Rare but serious complications of acupuncture: traumatic lesions

Correlation between thoracic kyphosis and dry needle length required to reach the pleural space needling the upper trapezius: A cadaveric fluoroscopic assessment

BACKGROUND

It is unknown whether greater prone thoracic kyphosis increases pneumothorax risk during upper trapezius dry needling.

OBJECTIVES

To fluoroscopically assess for a correlation between prone thoracic kyphosis and needle length required to reach the pleural space dry needling the upper trapezius in prone.

DESIGN

Cadaveric study.

METHODS

Prone thoracic kyphosis was assessed using dual bubble inclinometers. A 30 mm dry needle was inserted into the midsubstance of the upper trapezius perpendicular to the thoracic kyphosis. A single C-arm fluoroscopic image was obtained. This procedure was repeated with 40, 50, and 60 mm needles. Images were independently viewed by a radiologist to make a binary decision (yes vs. no) whether the needle had potentially broached the pleural space.

RESULTS

Fifteen cadaveric specimens with a mean age of 74.9 ± 9.7 and mean kyphosis of 21.5° ±7.7 were used. A 30 mm needle never reached the pleural space. The pleural space was potentially broached on one, four and six occasions by the 40, 50, and 60 mm needle respectively. The correlation between needle depth penetration and kyphosis was not significant (r = 0.03, p = 0.93). Longer needles (50 and 60 mm) were significantly (p = 0.0049) more likely to reach the pleural space than shorter needles (30 and 40 mm).

CONCLUSION

Thoracic kyphosis was not correlated with needle length required to reach the pleural space. Clinicians may consider selecting shorter needles (<40 mm) to mitigate potential risk while dry needling the upper trapezius in prone.

Stent-Assisted Coil Embolization of a Vertebro-Vertebral Arteriovenous Fistula Secondary to Oriental Acupuncture: A Case Report

A vertebro-vertebral arteriovenous fistula is an abnormal communication between the vertebral artery and adjacent venous structures. Trauma is the most common cause of vertebral arteriovenous fistulas; however, the fistulas can also occur spontaneously. We herein report a case of a traumatic vertebro-vertebral arteriovenous fistula that occurred following the application of oriental acupuncture in the posterior neck region. A 64-year-old previously healthy female patient took over-the-counter medicine for cervical pain that occurred several months before the acupuncture session but showed no improvement. She had undergone oriental acupuncture treatment in the posterior lower neck region 1 month before visiting our hospital. After the treatment, she gradually developed tinnitus, accompanied by dizziness. Abnormal aneurysmal dilated vessels were observed in the right vertebral artery on computed tomography angiography. The patient was immediately admitted and underwent diagnostic angiography. She subsequently underwent stent-assisted coil embolization, which gradually resolved her dizziness and tinnitus.

Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events

OBJECTIVE

Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT.

METHODS

Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy," "auricular acupuncture" or "auricular acupressure," "safety," "adverse events," "chondritis," and "perichondritis," with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT.

RESULTS

Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included.

CONCLUSIONS

The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.

Myofascial pain and treatment: Editorial a critical overview of the current myofascial pain literature - August 2019

This quarter's overview of the myofascial pain literature includes quite a few basic research papers in addition to the usual high quantity of dry needling (DN) papers. Of particular interest are a study by Fischer and colleagues studying the role of mitochondrial functions in chronic trigger points (TrPs) (Fischer et al 2018), a study by Li and associates who conducted a quantitative proteomics analysis to identify biomarkers of chronic myofascial pain and therapeutic targets of dry needling in a rat model of TrPs (Li et al 2019), and a sonography study by Mitchell et al. looking into the distances from the skin to the pleura in the context of DN (Mitchell et al 2019). A total of 33 papers are included in this overview article. We welcome Dr. Jacob Thorp to our team of authors. Dr. Thorp is a US-based physical therapist. He is Professor and Founding Director of the Physical Therapy Program at Charleston Southern University in North Charleston, SC.

