Acupuncture has 'hidden dangers'

Hundreds of NHS patients undergoing acupuncture have suffered complications including dizziness, collapsed lungs and even needles being left in their bodies, the Daily Mail warned today.

The story comes from a review looking at the harms reported from acupuncture treatments given within the NHS. Over a three-year period, researchers identified 325 patient safety incidents related to having acupuncture treatment. 

The most commonly reported adverse incidents (accounting for 95.5% of reports) were judged to present no or very low risk of harm to patients, and included:

• acupuncture needles being left in patients for longer than prescribed
• dizziness
• temporary loss of consciousness

More serious but rarer side effects of acupuncture were also observed to occur, such as collapsed lung (pneumothorax), which accounted for 1.5% of incidents.

One important drawback is that since there is no information on how many acupuncture treatments were given within the NHS during the same period, we do not know how common such harms are.

Also, as these were NHS trained acupuncturists, their standard of care may be higher than in other sectors. Unlike conventional health professionals (who need to be registered), anyone can offer acupuncture treatment whatever their level of training or expertise (though they do need to register with their local authority in the same way as body piercing shops).

Currently, there is only reliable evidence that acupuncture may be effective in the treatment of  chronic lower back pain. There is little or no scientific evidence that acupuncture works for many of the other conditions for which it is often used such as headaches, migraines and joint pain. 

Where did the story come from?

The study was carried out by researchers from the National Patient Safety Agency, London and the Department of Complementary Medicine at the Peninsula Medical School, Plymouth. There was no external funding. 

The study was published in the peer-reviewed International Journal of Risk and Safety Medicine.

The Daily Mail’s report was perhaps alarmist, with a headline describing the ‘hidden perils’ of acupuncture. As the researchers point out, most of the incidents they recorded were of no or low harm.

Also, acupuncture needles would not normally have been left ‘inside’ the body, as stated by the Mail, since they are inserted through the skin, with one end remaining on the body’s surface.

The researchers stated that ‘acupuncture, as practised in the NHS, seems to be a low-harm treatment’.

What kind of research was this?

This was a review of patient safety incidents associated with acupuncture performed within the NHS, which were reported to the National Patient Safety Agency (NPSA) over a three-year period (2009-2011).

The researchers state that acupuncture is one of the best-known forms of complementary medicine in the West and is frequently used to treat chronic pain. The safety of acupuncture has therefore become an important public health issue, with a ‘growing literature’ on adverse events associated with it.

Acupuncture is a form of complementary medicine in which fine needles are inserted into the skin at certain points on the body. In the UK, the two main styles used are traditional Chinese acupuncture and Western medical acupuncture.

Most acupuncture treatments are provided outside of the NHS. Within the NHS, the Royal London Hospital for Integrated Medicine is currently said to be the largest provider of acupuncture services, with several thousand patient sessions a year. Acupuncture is also provided at other hospitals, almost all NHS pain clinics and by many GPs and physiotherapists.

What did the research involve?

The researchers used for their review a national database (called the National Reporting and Learning System database), which collects and analyses reports of incidents where patients receiving NHS care have been harmed, or a ‘near miss’ incident has occurred.

They searched for patient safety incidents relating to acupuncture from January 2009 to December 2011, using the term ‘acupuncture’ to conduct their search. All relevant incidents were reviewed to provide more details about the harm caused. Only incidents that described harms caused to patients during or immediately following acupuncture treatment were included for analysis in the review.

The database also grades the degree of harm of patient safety incidents (no harm, low, moderate, severe and death).

What were the basic results?

The search produced 468 patient safety incidents, of which 325 met the inclusion criteria. Below are the main results:

• 31% (100) of adverse events related to needles being left in the patient for longer than prescribed. In 59 incidents, the needles were found by patients either on their way home or at home. The remaining incidents often happened in busy clinics, where treatment continued for up to three hours longer than intended. In 12 incidents, staff treating patients had left the department or even gone home at the end of the day.
• 30% (99) of incidents described the patient feeling dizzy and/or faint.
• 19% (63) of incidents related to patients temporarily losing consciousness, 32% of these incidents required assessing by accident and emergency staff. Six of these patients also appeared to have suffered a minor seizure.
• 4% (12) of incidents related to patients having a fall, eight of them off the treatment couch.
• 2% (7) of incidents related to bruising or soreness at the site of the needle entry.
• 1% (5) of incidents described pain and difficulty breathing following acupuncture treatment; two of these incidents were formally diagnosed as pneumothorax caused by acupuncture (where a puncture causes air to collect between the lung and chest wall, causing the lung to collapse).
• 12% (39) of incidents included other harms such as hot flushes, vomiting, headache or other pains during treatment.
• 95% of the incidents were categorised by the staff who reported them as of no or low harm, 4% were categorised as moderate harm and one case of pneumothorax as severe harm. Only two of the incidents describing retained needles were reported as causing moderate harm, one of which required surgery to remove the needle. Overall, in 29 incidents, patients needed further assessment by accident and emergency staff.

How did the researchers interpret the results?

The researchers conclude that acupuncture, as practised in the NHS, appears to be a ‘low-harm’ treatment, although they point out, the degree of harm reported as being caused by adverse events may have been either understated or overstated by staff. In particular they point out, there were five cases of pneumothorax, a potentially life-threatening condition, yet only one of these was classified as severe by staff reporting harms.

They say it is also possible, even likely, that many adverse events were not reported at all. They say acupuncture practitioners should be aware of and be prepared to manage any significant harm from treatment.

They believe that serious adverse events may be more frequent among patients who receive acupuncture outside the NHS.

Conclusion

At a time of growing public interest in acupuncture and its increasing use within the NHS, this review of its possible harms is timely. Finding out more about both the potential benefits and risks of different types of treatment means we can make a more informed decision about whether the benefits outweigh the risks.

Frustratingly, since there is no information on how many acupuncture treatments were given within the NHS during the same period, we do not know how common such harms are. Also, records of patient harms do not include any information of patient conditions, which may have caused or contributed to the adverse events. Also, as the researchers point out, it is possible that many adverse events relating to acupuncture have gone unreported.

The study does site a number of previous studies that estimated the rate of mild adverse incidents could range from 671 per 10,000 consultations (6.71%) to 1510 per 10,000 (15.1%).

Currently, acupuncture is recommended by the National Institute for Health and Clinical Excellence (NICE), the body that makes recommendations about which treatments should be available on the NHS, as a treatment option for only one condition - chronic lower back pain. There is little or no scientific evidence that acupuncture works for many of the other conditions for which it is often used.

There is also no statutory regulation on acupuncture in England, although a number of voluntary organisations have drawn up codes of practice. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions, whether the treatment takes place within the NHS or elsewhere.

Analysis by NHS Choices. Follow Behind the Headlines on twitter.