Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews

&NA; Acupuncture is commonly used for pain control, but doubts about its effectiveness and safety remain. This review was aimed at critically evaluating systematic reviews of acupuncture as a treatment of pain and at summarizing reports of serious adverse effects published since 2000. Literature searches were carried out in 11 databases without language restrictions. Systematic reviews were considered for the evaluation of effectiveness and case series or case reports for summarizing adverse events. Data were extracted according to predefined criteria. Fifty‐seven systematic reviews met the inclusion criteria. Four were of excellent methodological quality. Numerous contradictions and caveats emerged. Unanimously positive conclusions from more than one high‐quality systematic review existed only for neck pain. Ninety‐five cases of severe adverse effects including 5 fatalities were included. Pneumothorax and infections were the most frequently reported adverse effects. In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported. Numerous reviews have produced little convincing evidence that acupuncture is effective in reducing pain. Serious adverse events, including deaths, continue to be reported.

[1]  C. Schmid,et al.  Acupuncture for pain relief in patients with rheumatoid arthritis: a systematic review. , 2008, Arthritis and rheumatism.

[2]  Y. Do,et al.  Pseudoaneurysm of the Abdominal Aorta Caused by Acupuncture Therapy , 2002, Surgery today (Print).

[3]  Masaki Sato,et al.  Peroneal nerve palsy following acupuncture treatment. A case report. , 2003, The Journal of bone and joint surgery. American volume.

[4]  C. Kao,et al.  Pseudoaneurysm of the popliteal artery: a rare sequela of acupuncture. , 2002, Texas Heart Institute journal.

[5]  Kenneth Pietz,et al.  A randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient‐provider communication , 2010, Arthritis care & research.

[6]  M. O’Malley,et al.  Unilateral Septic Arthritis of a Lumbar Facet Joint Secondary to Acupuncture Treatment - a Case Report , 2004, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[7]  L. Fu,et al.  Randomized controlled trials of acupuncture for neck pain: systematic review and meta-analysis. , 2009, Journal of alternative and complementary medicine.

[8]  Klaus Linde,et al.  Systematic reviews of complementary therapies – an annotated bibliography. Part 3: Homeopathy , 2001, BMC complementary and alternative medicine.

[9]  E. Peuker Case Report of Tension Pneumothorax Related to Acupuncture , 2004, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[10]  Jian-ping Liu,et al.  Systematic review of clinical trials of acupuncture‐related therapies for primary dysmenorrhea , 2008, Acta obstetricia et gynecologica Scandinavica.

[11]  D. Choo,et al.  Acute intracranial hemorrhage caused by acupuncture. , 2000, Headache.

[12]  A. Hrõbjartsson,et al.  Acupuncture treatment for pain: systematic review of randomised clinical trials with acupuncture, placebo acupuncture, and no acupuncture groups , 2009, BMJ : British Medical Journal.

[13]  K. Ha,et al.  Chronic Inflammatory Granuloma Mimics Clinical Manifestations of Lumbar Spinal Stenosis after Acupuncture: A Case Report , 2003, Spine.

[14]  J. Richter,et al.  Pneumothorax and pleural empyema after acupuncture , 2008, Internal medicine journal.

[15]  E. Ernst,et al.  Acupuncture for labor pain management: A systematic review. , 2004, American journal of obstetrics and gynecology.

[16]  D. Chang,et al.  Acupuncture-associated Listeria monocytogenes arthritis in a patient with rheumatoid arthritis. , 2008, Joint, bone, spine : revue du rhumatisme.

[17]  D. Choo,et al.  Acute Intracranial Hemorrhage in the Brain Caused by Acupuncture , 2000 .

[18]  E. Ernst,et al.  Acupuncture for the relief of cancer‐related pain — a systematic review , 2005, European journal of pain.

[19]  B. Koes,et al.  Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration , 2005, Spine.

[20]  E. Neugebauer,et al.  Evidenz zur Laserakupunktur bei orthopädischen Erkrankungen , 2007, Der Schmerz.

[21]  I. Katayama,et al.  Localized argyria 20-years after embedding of acupuncture needles. , 2002, EJD. European journal of dermatology.

[22]  H. Shigematsu,et al.  CASE REPORT: Infectious Aneurysm Formation After Depot Acupuncture , 2000 .