Cochrane reviews on acupuncture therapy for pain: A snapshot of the current evidence

Cochrane is an international non-profit organization established in 1993 to produce and disseminate high quality and unbiased systematic reviews of evidence on health care interventions. At the forefront of systematic review methodology, Cochrane is generally accepted to be among the most carefully prepared and rigorous sources of systematic review evidence. There are numerous Cochrane reviews on nonpharmacologic interventions for pain and multiple Cochrane reviews evaluating acupuncture therapy in pain conditions. But how complete and up to date are those reviews relative to other rigorous systematic reviews with meta-analyses of acupuncture therapy for pain published in the literature? In this 'snapshot' overview, we found 22 relevant Cochrane reviews, some concluding that acupuncture therapy is probably useful for treating specific pain conditions. However, many of the conditions for which acupuncture is most commonly used are either not represented in Cochrane reviews or the existing Cochrane reviews are seriously outdated and do not reflect current evidence. This creates confusion with the risks of adverse effects and addiction liability associated with pain medications, the prevalence of chronic pain, the ongoing opioid epidemic and the need for evidence-based options for pain as part of comprehensive pain care. Clinicians and patients want clarification on safe and effective options to treat pain. Issues involving reviewed trials' inadequate use of sham comparators, of acupuncture as a complex intervention with interactive components and a shift in research focus from efficacy trials to real-world pragmatic trials are discussed in relation to updating Cochrane reviews of acupuncture therapy for pain.

Prediction Model for Choosing Needle Length to Minimize Risk of Median Nerve Puncture With Dry Needling of the Pronator Teres

OBJECTIVE

The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling.

METHODS

We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness.

RESULTS

For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%.

CONCLUSION

Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.

Ultrasound Visualization of Radial Nerve Excursion During Acupuncture

Objective: Nerves are likely to be contacted by needles somewhat regularly during acupuncture treatments. However, the effects of this are not well-known or described. The aim of this article is to describe the effects of acupuncture needling to the radial nerve in a single healthy subject. Materials and Methods: In this experiment, conducted at an academic medical center (Washington University School of Medicine in St. Louis, St. Louis, MO), ultrasound-guided acupuncture needling was performed to the radial nerve of one of the authors (C.-T.T.) in the upper arm at acupoint LI 13. The main outcome measures sought were ultrasonic visualization of the nerve during acupuncture needling and the sensations experienced during acupuncture needling of the nerve. Results: The radial nerve was seen to "roll" out of the way when it was needled. Two De Qi responses were elicited en route to the nerve, but, during nerve contact and penetration, minimal-to-no sensation was experienced. Conclusions: Healthy nerves can show side-to-side excursion when needled, and providers and patients cannot know reliably whether or not a nerve has been contacted or penetrated based on the sensations the patient experiences.

Towards Greater Safety in Acupuncture Practice - a Systems Approach

Everyone wants safe medicine. The traditional approach to adverse events has developed within a culture of blaming the individual practitioner. Such an approach is likely to be damaging to individuals and possibly counterproductive by creating an atmosphere of defensiveness and denial. Industries such as airlines have developed an alternative culture using a systems approach. This approach concentrates on assessing and improving the systems of working rather than blaming an individual's performance. Frameworks have been developed for applying this approach to investigating and avoiding medical accidents. These form the basis of a check-list for acupuncture practice that is presented here, and may be useful for individuals and organisations who are concerned to reduce the risk of adverse events.

Guidelines for Providing Acupuncture Treatment for Cancer Patients – a Peer-Reviewed Sample Policy Document

Clinical guidelines are statements that have been systematically developed and which aim to assist clinicians in making decisions about treatment for specific conditions, and promote best practice. They are linked to evidence and are meant to facilitate good medical practice. We are not aware of any guidelines for the safe practice of acupuncture in a conventional healthcare setting, yet they are necessary as acupuncture may be performed in a variety of settings and by a variety of healthcare professionals: doctors, nurses, physiotherapists, midwives, and non medically trained practitioners. These guidelines were developed for use in cancer patients, mainly for pain but also for some non-pain indications such as hot flushes. They are presented here as a template for other acupuncturists who are requested to provide policies for acupuncture treatment for cancer patients.

This article includes a general review of the evidence on mechanisms, effectiveness and safety of acupuncture that is intended to be used in conjunction with the guidelines; and the guidelines themselves. An appendix includes instructions for self acupuncture. The guidelines contain sections on roles and responsibilities, criteria for acupuncture practice, indications for acupuncture, contraindications and cautions, acupuncture treatment, and review and audit. These guidelines set basic, minimum standards of care, and need reassessment and ongoing validation as further data and evidence accumulate.

A Cumulative Review of the Range and Incidence of Significant Adverse Events Associated with Acupuncture

Objective

To summarise the range and frequency of significant adverse events associated with acupuncture in order to provide evidence on which to base continuing efforts to improve the safety of acupuncture practice.

