Summary

Acupuncture is a method of treatment originating from ancient Chinese system of medicine. For about fifty years it has been a subject of intensive scientific evaluation and has proved its effectiveness in treatment of many diseases occurring in modern Western societies. Any treatment technique must be not only effective but also safe for patients In order to be integrated with modern health care systems. If the effectiveness of acupuncture is surprising, its safety profile is far beyond imagination. There is no other intervention in modern Western medical system which can be even compared to acupuncture by the means of safety. Following article presents the safety of acupuncture and discusses some main issues concerning research on that field. 

RECENT RESEARCHES ON ACUPUNCTURE SAFETY

Clinical trials performed in the preceding years have proved the effectiveness of acupuncture in treatment of numerous medical conditions, and trials in basic disciplines extend the knowledge concerning mechanisms of activity of this fascinating treatment method. In the process of making conscious decisions concerning treatment, apart from efficiency and understanding mechanisms of activity of a given method, its safety is the vital aspect as well. 

Researchers performing controlled clinical trials observe various aspects of health of their patients, they also make notes and report any adverse events related to applied medications, drugs or medical interventions. The same process is applied to trials on acupuncture. According to the protocols of clinical trials, in the course of follow up, lasting from several months to several years, all the adverse events are reported, both connected and not connected with the treatment. Data collected in this way may be further used for the safety analysis. However, the data systematically obtained in accordance with the protocol of controlled clinical trials must be differentiated from anecdotic description of cases, the scientific value of which is minor. These first ones are subject to rigorous procedures of reporting, in which the intensity of symptom is specified, time of its duration, results, as well as its relation with the applied treatment. The second group consists of descriptions of clinical events which drew the particular attention of practitioners. Their contents is based exclusively on personal beliefs and experiences of their authors, so they have no meaningful scientific value.

The data systematically obtained in accordance with the protocol of controlled clinical trials must be differentiated from anecdotic description of cases, the scientific value of which is minor.

RESEARCH RESULTS ON ACUPUNCTURE SAFETY

In 2006 the analysis of acupuncture safety by British researcher Adrian white was published. The author presented the findings of two prospective trials carried out in Great Britain in the years 1998-2000. 66,229 treatments performed in various clinics by different therapists were reviewed. This number of treatment did not entail any Serious Adverse Events In SAFA research 2178 adverse events were reported in total per 31,822 treatments (7%), and in York research- 4528 adverse events per 34,407 treatments (13%). This difference results, at least partially, from the applied methodology and extended scope of reported adverse events, which in York trial included, for instance, the events when patient felt weak and tired. 

In the analysis of the most frequently reported events, White enumerates:

  • feeling weak and tired – 3%
  • bleeding or bruise – 3%
  • aggravation of symptoms – 2%
  • pain connected with puncturing – 1%

In the same article White also provides the findings from other papers describing the safety of acupuncture. In a summarizing table he analyses serious adverse events.

There were 11 (literally: eleven!) serious adverse effects reported per 4,441,103 treatments.

The most frequent serious adverse event was pneumothorax (7 per 4,441,103 treatments) and fracture of needle inside patient’s body (2 per 4,441,103 treatment). These figures alone make acupuncture the safest procedure  known in the contemporary medicine. When the presented safety profile is compared to -for instance- serious side effects of non-steroid anti-inflammatory drugs and the amount of death connected with their application, the safety of acupuncture becomes even more astounding. There is only one condition: the treatment of acupuncture must be performed by qualified specialists using diagnostic methods based on Chinese Medicine. 

PROPER EDUCATION OF ACUPUNCTURISTS IS A KEY TO SAFETY

Proper education of acupuncturists is the essential condition ensuring the safety of patients benefiting from this method of treatment. This conclusion is conformed also by authors who are decidedly prejudiced against acupuncture.  In 2011, prestigious „Pain” magazine published the article by Edzard Ernst, impeaching both the effectiveness and safety of acupuncture. The author browsed through the literature of all and any description of adverse effects which could be assigned to acupuncture. He found some  of these cases, reported mainly in exotic countries, where acupuncture is performed by uneducated personnel in conditions reviling any possible hygienic standards. Acupuncture performed in such a way may-of course- entail the risk of transmission of infectious diseases or puncture of some anatomical structures. What is more important, these complications may be easily evaded. This is why proper quality of education of acupuncturists is so vital.   

In order to help patients and physicians undertake conscious decisions on beneficial therapeutic procedures, the safety of acupuncture in the light of the presented arguments and findings must be considered. Data obtained in controlled clinical trials explicitly show that acupuncture applied by qualified personnel is one of the safest methods of treatment. The frequency of occurrence of serious adverse effect is so low that it is negligent for a scientist.  In one Ernst must be admitted right- even one adverse effect which could have been avoided is worth discussing. 

HOW TO PREVENT FORM RARE ADVERSE EFFECTS

The most common, though extremely rare in frequency, are the following adverse effects: pneumothorax, fracture of needle in patient’s body, transmission of infectious diseases, haematoma or bleeding in the place of puncture, no effect, deterioration of symptoms, vertigo.

  • Pneumothorax or possible puncture of other organ (vessel, urinary bladder, pericardium), can be avoided via well-acquired knowledge of human anatomy and physiology in the process of education of acupuncturists.

  • Technical development facilitates the production of high-quality acupuncture needles made of steel assuring flexibility which secures patients’ safety.

  • Acupuncture needles are single-use only, and they are utilized in accordance with regulations. This way of using needles effectively prevents possible transmission of infectious diseases.

  • Puncture and needle removal techniques usually protect against haematoma, unless minor bleeding is the intention of the therapist as one of the techniques commonly used in acupuncture.

  • Dizziness, vertigo, lack of effect or even deterioration of symptoms are the problem occurring mainly in case of wrong diagnosis. In order to avoid it, acupuncturist must have knowledge and skills in the area of diagnosing according to the principles of Traditional Chinese Medicine. It allows for immensely precise personalization of  treatment and adjustment of the procedure to the condition of a given patient, and- as a result- major increase of its efficiency and safety.

Problems-in-safety-of-acupuncture

To sum up, acupuncture is the safest intervention known to modern medicine with the frequency of occurrence of serious adverse effects at the level of 11 per 4,441,103 procedures. In order to obtain this profile of safety acupuncture must be performed by a qualified acupuncturist who has satisfactory knowledge of human anatomy and physiology, and also skilled in diagnostic methods of Traditional Chinese Medicine that allows for precise personalization of the procedure. Acupuncture practitioners without knowledge of anatomy pose their patients at risk connected with possible puncture of organs; practitioners without skills in proper diagnosing imperil their patients with inefficient therapy, deterioration of symptoms, pain, vertigo and so on. It is worth stressing that despite growing popularity, the risks occur rarely and acupuncture, as a method of treatment, remains one of the safest contemporary procedures.

BIBLIOGRAPHY

1 White A. „The safety of acupuncture – evidence from the UK” Acupuncture in Medicine 2006;24(Suppl):S53-57.

2 E. Ernst, Myeong Soo Lee, Tae-Young Choi „Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews” Pain 152 (2011) 755–764

THE AUTHOR