[23]  B. Nickolay,et al.  Evidence-Based Complementary Medicine. State of the Evidence · Methodological Challenges. Intenrnational Congress on Clinical Research and Quality Management in Complementary Medicine, Munich, April 6 to 8, 2000 – Abstracts , 2000, Complementary Medicine Research.

[24]  M. Karst,et al.  Acupuncture in the Treatment of Painful Dysfunction of the Temporomandibular Joint – a Review of the Literature , 2006, Complementary Medicine Research.

[25]  Guo-liang Zhang,et al.  [Clinical analysis on 38 cases of pneumothorax induced by acupuncture or acupoint injection]. , 2009, Zhongguo zhen jiu = Chinese acupuncture & moxibustion.

[26]  M. Freysz,et al.  [Bilateral pneumothorax and tamponade after acupuncture]. , 2003, Presse medicale.

[27]  P. Zaballos,et al.  Mycobacterium chelonae infection with multiple cutaneous lesions after treatment with acupuncture , 2003, International journal of dermatology.

[28]  R. Studd,et al.  Intraabdominal Abscess after Acupuncture , 2004 .

[29]  Yong-Jin Kim,et al.  Aortoduodenal fistula complicated by acupuncture. , 2005, International journal of cardiology.

[30]  E. Neugebauer,et al.  [Evidence for laser acupuncture in cases of orthopedic diseases : a systematic review]. , 2008, Schmerz.

[31]  Dm Marcus Acupuncture for osteoarthritis of the knee. , 2012, Drug and therapeutics bulletin.

[32]  E. Ernst,et al.  Acupuncture analgesia during surgery: a systematic review , 2005, Pain.

[33]  M. Shin,et al.  Seroprevalence and risk factors for hepatitis C virus infection among female commercial sex workers in South Korea who are not intravenous drug users. , 2006, The American journal of tropical medicine and hygiene.

[34]  Gerben ter Riet,et al.  Systematic reviews of complementary therapies - an annotated bibliography. Part 1: Acupuncture , 2001, BMC complementary and alternative medicine.

[35]  G. Kaya,et al.  Basal Cell Carcinoma of the Earlobe after Auricular Acupuncture , 2002, Dermatology.

[36]  Jong-Jae Park,et al.  Pneumoretroperitoneum following acupuncture. , 2008, Journal of alternative and complementary medicine.

[37]  Ming-Hong Chen,et al.  Cervical subdural empyema following acupuncture , 2004, Journal of Clinical Neuroscience.

[38]  G. Dore,et al.  Highly endemic hepatitis B infection in rural Vietnam , 2007, Journal of gastroenterology and hepatology.

[39]  T. Gan,et al.  Acupuncture for the Management of Chronic Headache: A Systematic Review , 2008, Anesthesia and analgesia.

[40]  S. Rolin,et al.  Acupuncture for tension-type headache: a meta-analysis of randomized, controlled trials. , 2008, The journal of pain : official journal of the American Pain Society.

[41]  Zhi-qi Zhao,et al.  Neural mechanism underlying acupuncture analgesia , 2008, Progress in Neurobiology.

[42]  [Acupuncture for back pain: meta-analysis of randomised controlled trials and an update with data from the most recent studies]. , 2002, Schmerz.

[43]  Jing-Long Huang,et al.  Pott’s puffy tumor after acupuncture therapy , 2009, European Journal of Pediatrics.

[44]  V. Sundararajan,et al.  Ethnic and cultural determinants influence risk assessment for hepatitis C acquisition , 2004, Journal of gastroenterology and hepatology.

[45]  Alejandro R Jadad,et al.  Is acupuncture effective for the treatment of chronic pain? A systematic review , 2000, Pain.

[46]  S. Haines,et al.  Acupuncture needles causing lumbar cerebrospinal fluid fistula. Case report. , 2007, Journal of neurosurgery. Spine.

[47]  Chien-Liang Liu,et al.  Rectus sheath hematoma after acupuncture. , 2005, The Journal of emergency medicine.

[48]  R. Studd,et al.  Images in clinical medicine. Intraabdominal abscess after acupuncture. , 2004, New England Journal of Medicine.

[49]  Daniel Paul Kerr,et al.  Effectiveness of Acupuncture for Low Back Pain: A Systematic Review , 2008, Spine.

[50]  M. Bang,et al.  Paraplegia caused by spinal infection after acupuncture , 2006, Spinal Cord.

[51]  E. Ernst Auricular acupuncture , 2007, Canadian Medical Association Journal.