Methods

Searches were conducted of computerised databases, previous reviews of case reports, population surveys, prospective surveys of acupuncture practice and relevant sections of textbooks for primary and secondary reports to indicate the range of significant adverse events associated with acupuncture. Data from prospective surveys of acupuncture were combined to estimate the incidence of serious adverse events.

Results

A total of 715 adverse events was included. There were 90 primary reports of trauma, and 186 secondary reports; the most common were pneumothorax and injury to the central nervous system. Infection accounted for 204 primary reports and 91 secondary reports. Over 60% of these cases were hepatitis B. The next most common infection was of the external ear, as a complication of auricular acupuncture. The 144 miscellaneous events mainly comprised seizures and drowsiness judged severe enough to cause a traffic hazard. There were 12 primary reports of deaths. According to the evidence from 12 prospective studies which surveyed more than a million treatments, the risk of a serious adverse event with acupuncture is estimated to be 0.05 per 10 000 treatments, and 0.55 per 10 000 individual patients.

Conclusions

The risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. The range of adverse events reported is wide and some events, specifically trauma and some episodes of infection, are likely to be avoidable.

Evaluation of bleeding-related adverse events following acupuncture treatment in patients on anticoagulant or antiplatelet drugs: A prospective observational study

OBJECTIVE

To evaluate the risk of bleeding-related adverse events after acupuncture treatment in patients receiving anticoagulant or antiplatelet drugs.

DESIGN AND SETTING

A total of 428 inpatients who received acupuncture treatment underwent two assessments for bleeding-related adverse events, such as micro-bleeding, hematoma, and ecchymosis: 1) immediately after acupuncture treatment on the first day and 2) before acupuncture treatment on the following day. Additional analyses were performed using the number of acupuncture needles as independent variables. Multivariable analysis using factors likely related to bleeding and subgroup analysis according to regions of needle insertion were also performed.

RESULTS

A total of 169 patients receiving anticoagulant or antiplatelet drugs (exposure group) and 259 patients not receiving either drug (non-exposure group) were studied. Sixty-five (38.5%) patients in the exposure group and 115 (44.4%) patients in the non-exposure group had bleeding-related mild adverse events. There was no difference in the risk of bleeding-related adverse events between the two groups per sessions (relative risk (RR) 0.87, 95% confidence interval (CI), 0.69-1.10) and per needles (RR 0.89, 95% CI 0.70-1.13). In multivariable analysis, thickness of needle only increased risk of bleeding. Subgroup analysis showed that taking these drugs did not increase the risk of bleeding in any of the regions.

CONCLUSION

Our findings suggest that anticoagulant and antiplatelet drugs do not increase the incidence of bleeding-related adverse events after acupuncture treatment.

Accuracy and safety of dry needle placement in the piriformis muscle in cadavers

Objectives

The purpose of this anatomic investigation is to (1) establish accuracy of dry needle placement into the medial third of the piriformis muscle as it exits the pelvis from the greater sciatic notch in unembalmed cadaveric specimens, while avoiding puncture of the sciatic nerve, and (2) establish guidelines for dry needle length selection.

Methods

Dry needles were placed in nineteen unembalmed cadaveric posterior hips. Dissection of the posterior hip musculature was performed to confirm location of the needle. A binary decision (yes/no) was made to determine whether the needle reached the piriformis muscle, went through the piriformis muscle, and/or pierced the sciatic nerve. Additionally, mean adipose tissue thickness, gluteus maximus muscle thickness, and perpendicular distance from the needle to the exiting sciatic nerve were recorded.

Results

The needle reached the medial third of the piriformis in 16 out of 19 hips (84.2% accuracy) and never punctured the sciatic nerve. There was a fair (r = 0.493) and good (r = 0.759) correlation between the needle length and the mean fat thickness for the left and right hips, respectively.

Discussion

A physical therapist was able to use bony landmark palpation to locate the piriformis muscle and use estimated adipose tissue thickness to choose a sufficient needle length to reach the medial third of the piriformis muscle. While the needle placement technique was safe and no sciatic nerve puncture occurred, the proximity of the piriformis muscle to the sciatic nerve warrants caution during needle placement.

Level of Evidence

2c.

