Survey of Adverse Events following Acupuncture (Safa): A Prospective Study of 32,000 Consultations

Abstract

Acupuncture is increasingly used, so it is important to establish whether its benefits outweigh its risks. Numerous case reports of adverse events show that acupuncture is not free of risk, but accurate data from prospective investigations is scarce. A prospective survey was undertaken using intensive event monitoring. Forms were developed for reporting minor events each month and significant events as they occurred. The sample size was calculated to identify any adverse events that occurred more frequently than once in 10,000 consultations. Acupuncturists were recruited from two professional organisations in the UK. Seventy-eight acupuncturists, all doctors or physiotherapists, reported a total of 2178 events occurring in 31,822 consultations, an incidence of 684 per 10,000 consultations. The most common minor adverse events were bleeding, needling pain, and aggravation of symptoms; aggravation was followed by resolution of symptoms in 70% of cases. There were 43 significant minor adverse events reported, a rate of 14 per 10,000, of which 13 (30%) interfered with daily activities. One patient suffered a seizure (probably reflex anoxic) during acupuncture, but no adverse event was classified as serious. Avoidable events included forgotten patients, needles left in patients, cellulitis and moxa burns. In conclusion, the incidence of adverse events following acupuncture performed by doctors and physiotherapists can be classified as minimal; some avoidable events do occur. Acupuncture seems, in skilled hands, one of the safer forms of medical intervention.

Adverse events following trigger point dry needling: a prospective survey of chartered physiotherapists

“…41 In the current study, however, no significant AEs were reported in 7629 treatments, giving an upper risk rate for significant AEs of #0.04%. 38 This compares favorably with 0.14% in the study by White et al 28 and 0.22% (AEs requiring further treatment) in the study by Witt et al 30 The estimated risk of significant AEs in this study (#0.04%) is also much lower than that reported for some over-the-counter pain medications (aspirin, 18.7%; ibuprofen, 13.7%; and Paracetamol, 14.5%). 42 In the current study a large variation is seen in the rate of AEs reported per participant with figures ranging from 3.13-93.1/100 treatments with six of the 39 participants reporting particularly high rates of AEs.…”

“…The current study used a similar methodology to White et al, 28 but that study reported a lower rate of AEs, 7%. Acupuncture and TrP-DN differ in the points treated and methods and depth of needle stimulation, and therefore are not directly comparable.…”

“…33 This was chosen to include mild events and events that occurred through error. 28 Based on severity, AEs were sub-classified as 'significant' or 'mild'. The definitions for 'significant' and 'mild' events were adapted from those proposed by Carnes et al 34 In the current study, a 'mild' AE was defined as short-term and non-serious, with no change in function, whereas the term, 'significant', was chosen to represent moderate or major AEs, described by Carnes et al 34 as medium to long-term events that are serious, distressing and may require further treatment.…”

“…The questionnaire consisted of two forms, modified with permission from those used by White et al, 28 and a demographic data form. The forms were piloted by two physiotherapists for 2 weeks and subsequently, small changes were made.…”

“…[26][27][28][29][30][31] Results from acupuncture AE studies cannot be extrapolated and applied to TrP-DN as it differs from acupuncture in the points treated and the method and depth of needle stimulation. 27 however the majority of these could be viewed as positive such as feeling relaxed, and feeling energized.…”