Patient safety incidents from acupuncture treatments: a review of reports to the National Patient Safety Agency
Acupuncture is frequently employed to treat chronic pain syndromes or other chronic conditions. Nevertheless, there is a growing literature on adverse events (AEs) from treatments including pneumothorax, cardiac tamponade and spinal cord injury. Acupuncture is provided in almost all NHS pain clinics and by an increasing number of GP's and physiotherapists. Considering acupuncture's popularity, its safety has become an important public health issue.
To evaluate the harm caused to patients through acupuncture treatments within NHS organisations.
The National Reporting and Learning System (NRLS) database was searched for incidents reported from 1st January 2009 to 31st December 2011. The free text fields of all reports received from all healthcare settings and specialties were searched for the keyword 'acupuncture'. All relevant incidents were reviewed to provide a qualitative theme of the harm to patients. Results: 468 patient safety incidents were identified; 325 met our inclusion criteria for analysis. Adverse events reported include retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), Bruising or soreness at needle site (2%), Pneumothorax (1%) and other adverse reactions (12%). The majority (95%) of the incidents were categorised as low or no harm.
A number of AEs are recorded after acupuncture treatments in the NHS but the majority is not severe. However, miscategorisation and under-reporting may distort the overall picture. Acupuncture practitioners should be aware of, and be prepared to manage, any significant harm from treatments.
Available from: Caroline Barry
- "These reports reveal the multiplicity and the severity of serious events but do not allow estimating their incidence, because, inter alia, they are open to biases in reporting and publication. More recently, surveys explicitly designed to study adverse events associated with complementary medicines have been published; these include notably cohort studies [20 –22] , case-control studies   , review of spontaneous reports of side effects to a National Patient Safety Agency  , and surveys   . "
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ABSTRACT: Complementary medicine comprises many different disciplines and some, for instance, acupuncture, chiropractic, herbal medicine, and homoeopathy, are widely used. Patients with chronic pain show particular high rates of use. Efficacy and safety evaluations are warranted to sort out helpful interventions from unsafe practices. Thousands of randomized trials have evaluated the efficacy of the most popular complementary medicines but there is less information on their safety. However, important methodological problems in design and conduct, disagreement on the practice, variability of comparisons, and discordant interpretation of the trial results of studies have precluded reaching solid consensual conclusions. The challenge is to design studies in a way that fully satisfies methodological standards and that is consistent with everyday practice of complementary medicines including individualization of treatment and holistic aspects. The specific methodological problems of trials evaluating complementary medicines are discussed, with an emphasis on the necessity to use the full spectrum of trial designs, from very explanatory to completely pragmatic, in order to achieve a complete evaluation.
Available from: PubMed Central
- "Complications in acupuncture practice may result from violations of sterile procedure and/or negligence of the practitioners. Serious side effects include cardiac tamponade [43, 44], pneumothorax [45, 46], endocarditis [47–49], hepatitis [50–52], chylothorax , and spinal cord injury [50, 54], and minor side effects include fainting [55, 56] and skin reactions [57–60]. Pneumothorax is the most common mechanical organ injury associated with acupuncture treatment [50, 61–64], and the related reports are from the United States [65–67], Canada , The Netherlands [69, 70], France , Norway , Portugal [72, 73], Denmark , Taiwan , Japan [50, 76], China [45, 77], and Hong Kong . "
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ABSTRACT: Objective. To explore the existing scientific information regarding safe needling depth of acupuncture points and the needling depth of clinical efficacy. Methods. We searched the PubMed, EMBASE, Cochrane, Allied and Complementary Medicine (AMED), The National Center for Complementary and Alternative Medicine (NCCAM), and China National Knowledge Infrastructure (CNKI) databases to identify relevant monographs and related references from 1991 to 2013. Chinese journals and theses/dissertations were hand searched. Results. 47 studies were recruited and divided into 6 groups by measuring tools, that is, MRI, in vivo evaluation, CT, ultrasound, dissected specimen of cadavers, and another group with clinical efficacy. Each research was analyzed for study design, definition of safe depth, and factors that would affect the measured depths. Depths of clinical efficacy were discussed from the perspective of de-qi and other clinical observations. Conclusions. Great inconsistency in depth of each point measured from different subject groups and tools exists. The definition of safe depth should be established through standardization. There is also lack of researches to compare the clinical efficacy. A well-designed clinical trial selecting proper measuring tools to decide the actual and advisable needling depth for each point, to avoid adverse effects or complications and promote optimal clinical efficacy, is a top priority.
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