Safety of different acupuncture manipulations for posterior circulation ischemia with vertigo

Acupuncture at Fengchi (GB20) in the posterior neck improves vertigo. However, subarachnoid hemorrhage and spinal epidural hematoma have been reported to occur after acupuncture in the posterior neck. Therefore, in the present study, we assessed the safety of acupuncture at Fengchi. Laboratory tests and adverse event reports were used to evaluate the safety of different acupuncture manipulations for the treatment of posterior circulation ischemia with vertigo. A total of 136 patients were randomly assigned to four groups. Verum acupuncture was conducted with different needle insertion directions (contralateral paropia or prominentia laryngea) and different needle twisting frequencies (60 or 120 times/minute) at Fengchi and matching acupoints (for example, Zhongwan [CV12], Qihai [CV6], Zusanli [ST36], and Fenglong [ST40]). The patients received 14 treatments over 3–4 weeks. Routine blood analysis, hepatic and renal function tests, urine and feces tests and electrocardiography were performed before the first treatment session and after the final session. Adverse events were recorded after every session. Of the 136 patients, 120 completed the study. There were no significant differences between pretreatment and posttreatment test results in any of the groups. Only five patients suffered from minor adverse events (needling pain, slight hematoma and transient chest tightness). No serious adverse events were found. Our results indicate that a 14-session course of needling at Fengchi is relatively safe for treating posterior circulation ischemia with vertigo.

A rare case of multiple spinal epidural abscesses and cauda equina syndrome presenting to the emergency department following acupuncture

BACKGROUND

Acupuncture is a form of traditional Chinese medicine being increasingly used as complementary therapy in many countries. It is relatively safe and rarely associated with deep infections.

CASE PRESENTATION

In this case report, we describe a middle-aged Chinese patient who presented acutely to our emergency department with cauda equina syndrome secondary to acupuncture-related epidural abscesses, which were treated with surgical decompression and intravenous antibiotics. We also present a review of case reports of this rare condition in available literature.

CONCLUSION

Emergency physicians should be aware that spinal abscesses may occur after acupuncture, with a broad spectrum of clinical presentations. If a history of recent acupuncture over the symptomatic area is elicited, a high index of suspicion should be maintained and appropriate imaging performed to establish the diagnosis. Treatment is directed by a number of factors, such as severity and duration of neurological deficit and progression of symptoms.

Dry needling for the management of thoracic spine pain

Thoracic spine pain is as disabling as neck and low back pain without receiving the same level of attention in the scientific literature. Among the different structures that can refer pain to the thoracic spine, muscles often play a relevant role. Trigger points (TrPs) from neck, shoulder and spinal muscles can induce pain in the region of the thoracic spine. There is a lack of evidence reporting the presence of TrPs in the region of the thoracic spine, but clinical evidence suggests that TrPs can be a potential source of thoracic spine pain. The current paper discusses the role of TrPs in the thoracic spine and dry needling (DN) for the management of TrPs in the thoracic multifidi and longissimus thoracis. This paper also includes a brief discussion of the application of DN in other tissues such as tendons, ligaments and scars.

Unusual case of pyogenic spondylodiscitis, vertebral osteomyelitis and bilateral psoas abscesses after acupuncture: diagnosis and treatment with interventional management

BACKGROUND

We report, for the first time, a case of pyogenic spondylodiscitis combined with vertebral osteomyelitis and bilateral psoas abscesses after acupuncture.

CASE HISTORY

A 60-year-old man was diagnosed with rectal cancer, and radical rectectomy and permanent colostomy were carried out. However, 3 years after the surgery the patient complained of pain in the lower back, and the symptoms worsened after seven sessions of acupuncture. Technetium 99m-labelled methylene diphosphonate ((99m)Tc-MDP) bone scintigraphy (BS) revealed abnormal uptake of (99m)Tc-MDP in the L4 and L5 vertebrae. He was admitted to our hospital because of suspected bone metastases from rectal cancer. He was diagnosed with infection based on a history of acupuncture and the findings of enhanced MRI and CT. Percutaneous lumbar discectomy (PLD), external drainage and irrigation using antibiotics were carried out to treat the L4-5 disc. Pathological analyses and bacterial culture of the resected disc confirmed infection with group C streptococcus. Postoperative antibiotic treatment resulted in significant pain relief on the third day and gradual complete relief. Considerable improvement was seen on CT and MRI at follow-up.

