Patient reports of adverse events associated with acupuncture treatment: a prospective national survey
MacPherson et al. · Quality and Safety in Health Care · 2004
Evidence Level
STRONGOBJECTIVE
Establish the types and frequency of adverse events reported by patients after acupuncture treatment
WHO
6,348 patients treated by registered acupuncturists in the United Kingdom
DURATION
3-month follow-up after treatment initiation
POINTS
Not specified — the study focused on the overall safety of acupuncture
🔬 Study Design
Acupuncture patients
n=6348
Traditional Chinese medicine acupuncture treatment
📊 Results in numbers
Adverse event rate
Adverse events per 1000 patients
Serious adverse events
Patients willing to continue acupuncture
Percentage highlights
📊 Outcome Comparison
Adverse event rate by type
This large British study showed that acupuncture is very safe when performed by qualified professionals. Only 1 in 10 patients reported any side effect, the majority being mild, such as tiredness or pain at the needle site. Serious events were extremely rare.
Article summary
Plain-language narrative summary
This prospective national study represents a landmark in research on acupuncture safety, being the first to collect data directly from patients on adverse events on a large scale. Conducted in the United Kingdom in 2002, the study followed 6,348 patients treated by 638 acupuncturists registered with the British Acupuncture Council over a 3-month period. The innovative methodology focused on the patient's perspective, recognizing that professionals may underreport adverse events due to biases or sensitivities. The researchers sent structured questionnaires directly to patients, collecting data on perceived adverse events, advice on conventional medications, and possible delays in conventional diagnoses or treatments.
The sample was robust and representative, covering 30,196 acupuncture consultations. Participating patients were predominantly women (76%), with a mean age of 52 years, and most (95%) paid for treatment privately. The main problems treated were musculoskeletal (38%) and psychological (11%). The results demonstrated that 682 patients (10.7%) reported at least one adverse event during the 3-month follow-up, a rate of 107 per 1,000 patients.
The most common event was severe tiredness and exhaustion (36 cases per 1,000), followed by prolonged pain at the needle site (16 per 1,000) and severe headache (12 per 1,000). Crucially, only three events were classified as serious (0.5 per 1,000), including one case of back pain leading to hospitalization, one severe skin reaction, and one car accident possibly related to post-treatment drowsiness. The risk factor analysis revealed that patients with non-NHS-funded treatment and those without contact with general practitioners or hospital specialists were less likely to report adverse events. Paradoxically, patients on their first acupuncture consultation and those treated by professionals with less than 2 years of experience had a higher risk.
Regarding concerns about inadequate advice on medications, only 199 patients (3%) received guidance to reduce or discontinue prescribed medications, and only six reported adverse consequences. The medications most frequently involved were antidepressants, corticosteroids, and anti-inflammatories. Importantly, the majority of patients (58%) who received such advice also discussed the guidance with their physicians. Only two patients reported a delay in conventional treatment due to consultation with an acupuncturist.
Notably, 94% of patients who experienced adverse events remained willing to continue acupuncture treatment, suggesting that perceived benefits outweighed the risks. The study identified 109 potentially avoidable events (10% of the total), mainly forgotten needles at the site (55 cases), moxa burns (28 cases), and electroacupuncture problems (15 cases). These findings highlight specific areas for improvement in clinical practice and professional education. The clinical implications are significant for acupuncture regulation and public health policies.
The study provides robust evidence that acupuncture, when practiced by qualified and regulated professionals, is a safe intervention. The data contradict frequently raised concerns about risks associated with treatment outside the national health system or by non-physician professionals.
Strengths
- 1Largest prospective safety study with the patient perspective
- 2Robust sample of 6,348 patients and well-structured methodology
- 3First large-scale evidence on medication advice by acupuncturists
- 4High response rate (67%) and good representativeness of the population
Limitations
- 1Follow-up period of only 3 months may have missed late events
- 2Possible overreporting due to use of checklists with 'severe' descriptors
- 3Was not possible to link events to specific professionals
- 4Differences between respondents and non-respondents may affect generalization
Expert Commentary
Dr. Marcus Yu Bin Pai
MD, PhD · Pain Medicine · Physical Medicine and Rehabilitation · Medical Acupuncture
▸ Clinical Relevance
The safety of any intervention is the foundation on which we build therapeutic indications, and this British national survey offers the most solid empirical base available to date for the risk-benefit discussion of acupuncture in the clinical context. With 6,348 patients followed prospectively, the data allow us to state with reasonable confidence that serious adverse events are exceptionally rare — 0.5 per thousand patients — and that the overall event rate of 10.7% is concentrated in mild and transient manifestations such as fatigue and residual pain at the point. In the practice of a musculoskeletal pain service, where acupuncture often integrates a multimodal plan with analgesics, physical therapy, and nerve blocks, knowing that the chance of a clinically relevant event is of this order of magnitude positions the technique very favorably relative to other options in the therapeutic arsenal — including NSAIDs and invasive procedures. The finding about medication advice deserves special attention: only 3% of patients received guidance to modify prescriptions, reinforcing that communication between the acupuncture physician and other team members is a point of active management, not just a theoretical concern.
▸ Notable Findings
The most clinically informative finding is not the overall event rate, but rather the granularity of the categories identified. Severe fatigue and exhaustion leading reports, with 36 cases per thousand, is a finding that resonates directly with what we know about the neurobiology of acupuncture: activation of descending inhibitory pathways and modulation of the hypothalamic-pituitary-adrenal axis produce measurable autonomic responses, and transient fatigue is the expected clinical expression of this process. Even more revealing is the subgroup of 109 potentially avoidable events — almost 16% of the total adverse events reported — concentrated in specific technical errors: forgotten needles at the site, moxa burns, and electroacupuncture intercurrences. This data transforms the safety discussion from an abstract statistical exercise into a map of critical quality control points. The paradox observed — higher risk on the first consultation and with less experienced professionals — points to the learning curve as a real safety variable, data with direct implications for training and supervision programs in services that are integrating acupuncture.
▸ From My Experience
In my practice at the musculoskeletal pain clinic, post-session fatigue is practically a constant in the first consultations, and I usually advise patients beforehand not to interpret this signal as clinical deterioration — on the contrary, I have observed that this autonomic response in the first sessions is a predictor of good subsequent analgesic response. In terms of response speed, I usually perceive measurable functional improvement between the third and fifth session for acute and subacute musculoskeletal conditions; chronic cases typically require eight to twelve sessions before we consolidate a maintenance plateau. The finding about avoidable events — forgotten needles and moxa burns — led us to standardize a session-closure checklist at the service, a simple protocol that virtually eliminated these events in our case series. As for the patient profile that responds best, in my experience there is a clear correlation with active engagement in the integrated therapeutic plan: those who combine acupuncture with a supervised exercise program consistently evolve better than those who use the technique in isolation.
Full original article
Read the full scientific study
Quality and Safety in Health Care · 2004
DOI: 10.1136/qshc.2003.009134
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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