Pneumoretroperitoneum Following Acupuncture

The reporting quality of acupuncture-related traumatic adverse events: a systematic review of case studies in Korea

BACKGROUND

Acupuncture is known for a harmless treatment when administered by well-trained clinicians. However, multiple case reports of traumatic adverse events (AEs) related to acupuncture treatments continue to be published in literature. In this review, we evaluated the reporting quality and conducted causality assessments of case studies that have reported acupuncture-related traumatic AEs in Korea.

METHODS

Eight databases were searched from their inception to January 2024. Only Korean case studies that reported traumatic AEs following acupuncture procedures were included without any language restrictions. Reporting quality was evaluated based on patient characteristics, AEs, and acupuncture practice. Causality was assessed using the modified WHO-UMC causality criteria.

RESULTS

Twenty-eight studies were included from a total of 1,154 identified studies. The quality of reporting in the included studies was low overall. While the descriptions of patient characteristics and AEs were relatively well detailed, most information on acupuncture practice was not reported at all. During the causality assessment, only three (10.7%) studies were judged to be "certain". Twelve (42.9%) studies were "unassessable" because they inadequately described the information necessary for decision-making. It was practically difficult to establish the causality between acupuncture and AEs, as well as the appropriateness of acupuncture practice.

CONCLUSIONS

Insufficient and inappropriate reporting was observed in most case studies reporting acupuncture-related traumatic AEs in Korea. To overcome these limitations, we have suggested tentative guidelines in the form of a set of items that should be reported by future authors who plan to publish case studies on acupuncture-related traumatic AEs in a clinical setting.

Adverse events of acupuncture: a systematic review of case reports

Acupuncture, moxibustion, and cupping, important in traditional Eastern medicine, are increasingly used in the West. Their widening acceptance demands continual safety assessment. This review, a sequel to one our team published 10 years ago, is an evaluation of the frequency and severity of adverse events (AEs) reported for acupuncture, moxibustion, and cupping between 2000 and 2011. Relevant English-language reports in six databases were identified and assessed by two reviewers. During this 12-year period, 117 reports of 308 AEs from 25 countries and regions were associated with acupuncture (294 cases), moxibustion (4 cases), or cupping (10 cases). Country of occurrence, patient's sex and age, and outcome were extracted. Infections, mycobacterial, staphylococcal, and others, were the main complication of acupuncture. In the previous review, we found the main source of infection to be hepatitis, caused by reusable needles. In this review, we found the majority of infections to be bacterial, caused by skin contact at acupoint sites; we found no cases of hepatitis. Although the route of infection had changed, infections were still the major complication of acupuncture. Clearly, guidelines such as Clean Needle Technique must be followed in order to minimize acupuncture AEs.

Adverse events following acupuncture: a systematic review of the Chinese literature for the years 1956-2010

OBJECTIVES

The objective of this study was to make non-Chinese readers better informed about the current safety situation of acupuncture in China.

METHODS

Four (4) major Chinese comprehensive databases were searched: Chinese Journal Full-text Database (1949-2010), China Biomedical Literature Database (1978-2010), Chinese Technology Journal Database (1989-2010), and Wanfang (1998-2010). Case reports of adverse events related to acupuncture therapy were included. Literature reviews, case-control study, translations, duplicate literatures in various databases, and duplicate published articles with duplicate data were excluded.

RESULTS

One hundred and sixty-seven (167) articles were included with 1038 cases, among which 35 patients died. The most frequent adverse events were syncope (468 cases), pneumothorax (307 cases), and subarachnoid hemorrhage (64 cases).

CONCLUSIONS

Acupuncture-related adverse events were mainly caused by mental tension of the patient, improper operation by the doctor, and incompleteness of sterilization. Most of them can be avoided by standardizing teaching and clinical practices. Making the corresponding safety standards can greatly lower the risk of adverse events and protect patient safety to the greatest extent.

Safe needling depth of acupuncture points

OBJECTIVES

The objective of this review is to investigate the existing scientific information on the safe needling depth of acupuncture points.

METHODS

The PubMed, EMBASE, Cochrane, AMED (Allied and Complementary Medicine), NCCAM (The National Center for Complementary and Alternative Medicine), and CNKI (China National Knowledge Infrastructure) databases were searched to identify relevant monographs from 1991 to 2009. Additional articles were also identified from the reference list of identified articles. Chinese journals that we thought might be relevant to our study were hand searched.

RESULTS

Thirty-three (33) studies were recruited into the review. Each research study was analyzed for study design, investigated acupuncture points, definition of safe depth, measuring methods, subject number, and for discussion of de qi. Factors that would affect the measured depth such as gender, age, body sizes, right or left side of limb, if using Ton Shen Cun for comparison, and needling angles were also reviewed. Needling depth of each point was revealed as well.

CONCLUSIONS

There is great inconsistency in terms of safe needling depths measured from different subject groups and measuring methods. There is suitable justification for a well-designed clinical trial to investigate the real needling depth for each acupuncture points to avoid adverse effects or complications.

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

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.

Development of postdural puncture headache following therapeutic acupuncture using a long acupuncture needle

Acupuncture appears to be a clinically effective treatment for acute and chronic pain. A considerable amount of research has been conducted to evaluate the role that acupuncture plays in pain suppression; however, few studies have been conducted to evaluate the side effects of the acupuncture procedure. This case report describes a suspected postdural puncture headache following acupuncture for lower back pain. Considering the high opening pressure, cerebrospinal fluid leakage, and the patient's history of acupuncture in the lower back area, our diagnosis was iatrogenic postdural puncture headache. Full relief of the headache was achieved after administration of an epidural blood patch.