CONCLUSIONS

We consider it highly likely that this patient's infection was caused by acupuncture. In patients with malignancy, abnormal uptake of (99m)Tc-MDP in BS may signify bone metastasis but can also be observed in bone infections. PLD can be used to resect diseased discs to relieve pain quickly and to prevent herniation of lumbar discs. After PLD, external drainage can be employed for abscess drainage, decompression and perfusion of antibiotics. PLD may serve as an alternative to open surgery for pyogenic spondylodiscitis.

Electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy in multiple myeloma: a feasibility study

Background

This single-arm study evaluated feasibility, safety, and initial efficacy of electroacupuncture for thalidomide/bortezomib-induced peripheral neuropathy (PN) in cancer patients with multiple myeloma.

Methods

Patients with neuropathy ≥ grade 2 received 20 acupuncture treatments over 9 weeks.

Results

For the 19 evaluable patients, Functional Assessment of Cancer Therapy/Gynecological Oncology Group-Neurotoxicity (FACT/GOG/NTX) mean (SD) scores improved significantly between baseline and week 13 (20.8 [9.6] vs 13.2 [8.5], p = 0.0002). Moderate effect size differences began on week 4, with the largest effect size differences found at week 9 for FACT/GOG/NTX scores, worst pain in the last 24 hours, and pain severity (Cohen’s d = 1.43, 1.19, and 1.08, respectively) and continuing through week 13 (Cohen’s d = 0.86, 0.88, and 0.90, respectively). From baseline to week 13, additional significant improvements were seen as follows: postural stability (1.0 [0.6] vs 0.8 [0.4], p = 0.02); coin test (10.0 [7.4] vs 5.6 [1.9], p < 0.0001); button test (96.1 [144.4] vs 54.9 [47.3], p < 0.0001); and walking test (21.6 [10.0] vs 17.2 [7.7], p = 0.0003). No significant changes were seen with NCS.

Conclusions

Acupuncture may help patients experiencing thalidomide- or bortezomib-induced PN. Larger, randomized, clinical trials are needed.

Trial registration

ClinicalTrials.gov Identifier: NCT00891618.

Use of acupuncture and other CAM methods in obstetrics: an analysis of 409,413 deliveries from Hesse, Germany

OBJECTIVES

This study was done to analyze the frequency of use of acupuncture and other complementary and alternative medicine (CAM) methods during labor and to investigate the different characteristics of women being treated with or without acupuncture and CAM methods, as well as try to analyze birth-related outcome measures.

STUDY DESIGN

Data were analyzed from 409,413 deliveries, registered between 2001 and 2008 by the agency for quality assurance in Hesse (the Hessian Perinatal Registry [HEPE] survey), which made up more than 95% of all deliveries in this German state during the given time period.

RESULTS

Interest in the use of CAM seems to have decreased within the given time period. On average, acupuncture was used in 3.7% (15,345/409,295) of all deliveries and other CAM methods in 4.8% (19,507/409,295). The most important determinant for the use of one or both methods was the type of hospital. It was also found that German women with higher job qualifications were more likely to receive CAM treatment during delivery. Interestingly, application of CAM methods was associated with a higher use of analgesics during labor. The risk status of the pregnancy or the delivery was of minor importance.

CONCLUSIONS

This analysis shows that the determinants of CAM use are similar to those in the field of oncology. In order to assess the efficacy of acupuncture or other CAM methods in the field of obstetrics, it seems necessary to extend the HEPE survey to cover these areas.

The Role of Acu-TENS in Hemodynamic Recovery after Open-Heart Surgery

Increased heart rate (HR) and reduced blood pressure (BP) are common consequences of cardiac surgery. This study investigated the effect of transcutaneous electrical nervous stimulation applied over acupuncture points (Acu-TENS) on HR, BP, rate pressure product (RPP) and nausea and vomiting score after open-heart surgery. After open heart surgery, 40 patients were randomly allocated to either an Acu-TENS group, which received a 40-min session of TENS applied bilaterally over the acupuncture point PC6 on postoperative days 1-5, or a Placebo-TENS group, which received identical electrode placement but with no electrical output from the TENS unit, despite an output indicator light appearing activated. HR, systolic and diastolic BPs (SBP and DBP) were recorded and RPP computed. Nausea and vomiting symptoms were quantified using a 4-point Likert scale before and after TENS intervention. Daily HR, BP and antiemetic administration data were recorded from a further 20 consecutive subjects who received no intervention and formed the Control group. A trend of decreasing HR and increasing BP in the Acu-TENS group was observed over the five postoperative days, with all variables returning to preoperative values by Day 4 (P > .2). In the Placebo-TENS and Control groups the HR remained higher (P < .0001), BP lower (P < .05) and RPP higher (P = .01) than respective preoperative values at Day 4. The dose of Maxolon required was lowest in the Acu-TENS group (P = .038). We concluded that Acu-TENS facilitated an earlier return to preoperative BP, HR and RPP values in patients after acute heart surgery.