[52]  K. Yuen,et al.  Relatively Alcohol-Resistant Mycobacteria Are Emerging Pathogens in Patients Receiving Acupuncture Treatment , 2002, Journal of Clinical Microbiology.

[53]  H. Shigematsu,et al.  Infectious aneurysm formation after depot acupuncture. , 2000, European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery.

[54]  Palle Rosted,et al.  Bell's Palsy following Acupuncture Treatment – a Case Report , 2007, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[55]  A. Vickers,et al.  Acupuncture for migraine prophylaxis , 2015, Sao Paulo medical journal = Revista paulista de medicina.

[56]  T. Kaji,et al.  A migrated acupuncture needle in the medulla oblongata. , 2004, Archives of neurology.

[57]  E. Ernst,et al.  Acupuncture for rheumatoid arthritis: a systematic review. , 2008, Rheumatology.

[58]  K. Jeong,et al.  Two cases of factitial panniculitis induced by electroacupuncture , 2009, Clinical and experimental dermatology.

[59]  R. Buchbinder,et al.  Acupuncture for shoulder pain. , 2005, The Cochrane database of systematic reviews.

[60]  A. White,et al.  Acupuncture for pelvic and back pain in pregnancy: a systematic review. , 2008, American journal of obstetrics and gynecology.

[61]  E. Stener-Victorin The pain-relieving effect of electro-acupuncture and conventional medical analgesic methods during oocyte retrieval: a systematic review of randomized controlled trials. , 2005, Human reproduction.

[62]  K. Yuen,et al.  Staphylococcus aureus subcutaneous abscess complicating acupuncture: need for implementation of proper infection control guidelines. , 2003, The new microbiologica.

[63]  Ryan J. Chauffe,et al.  Pneumothorax Secondary to Acupuncture Therapy , 2006, Southern medical journal.

[64]  T. Gan,et al.  Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. , 2008, British journal of anaesthesia.

[65]  M. Mckee,et al.  Possible risks of transmission of bloodborne infection via acupuncture needles in Guizhou province, southwest China. , 2008, Journal of alternative and complementary medicine.

[66]  P. Woo,et al.  Acupuncture mycobacteriosis. , 2001, The New England journal of medicine.

[67]  W. Lien,et al.  Bilateral psoas abscess formation after acupuncture. , 2011, The Journal of emergency medicine.

[68]  Klaus Linde,et al.  Meta-analysis: Acupuncture for Osteoarthritis of the Knee , 2007, Annals of Internal Medicine.

[69]  T. M. Cashman,et al.  A case control investigation of hepatitis C risk factors in Hawaii. , 2005, Hawaii medical journal.

[70]  T. Selfe,et al.  Acupuncture and Osteoarthritis of the Knee: A Review of Randomized, Controlled Trials , 2008, Family & community health.

[71]  Hai-rim Shin Epidemiology of Hepatitis C Virus in Korea , 2005, Intervirology.

[72]  Wang Lin-peng Evaluation of the Quality of Reports on Acupuncture for Migraine Prophylaxis , 2008 .

[73]  Anita Gross,et al.  Acupuncture for Neck Disorders , 2007, Spine.

[74]  Wei Liu,et al.  Adenosine A1 receptors mediate local anti-nociceptive effects of acupuncture , 2010, Nature Neuroscience.

[75]  A. White,et al.  Needling therapies in the management of myofascial trigger point pain: a systematic review. , 2001, Archives of physical medicine and rehabilitation.

[76]  Min Ding,et al.  Acupuncture-associated pneumothorax. , 2013, Journal of alternative and complementary medicine.

[77]  L. G. Olmos,et al.  Efectividad de la acupuntura en el tratamiento del dolor en la artrosis de rodilla , 2002 .

[78]  R. Severijnen [Physical diagnosis--rectal palpation]. , 2002, Nederlands tijdschrift voor geneeskunde.

[79]  Acupuncture in the management of tension-type headache , 2005 .

[80]  E. Ernst,et al.  Bee venom acupuncture for musculoskeletal pain: a review. , 2008, The journal of pain : official journal of the American Pain Society.

[81]  T. Usichenko,et al.  Auricular acupuncture for pain relief after total hip arthroplasty – a randomized controlled study , 2005, Pain.

[82]  J. Jiménez-Alonso,et al.  Pyoderma gangrenosum induced by acupuncture in a patient with ulcerative colitis. , 2000, Archives of internal medicine.

