Acupuncture (PDQ®)–Health Professional Version

Adverse Effects

Serious adverse effects of acupuncture are rare. Reported accidents and infections appear to be related to violations of sterile procedure, negligence of the practitioner, or both.[1,2] A systematic review of case reports on the safety of acupuncture, involving 98 papers published in the English language from 22 countries during the period from 1965 to 1999, found only 202 incidents. The number of incidents appeared to decline as training standards and licensure requirements were enhanced. Among the 118 (60%) reported incidents involving infection, 94 (80%) involved hepatitis, occurring mainly in the late 1970s and early 1980s. Very few hepatitis or other infections associated with acupuncture have been reported since 1988, when widespread use of disposable needles was introduced and national certification requirements for clean-needle techniques were developed and enforced as an acupuncture licensure requirement.[3,4] Because cancer patients who are undergoing chemotherapy or radiation therapy are immunocompromised, precautions must be taken and strict clean-needle techniques must be applied when acupuncture treatment is given.[5]

Minor adverse effects of acupuncture, such as pain at needling sites, hematoma, tiredness, lightheadedness, drowsiness, and localized skin irritation, have been reported.[6-11] These minor adverse effects can be minimized by appropriate patient management, including local pressing and massage at the needling site after treatment.[12,13]

Acupuncture in children has not been studied extensively; however, adverse effects appear to be rare and limited to the same effects as observed in adults.[14-16]. At least one study has shown that there was no increased incidence of adverse events in children with thrombocytopenia or neutropenia. [16]

References

Lao L: Acupuncture techniques and devices. J Altern Complement Med 2 (1): 23-5, 1996. [PUBMED Abstract]
MacPherson H: Fatal and adverse events from acupuncture: allegation, evidence, and the implications. J Altern Complement Med 5 (1): 47-56, 1999. [PUBMED Abstract]
Lao L, Zhang G, Wong RH, et al.: The effect of electroacupuncture as an adjunct on cyclophosphamide-induced emesis in ferrets. Pharmacol Biochem Behav 74 (3): 691-9, 2003. [PUBMED Abstract]
National Acupuncture Foundation: Clean Needle Technique Manual for Acupuncturists: Guidelines and Standards for the Clean and Safe Clinical Practice of Acupuncture. 6th ed. Washington, DC: National Acupuncture Foundation, 2009.
Shen J, Wenger N, Glaspy J, et al.: Electroacupuncture for control of myeloablative chemotherapy-induced emesis: A randomized controlled trial. JAMA 284 (21): 2755-61, 2000. [PUBMED Abstract]
Enblom A, Johnsson A: Type and frequency of side effects during PC6 acupuncture: observations from therapists and patients participating in clinical efficacy trials of acupuncture. Acupunct Med 35 (6): 421-429, 2017. [PUBMED Abstract]
Brattberg G: Acupuncture treatment: a traffic hazard? Am J Acupunct 14 (3): 265-7, 1986.
Ernst E, White AR: Prospective studies of the safety of acupuncture: a systematic review. Am J Med 110 (6): 481-5, 2001. [PUBMED Abstract]
White A, Hayhoe S, Hart A, et al.: Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 323 (7311): 485-6, 2001. [PUBMED Abstract]
MacPherson H, Thomas K, Walters S, et al.: The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 323 (7311): 486-7, 2001. [PUBMED Abstract]
Yamashita H, Tsukayama H, Tanno Y, et al.: Adverse events related to acupuncture. JAMA 280 (18): 1563-4, 1998. [PUBMED Abstract]
Cheng X: Chinese Acupuncture and Moxibustion. 3rd ed. Beijing, China: Foreign Languages Press, 2018.
O'Connor J, Bensky D, eds.: Acupuncture: A Comprehensive Text. Chicago, Ill: Eastland Press, 1981.
Jindal V, Ge A, Mansky PJ: Safety and efficacy of acupuncture in children: a review of the evidence. J Pediatr Hematol Oncol 30 (6): 431-42, 2008. [PUBMED Abstract]
Ladas EJ, Rooney D, Taromina K, et al.: The safety of acupuncture in children and adolescents with cancer therapy-related thrombocytopenia. Support Care Cancer 18 (11): 1487-90, 2010. [PUBMED Abstract]
Chokshi SK, Ladas EJ, Taromina K, et al.: Predictors of acupuncture use among children and adolescents with cancer. Pediatr Blood Cancer 64 (7): , 2017. [PUBMED Abstract]

Summary of the Evidence for Acupuncture Treatment of Cancer-Related Symptoms

It is noteworthy that almost all reported clinical studies on the effects of acupuncture on cancer or cancer therapy–related symptoms focus on symptom management rather than the disease itself. Investigations into the effects of acupuncture on chemotherapy-induced nausea and vomiting, many of which were randomized and well-controlled, produced the most convincing findings. A number of randomized controlled trials have reported on the effect of acupuncture in alleviating other cancer treatment-associated side effects, with many showing promising evidence supporting the use of acupuncture. Additional phase III clinical trials are ongoing.

Changes to This Summary (01/17/2020)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

General Information

Updated Gongwang, Cheng, and Ergil as references 15, 16, and 19, respectively.

History

Updated Ergil, 2007 Maciocia, 2011 Maciocia, and Kaptchuk as references 4, 5, 6, and 7, respectively.

Human/Clinical Studies

Added text to state that researchers have attempted to augment the impact of acupressure on the antiemetic effects using certain methods, but they were not found to be effective (cited Peoples et al. as reference 51).

Adverse Effects

Updated the National Acupuncture Foundation and Cheng as references 4 and 12, respectively.

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About This PDQ Summary

Purpose of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of acupuncture in the treatment of people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.

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PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Acupuncture. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: https://www.cancer.gov/about-cancer/treatment/cam/hp/acupuncture-pdq. Accessed <MM/DD/YYYY>. [PMID: 26389159]

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