Acupuncture-induced popliteal arteriovenous fistula successfully treated with percutaneous endovascular intervention

A 39-year-old female visited our cardiovascular outpatient department with paresthesia and soreness around the right popliteal fossa, where thrill was palpable. There was no history of trauma, apart from her having undergone acupuncture several years previously. An arteriovenous fistula (AVF) was diagnosed by vascular ultrasonography and magnetic resonance imaging. Angiography confirmed the presence of an AVF fed by the medial geniculate artery. Transarterial embolization was performed to close the AVF using coils and tissue adhesive. To the best of our knowledge, acupuncture-induced AVF has not been previously reported. We present a case demonstrating the merits of percutaneous endovascular intervention for treating this rare complication. The additional administration of a tissue adhesive can achieve complete closure of the AVF in the event of an unsatisfactory result following coil embolization. Doctors should be aware of the potential vascular complications of acupuncture, and of the management options.

Cardiac tamponade caused by acupuncture: a review of the literature

This systematic review aims to summarize all reported cases of cardiac tamponade after acupuncture. Five electronic databases and our own files were searched for reports of cardiac tamponade after acupuncture. No restrictions in time or language were imposed. Data were extracted by two independent reviewers according to predefined criteria. We found a total of 26 cases. In 14 patients, the complications were fatal. In most instances, there is little doubt about causality. We conclude that cardiac tamponade is a serious, often fatal complication after acupuncture. As it is theoretically avoidable, acupuncturists should be trained to minimize the risk.

Acupuncture: Complications are preventable not adverse events

If adverse effects are understood as "something that happened unexpectedly" while receiving drug treatment, there is no difference between adverse effects and complications. However, acupuncture is a process different from the use of drugs. While acupuncture procedures should not be taken for granted as safe, complications causing harm are usually, according to the authors, the result of negligence, and should be differentiated from other adverse effects. Harmful complications noted consisted of bleeding and damage to the tissues and organs under the puncture sites. Adverse effects consisted of symptomatology like fainting and other systemic disturbances difficult to explain. In a study of acupuncture complications and adverse effects in 2000 procedures conducted by experienced professional acupuncturists in a research institution, it was found that complications did not occur, and adverse events happened infrequently. Attempts were made to explain the causes of adverse effects. Now that acupuncture is being widely incorporated into medical practice, a good understanding of adverse effects and complications would be necessary and helpful.

Evidenz zur Laserakupunktur bei orthopädischen Erkrankungen

BACKGROUND AND OBJECTIVES

The aim of this review is to evaluate the evidence for laser acupuncture in selected orthopaedic diseases.

MATERIAL AND METHODS

Randomized controlled studies, meta-analyses and systematic reviews were identified by a systematic search strategy in Medline and the Cochrane library. The studies were evaluated using the quality criteria of the Oxford Centre of Evidence Based Medicine.

RESULTS

For the selected orthopedic diseases (medial and lateral epicondylitis, myofascial pain syndrome of the neck, back and shoulder and osteoarthritis), meta-analyses, systematic reviews and eight randomized controlled studies were found. All other published studies used laser therapy without consideration of classical acupuncture points. All studies had significant drawbacks in methodological quality and the number of patients included. In more recent trials, improvement towards higher methodological quality was obvious. Although current evidence is equivocal, positive effects can be assumed in myofascial pain syndromes of the neck, back and shoulder. Laser acupuncture is advantageous in terms of side effects compared to classical acupuncture techniques.

CONCLUSION

Better, well designed randomized studies with higher power are mandatory in orthopedic diseases.

Broken Needle in The Cervical Spine: A Previously Unreported Complication of Xiaozendao Acupuncture Therapy

Xiaozendao (meaning "small-needle-knife," in Chinese) is a form of alternative medical instrument shaped like an acupuncture needle with a flat edge on the needle tip. It is widely used for the treatment of many different disorders in Asian countries, especially in the People's Republic of China. Its use has gained increasing popularity. To our knowledge, there are no reports of practitioners' experiences or adverse events related to "small-needle-knifed" therapy until now. We reported the first case of spinal-cord injury with delayed onset of neurologic symptoms from a broken small-needle-knife insertion into the spinal cord.

