…

I’m not trying to disparage aspirin or bandaids, but offering them as examples for perspective.  Acupuncture carries less risk than just about any commonly available medical interventions, including many that lay people use daily, without medical advice, throughout the world, billions of times every year.

I have avoided including references to specific studies here, because I recognize that I have my own biases and conflicts of interest, and I suspect that in choosing certain studies I would likely be swayed by these biases. Rather, I invite you to research this topic on your own.  With the web at your fingertips, I suspect won’t take you long to come to your own conclusions.

Still, when I attempt to put my own biases aside, I believe there is very little justification for concern, when acupuncture is performed by someone who is reasonably intelligent, schooled in anatomy and responsible clean needle handling, and prudent in the application of therapy.

Given the small amount of risk that it poses, I believe that if acupuncture were a drug, it would be available without a prescription, over the counter.

Jim Ventresca,

Principal, AcuPractice Seminars