[83]  M. Kwan,et al.  Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus. , 2004, Singapore medical journal.

[84]  Peter S. Y. Kim,et al.  Discitis in an adult following acupuncture treatment: a case report. , 2004, The Journal of the Canadian Chiropractic Association.

[85]  J. Hsieh,et al.  Convulsive syncope: an unusual complication of acupuncture treatment in older patients. , 2005, Journal of alternative and complementary medicine.

[86]  D. Ramnarain,et al.  [Bilateral pneumothorax in a young woman after acupuncture]. , 2002, Nederlands tijdschrift voor geneeskunde.

[87]  C. Griggs,et al.  Effectiveness of acupuncture for migraine: critical literature review. , 2006, Journal of advanced nursing.

[88]  Jae-Kwan Song,et al.  Successful removal of migrated acupuncture needles in a patient with cardiac tamponade by means of intraoperative transesophageal echocardiographic assistance. , 2005, The Journal of thoracic and cardiovascular surgery.

[89]  K. Trinh,et al.  Acupuncture for the alleviation of lateral epicondyle pain: a systematic review. , 2004, Rheumatology.

[90]  G. Guyatt,et al.  Validation of an index of the quality of review articles. , 1991, Journal of clinical epidemiology.

[91]  V. Wiwanitkit HIV infection after Chinese traditional acupuncture treatment. , 2003, Complementary therapies in medicine.

[92]  K. Tucker,et al.  Infected Compartment Syndrome after Acupuncture , 2002, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[93]  Dong Jun Kim,et al.  Spinal Epidural Abscess Associated With Moxibustion-Related Infection of the Finger , 2008, The journal of spinal cord medicine.

[94]  Y. Chua,et al.  Bilateral pneumothoraces as a complication of acupuncture. , 2007, Singapore medical journal.

[95]  P. Khalsa,et al.  A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. , 2009, Archives of internal medicine.

[96]  Seung-Hun Cho,et al.  Acupressure for primary dysmenorrhoea: a systematic review. , 2010, Complementary therapies in medicine.

[97]  B. R. Leavy Apparent adverse outcome of acupuncture. , 2002, The Journal of the American Board of Family Practice.

[98]  E. Ernst,et al.  Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis. , 2006, Rheumatology.

[99]  Acute spinal epidural hematoma after acupuncture. , 2006, The Journal of trauma.

[100]  R. La Touche,et al.  Effectiveness of acupuncture in the treatment of temporomandibular disorders of muscular origin: a systematic review of the last decade. , 2010, Journal of alternative and complementary medicine.

[101]  Acupuncture for Osteoarthritis of the Knee , 2004, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[102]  Ž. Ferenčić,et al.  Multiloculated Pleural Empyema following Acupuncture , 2005, Infection.

[103]  Chen-Chi Tsai,et al.  Epidural abscess caused by Haemophilus aphrophilus misidentified as Pasteurella species. , 2009, Internal medicine.

[104]  H. Mullett,et al.  Acupuncture-associated arthritis in a joint with an orthopaedic implant. , 2002, The Journal of infection.

[105]  E. Ernst,et al.  Is acupuncture a risk factor for hepatitis? Systematic review of epidemiological studies , 2003, Journal of gastroenterology and hepatology.

[106]  R. Brewer,et al.  Video-assisted thorascopic removal of migratory acupuncture needle causing pneumothorax. , 2007, Chest.

[107]  D. Carrington,et al.  Outbreak of hepatitis B in an acupuncture clinic. , 1999, Communicable disease and public health.

[108]  P. Tugwell,et al.  Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis. , 2005, The Cochrane database of systematic reviews.

[109]  Sak Lee,et al.  Acupuncture Induced Necrotizing Aortitis with Infected Pseudoaneurysm Formation , 2008, Yonsei medical journal.

[110]  E. Ernst,et al.  Akupunktur bei Rückenschmerzen , 2002, Der Schmerz.

[111]  E Ernst,et al.  Prospective studies of the safety of acupuncture: a systematic review. , 2001, The American journal of medicine.

[112]  H. Ishizaki,et al.  Silicone granuloma on the entry points of acupuncture, venepuncture and surgical needles , 2000, Journal of cutaneous pathology.

