Systematic Review into Acupuncture adverse events

Bäumler et al. (2021) Acupuncture Related Adverse-Events- a Summary of the Review and Findings

The systematic review and meta-analysis by Bäumler et al. (2021) explored prospective studies looking at acupuncture-related adverse events (AEs). The article was recently published in the BMJ-Open. The aim of the study was to evaluate the incidence and severity of AEs related to manual and/or electro-acupuncture with or without the use of moxibustion therapy. The types of AEs were differentiated between AEs and severe AEs (SAEs). The authors created a search strategy and searched for 3 databases (Pubmed, Scopus, and Embase) to identify appropriate literature.

The review authors discovered a total of 7 679 research articles through the literature search. 22 articles met the inclusion criteria and were included in the review. These articles provided data for altogether 12,9 million treatments delivered by practitioners trained in either Western or Traditional Chinese Medicine disciplines. A critical appraisal of the articles was performed and the review authors reported on the bias regarding information, selection, and confounding of the data. The authors recognized that some of the bias may have been due to the methodological shortcoming of the included acupuncture trials. The authors also found heterogeneity between the included studies in the meta-analysis. It was hypothesized by the authors that heterogeneity presented potentially due to the diversity of the included trials, the lack of standardization of practice, and the variety of assessment methods when researching AEs.

The results from the Bäumler et al. (2021) study indicated that the most commonly occurring minor AEs were related to needling-induced events (e.g. bleeding and/or pain at the needling site, vegetative reactions, aggravation of symptoms, or central nervous system-related events). This type of common AEs occurred in approximately 1 % to 5 % of the given treatments. Other AEs affecting e.g. peripheral nervous system, distant pain, gastrointestinal or gynecological symptoms occurred relatively rarely (1 to 7 per 1 000 treatments). AEs related to respiratory reactions induced by the acupuncture intervention were reported rarely (3 out of 10 000 treatments).

The most commonly reported SAEs were pneumothorax, strong cardiovascular or vasovagal reactions, and fall or trauma. The frequency of occurrence for these events was 1 to 3 cases per one million treatments. The meta-analysis for the general risk of acupuncture-related SAEs demonstrated a frequency of 1,01 patients with an SAE per 10 000 patients receiving an acupuncture treatment and/or 7,98 SAEs per one million treatments. It is worth acknowledging that fatal SAEs leading to death was found to be unrelated to acupuncture treatments.  The full list of AEs and SAEs data can be found in the original article.

The clinical implications from Bäumler et al.’s (2021) study are that acupuncture-induced AEs do occur in the clinical setting and patients should be informed about the risks related to the treatment. The study highlights the importance of communication between the practitioner and the patient as this will encourage the patient to observe and report the possible AEs they are experiencing. When AEs do occur, the practitioner should be equipped with appropriate medical knowledge and competence to assess the situation correctly. This is particularly true with patients at high risk of AEs such as pregnant women, the elderly, and patients with cardiovascular comorbidities.

Bäumler et al.’s (2021) review concluded that common acupuncture-related AEs are usually mild and transient and SAEs occur rarely. Their findings support the notion that acupuncture should be considered a safe treatment method when performed by a practitioner with proper training and a good understanding of medical sciences. The review authors raise awareness that rigorous and standardized research methods should be applied in future acupuncture studies to avoid the risk of bias and minimalize heterogeneity.

By Sari Tjurin

References

Bäumler, Petra, Wenyue Zhang, Theresa Stübinger, and Dominik Irnich. 2021. “Acupuncture-Related Adverse Events: Systematic Review and Meta-Analyses of Prospective Clinical Studies.” BMJ Open 11 (9): e045961. https://doi.org/10.1136/bmjopen-2020-045961.