Diabetic Ketoacidosis Precipitated byStaphylococcus aureusAbscess and Bacteremia Due to Acupuncture: Case Report and Review of the Literature

Acupuncture use is increasing in the United States. Despite multiple studies, the efficacy and safety of acupuncture are poorly defined. We report a previously healthy patient who developed a thigh abscess, bacteremia, and diabetic ketoacidosis after acupuncture treatment. We review the literature on infectious complications of acupuncture.

Iatrogenic bilateral pneumothorax arising from acupuncture: a case report

Acupuncture is often regarded as innocuous. However, its complication can be serious and deadly if unattended. We report a case of iatrogenic bilateral pneumothorax after acupuncture therapy. Setting up a government regulatory body and using needles with safety design can prevent further inadvertent incidences from occurring.

The effects of laser acupuncture on chronic tension headache--a randomised controlled trial

OBJECTIVE

Headache affects the quality of life for many people throughout the world. Tension headache is among the commonest forms. Acupuncture is the most widely practised non-medicinal treatment for headaches. The purpose of this study was to explore the effects of laser acupuncture in this type of headache.

METHODS

Fifty patients with chronic tension-type headache were randomly allocated to treatment or placebo groups. Patients in the treatment group received low energy laser acupuncture to LU7, LI4, GB14, and GB20 bilaterally. Points were irradiated for 43 seconds, and the intensity was 1.3J (approximately 13J/cm2). Ten sessions were given, three per week. The placebo group was treated in a similar way except that the output power of the equipment was set to zero. The outcome variables were headache intensity (VAS), duration of attacks, and number of days with a headache per month, by daily diary, assessed monthly to three months after treatment.

RESULTS

There were significant differences between groups (P<0.001) in changes from baseline in months one, two and three, in median score for headache intensity (treatment group -5, -3 and -2, placebo group -1, 0 and 0), median duration of attacks (treatment group -6, -4 and -4, placebo group -1, 0 and 0 hours), and median number of days with headache per month (treatment group -15, -10 and -8, placebo group -2, 0 and 0).

CONCLUSION

This study suggests that laser acupuncture may be an effective treatment for chronic tension-type headache, but the results should be confirmed in larger and more rigorous trials.

Kapalabhati pranayama: breath of fire or cause of pneumothorax? A case report

Spontaneous pneumothorax is the most common cause of pneumothorax. We report a case of a 29-year-old healthy woman who presented to the emergency department with a spontaneous pneumothorax caused by a yoga breathing technique called Kapalabhati pranayama, or breath of fire. Yoga breathing exercises are commonly practiced, and a limited number of studies have shown various physiologic benefits of yoga breathing. This is the only known report of spontaneous pneumothorax caused by pranayama, but some other rare causes are noted. This case should illustrate that adverse side effects can occur when one pushes the body to physiologic extremes.

Case report of tension pneumothorax related to acupuncture

Although recent prospective studies came to the conclusion that the incidence of adverse events following acupuncture can be classified as minimal, many cases of acupuncture-related pneumothorax have been published over the years, among them some cases of tension pneumothorax. In this case, a slender woman received acupuncture from a fully trained medical acupuncturist including needling of the points LU1 in the subacromial region and BL13, which is a paravertebral point at the level of the spinous process of the third thoracic vertebra. During the final treatment, she experienced difficulties in breathing and pain in the left chest. On x ray examination a tension pneumothorax was diagnosed. Even though pneumothorax is the most frequently reported serious complication related to acupuncture, it is not an inevitable complication of acupuncture, and in most cases involves negligence from inadequate consideration of basic anatomy.

Infected compartment syndrome after acupuncture

We present a case of septicaemia and compartment syndrome of the leg in a diabetic patient, following acupuncture to his calf. An emergency decompression fasciotomy was performed on the patient and gram-positive cocci were grown from the posterior compartment wound swab cultures and group A streptococcus from his blood cultures. He remained in the Intensive Therapy Unit postoperatively, requiring inotropic support and intravenous antibiotics for his septicaemia. We would like to remind acupuncturists, to consider the possibility of heightened risks in immunocompromised patients.