Adverse Events in Acupuncture and Moxibustion Treatment: A Six-Year Survey at a National Clinic in Japan

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Abstract
Many of the frequently reported adverse effects of acupuncture are serious or severe such as pneumothorax, infection, spinal cord injury, or cardiac injury. However, reviewing published case reports does not provide enough information to assess the safety of acupuncture and moxibustion. In order to investigate adverse events of acupuncture, we reviewed all the relevant cases reported by the therapists at our clinic. Over a 6 year period, in the national Tsukuba College of Technology Clinic in Japan, all the acupuncture and moxibustion therapists were required to report the cases of adverse events immediately upon recognition. A total of 84 therapists (13 preceptors and 71 interns) participated in the treatments. The total number of treatments was 65,482. Ninety four (0.14%) adverse events were reported. There were fourteen categories: failure to remove needles (27 cases), ecchymosis or hematoma without pain (9 cases), ecchymosis or hematoma accompanied by pain (8 cases), burn injury (7 cases), discomfort (7 cases), dizziness (6 cases), nausea or vomiting (6 cases), pain in the punctured region (6 cases), minor hemorrhage (4 cases), aggravation of complaint (4 cases), malaise (3 cases), suspected contact dermatitis (3 cases), fever (3 cases) and numbness in the upper extremities (1 case). No serious or severe cases such as pneumothorax, infection, or spinal cord injury were reported by the college preceptors and interns. The results indicate that serious or severe adverse events are rare in standard practice. We suggest that most severe or serious cases of adverse events caused by acupuncture reported in journals are actually cases of negligence. In the future, negligence should be discussed from the point of view of medical education and technical instruction for the therapists, and adverse reactions should be discussed from the point of view of incidence and prevention based on the result of further investigation.