| VICUS.COM (19 July 2000) --
Accurate diagnosis is the key to successful
therapy. But once a condition is diagnosed, selection of treatment
(conventional medicine or complementary) is based on a thoughtful
balance between the benefits versus the risks of each intervention.
There are more than two dozen conditions in which
the application of acupuncture is likely to have a positive effect. The
next logical question is: "Is it safe?"
Once a condition is diagnosed, selection of
treatment (conventional medicine or complementary) is based on a
thoughtful balance between the benefits versus the risks of each
intervention.
There are more than two dozen conditions in
which the application of acupuncture is likely to have a positive
effect. The next logical question is: "Is it safe?"
What are the risks of
acupuncture?
In the hands of an expert, acupuncture has
minimal risks for the patient. The results of a six-year survey of
adverse events associated with acupuncture and moxibustion at a national
clinic in Japan, published in 1999, are listed in the
table. During this time, 84 therapists (13
preceptors and 71 interns) at the Tsukuba College of Technology Clinic
in Japan were required to report all relevant adverse events during
acupuncture treatment.
Adverse events were rare. The most common
problems with acupuncture, such as failure to remove the needles, were
caused by carelessness
on the part of the therapist.
Admittedly, the impressive record of
acupuncture’s safety when practiced at an academic institution in Asia
may not be representative of what can be expected from a local
practitioner in Ames, Iowa or Sorrento, Italy. A more broadly based
review of the medical literature suggests that side effects due to
acupuncture are still uncommon events. However, poor technique and
negligence can place patients at risk of side effects that they had not
counted on when they agreed to treatment.
A review of adverse effects of acupuncture as
recorded in the MedLine database over 14 years (1981 to 1994) revealed
193 patients with adverse effects. Pneumothorax (lung collapse due to
lung or chest penetration) was the most common mechanical organ injury,
while hepatitis (liver inflammation, usually due to infection) was the
most-mentioned infection. Acupuncture treatment was also reported to be
responsible in the death of three patients.
More recently,
researchers from the University of Exeter's
Department of Complementary Medicine (U.K.) reported two cases of
hepatitis B infection and one case of a lodged broken needle as a result
of acupuncture.
Putting it into
perspective
Everyone has heard of the surgeon who amputated
the wrong limb, or the patient who died because they were given the
wrong medicine. Events such as these have been labeled as medical
errors, and they are a real but mostly preventable problem. (According
to a November 1999 Institute of Medicine report, the cost of errors in
the United States totals as much as $29 billion in lost income,
disability and health care costs.)
We even unnecessarily expose ourselves to
injury when we use power tools or drive a car after taking sedating
antihistamines to treat allergy symptoms. So, while it is important to
recognize the risks of therapy, any treatment must be viewed from the
perspective of its potential benefits and it should be used in a way
that minimizes the risk of side effects.
We know that in the hands of experts,
acupuncture does not expose patients to unreasonable risk, and may
provide analgesia that complements other forms of therapy. The first
step in making it safe for you is to find an experienced expert
acupuncturist. Many organizations can help
you find an expert.
There are more than 10,000 acupuncturists in the
United States, and many states require them to be licensed. The National
Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)
has certified about 9,000 practitioners who have met national standards.
In addition, the American Academy of Medical Acupuncture has a
membership of about 1,400 medical doctors and doctors of osteopathy who
have completed 220 hours of training in acupuncture.
One more recommendation: At the end of the
acupuncture treatment, before you get dressed, make sure all the needles
have been removed.
Table 1. Adverse events reported by 84
therapists following 65,482 acupuncture treatments in Japan
-
Failure to remove needles (27 cases)
-
Ecchymosis ("black and blue" mark) without
pain (9 cases)
-
Ecchymosis ("black and blue" mark)
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 bleeding (4 cases)
-
Aggravation of complaint (4 cases)
-
Malaise (3 cases)
-
Contact dermatitis (suspected) (3 cases)
-
Fever (3 cases)
-
Numbness in the upper extremities (1 case)
John Russo
is senior vice president of medical communications at Vicus.com. He is a
pharmacist and medical writer with more than 20 years of experience in
medical education.
References:
Hidden risks in alternative therapies. Daily
Mail (London), December 21, 1998.
Institute of Medicine. To Err is
Human: Building a Safer Health System. November 1999.
Norheim AJ. Adverse effects of acupuncture: a
study of the literature for the years 1981-1994. J Altern Complement
Med 1999; 2(2):291-7.
Yamashita H, Tsukayama H, Tanno Y, Nishijo K.
Adverse events in acupuncture and moxibustion treatment: A six-year
survey at a national clinic in Japan. J Altern Complement Med
1999; 5(3):229-36. |