[113]  E. Seeley,et al.  Diabetic ketoacidosis precipitated by Staphylococcus aureus abscess and bacteremia due to acupuncture: case report and review of the literature. , 2006, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[114]  T. H. Nguyen,et al.  Risque d'hépatite C lié à des pratiques traditionnelles : une étude cas témoins à Ho-Chi-Minh-Ville, Vietnam. , 2007 .

[115]  P. Lui,et al.  Broken needle in the cervical spine: a previously unreported complication of Xiaozendao acupuncture therapy. , 2007, Journal of alternative and complementary medicine.

[116]  Y. Takasaki,et al.  Polyarticular Septic Arthritis with Bilateral Psoas Abscesses following Acupuncture , 2009, Acupuncture in medicine : journal of the British Medical Acupuncture Society.

[117]  J. Hyun,et al.  Isolated median sensory neuropathy after acupuncture. , 2008, Archives of physical medicine and rehabilitation.

[118]  R. Buchbinder,et al.  Acupuncture for lateral elbow pain. , 2002, The Cochrane database of systematic reviews.

[119]  B. Eber,et al.  Cardiac tamponade following acupuncture. , 2000, Chest.

[120]  F. Carrat,et al.  A case–control study of risk factors for hepatitis C infection in patients with unexplained routes of infection * , 2006, Journal of viral hepatitis.

[121]  E. Ernst,et al.  Survey of Adverse Events following Acupuncture , 1997 .

[122]  J. L. R. Martin,et al.  Efficacy of Acupuncture for the Treatment of Fibromyalgia: Systematic Review and Meta-Analysis of Randomized Trials , 2009, The open rheumatology journal.

[123]  E. Mohammadi,et al.  Barriers and facilitators related to the implementation of a physiological track and trigger system: A systematic review of the qualitative evidence , 2017, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[124]  Haruo Ito,et al.  An autopsy case of bilateral tension pneumothorax after acupuncture. , 2003, Legal medicine.

[125]  D. Irnich,et al.  Efficacy of acupuncture in fibromyalgia syndrome--a systematic review with a meta-analysis of controlled clinical trials. , 2010, Rheumatology.

[126]  M. Hochberg,et al.  Acupuncture for osteoarthritis of the knee: a systematic review. , 2001, Arthritis and rheumatism.

[127]  N. Foster,et al.  Acupuncture treatment for chronic knee pain: a systematic review. , 2007, Rheumatology.

[128]  I. Oh,et al.  Two Cases of Iatrogenic Pneumothorax after Intra-Muscular Stimulation (IMS) Therapy , 2007 .

[129]  E. Ernst,et al.  Acupuncture for fibromyalgia--a systematic review of randomized clinical trials. , 2007, Rheumatology.

[130]  A. Morgan Pseudomonas aeruginosa infection due to acupunctural ear stapling. , 2008, American journal of infection control.

[131]  Suzanne H Richards,et al.  Acupuncture and dry needling in the management of myofascial trigger point pain: A systematic review and meta‐analysis of randomised controlled trials , 2009, European journal of pain.

[132]  Eric Manheimer,et al.  Meta-Analysis: Acupuncture for Low Back Pain , 2005, Annals of Internal Medicine.

[133]  A. White,et al.  The Safety of Acupuncture – Evidence from the Uk , 2006 .

[134]  M. Ishibe,et al.  Septic arthritis of a lumbar facet joint due to pyonex , 2001, Archives of Orthopaedic and Trauma Surgery.

[135]  P. Woo,et al.  First report of methicillin-resistant Staphylococcus aureus septic arthritis complicating acupuncture: simple procedure resulting in most devastating outcome. , 2009, Diagnostic microbiology and infectious disease.

[136]  J. Stirnemann,et al.  Facial Erysipelas After Receiving Acupuncture Treatment , 2003, Scandinavian journal of infectious diseases.

[137]  H. Fujita,et al.  [Successful deployment of a stent graft in the popliteal artery for pseudoaneurysm after acupuncture: a case report]. , 2007, Journal of cardiology.

[138]  S. Gandevia,et al.  Surface Functional Electrical Stimulation of the Abdominal Muscles to Enhance Cough and Assist Tracheostomy Decannulation After High-Level Spinal Cord Injury , 2008, Journal of Spinal Cord Medicine (JSCM).

[139]  J. Choi,et al.  CD30‐positive T‐cell‐rich pseudolymphoma induced by gold acupuncture , 2002, The British journal of dermatology.

[140]  H. Henderson Acupuncture: evidence for its use in chronic low back pain. , 2002, British journal of nursing.