Acupuncture: safety first
BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7091.1362 (Published 10 May 1997) Cite this as: BMJ 1997;314:1362
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Our Editorial on adverse effects of acupuncture [1] led to
considerable anxiety in the acupuncture world. It was claimed that serious
complications are avoidable and therefore do not occur any longer in
countries where acupuncturists are adequately trained. It was pointed out
that causality is often inadequately established in case reports.
Moreover, it was said that physician acupuncturists are likely to
contribute to the list of complications.
In an attempt to answer these open questions we have searched the
literature systematically (Medline, Embase, Cochrane Library) for all
reports of serious adverse effects published in 1997, the year not covered
by our review [1]. The results are summarised in the Table.
Table: Adverse effects of acupuncture reported in 1997
Condition, reference Outcome Auricular perichondritis 2 Disfiguration Bacterial meningitis 3 Full recovery Cardiac tamponade 4 Surgery, full recovery Drop foot 5 residual weakness at 6 years Pneumothorax 6 Full recovery Pneumothorax 6 Full recovery Pneumothorax 7 Full recovery Pyarthrosis 8 Full recovery
Eight adverse
effects were reported. The most common is pneumothorax. Five reports
originated in the US, and one each in Japan, Taiwan and Brazil. One case
was caused by an acupuncturist who was not medically qualified [6], in all
other cases no information on qualifications was given but it was implied
that treatment was carried out by non-medically trained acupuncturists.
Indwelling needles seem to carry greater risks than conventional
acupuncture techniques.
We conclude that acupuncture is not free of risks. All adverse events
reported in 1997 would have been avoidable. The absolute number of cases
is small but the level of under-reporting remains unknown.
Professor E. Ernst,
Director
A R White,
Research Fellow
Department of Complementary Medicine,
School of Postgraduate Medicine & Health Sciences,
University of Exeter,
25, Victoria Park Road,
Exeter EX2 4NT UK,
tel 01392 424839,
fax 01392 424989,
email e.ernst@ex.ac.uk
References
1.Ernst E, White A. Acupuncture: safety first. BMJ 1997;314:1362.
2.Ramos S, Pinto LF, Ramos RF. Auricular perichondritis due to
acupuncture. Revista Brasil de Otorrinol 1997;63:589-592.
3.Chen C-Y, Liu G-C, Sheu R-S, Huang C-L. Bacterial meningitis and lumbar
epidural hematoma due to lumbar acupunctures: a case report. Kaohsiung J
Med Sci 1997;13:328-331.
4.Kataoka H. Cardiac tamponade caused by penetration of an acupuncture
needle into the right ventricle. J of Thoracic and Cardio Surg
1997;114:674-676.
5.Sobel E, Huang EY, Wictung CB. Drop foot as a complication of
acupuncture injury and intragluteal injection. J of Amer Podiatric Med
Assoc 1997;87:52-59.
6.Vilke G M, Wulfert E A. Case reports of two patients with pneumothorax
following acupuncture. J of Emerg Med 1997:15:155-157.
7.Olusanya O, Mansuri I. Pneumothorax following acupuncture. J Amer Board
Fam Practice 1997;10:296-297.
8.Kirschenbaum A E, Rizzo C. Glenohumeral pyarthrosis following
acupuncture treatment. Orthopedics 1997;20:1184-1186.
Editorial note: the full table will be published in one of our forthcomming issues of the BMJ; unfortunately we are currently not able to present larger, or more complex tables in our rapid response section
(Letters Editor 26.1.1999)
Competing interests: Condition, reference OutcomeAuricular perichondritis 2 DisfigurationBacterial meningitis 3 Full recoveryCardiac tamponade 4 Surgery, full recoveryDrop foot 5 residual weakness at 6 yearsPneumothorax 6 Full recoveryPneumothorax 6 Full recoveryPneumothorax 7 Full recoveryPyarthrosis 8 Full recovery
cardiac tamponade is no side effect of acupuncture
Cardiac tamponade and acupuncture: no side effect!
Thanks to Dr Stephen Birch I can provide you with relevant details to
the case.
The first 'case' in Norway was in the mid 90s where the practitioner
did deep insertion over the chest. The patient had a congenital hole in
the sternum, so the heart was punctured and the patient died.
This should not be considered a side effect of acupuncture but
malpractice, though it has been reported as a death by acupuncture case.
Deep needling over the thorax is contraindicated, as stated in all
textbooks on acupuncture.
There is another case from the sixties, reported as death by
acupuncture in the literature. A woman sitting at home and who had heard
about acupuncture suffered from chest pain. She inserted a knitting needle
into her own chest through an intercostal space and punctured her own
heart killing herself. This death is not related to acupuncture.
Thus, cardiac tamponade is not a side effect of acupuncture, but
either a result of malpractice or an unfortunate event comparable to being
stabbed with a knife.
Prof. dr. Jan M. Keppel Hesselink, MD, PhD, FFPM, Lic. Ac.
Competing interests:
None declared
Competing interests: No competing interests