Incidence of adverse effects during acupuncture therapy—a multicentre survey

This German multicenter study represents one of the most comprehensive investigations of acupuncture safety in routine clinical practice. Conducted between December 1995 and December 1996 in Berlin, the study followed 409 patients (279 women, 125 men) who received a total of 3,535 acupuncture treatment sessions. The researchers collaborated with 13 general medicine clinics and outpatient services, plus 16 other professionals, to systematically document all adverse events occurring during treatments. The study methodology was rigorous, using standardized questionnaires completed by therapists after each session.

Practitioners questioned patients in a structured manner during treatment ('How do you feel now?') and before each subsequent session ('How did you feel after the last acupuncture therapy?'). A checklist was provided that included hemorrhage, hematoma, infections, neurological abnormalities, fainting, vestibular symptoms, nausea, prolonged DeQi effect, and increased pain, with free space to document other observed effects. The results revealed that adverse events were observed in 402 treatments (11.4%) involving 153 different patients (37.4% of the total). Women had an average of 9.01 treatments, while men had 7.85.

The main adverse events were mild hemorrhage (2.9% of treatments), hematoma (2.2%), dizziness (1.0%), and other systemic symptoms (2.7%). Less frequent events included fainting (0.1%), nausea (0.2%), prolonged DeQi effect (0.5%), and increased pain (0.4%). A notable case was the report of aphasia lasting one hour after acupuncture. The most common systemic symptoms included fatigue (51 treatments), generalized sweating (11), feeling cold (3), isolated hand sweating (14), increased peristalsis (4), and feeling hot (3).

The study found significant correlations between minor hemorrhages and hematomas and the number of needles used. Hemorrhages were less frequent in female patients, while hematomas were less observed in young patients, who in turn expressed more pain. The use of acetylsalicylic acid led to a higher incidence of hemorrhage. Notably, no local infections were reported, despite the practice of several therapists of using sterile needles without disinfecting the skin before insertion.

No contact allergic reactions were observed either, despite the high prevalence of nickel allergy in the general population (12.9%). The study found no differences in adverse event incidence rates between physicians and other professionals, suggesting careful documentation and treatment by the participating professionals. The clinical implications are significant for patients and professionals. The study confirms that acupuncture is a safe therapeutic method when practiced according to established safety rules and in appropriate anatomical regions.

However, patients should be informed about possible minor adverse events, especially those using anticoagulant medications such as acetylsalicylic acid. The medical history before treatment should include questions about coagulation disorders, immunodeficiencies, possible cardiac diseases, pregnancy, medications in use, and existing anatomical abnormalities.