Safety and Adverse Events in Acupuncture Practices

As acupuncture becomes more widely adopted across diverse healthcare settings, understanding its safety profile is essential. Generally considered low risk, acupuncture can nonetheless give rise to a range of adverse events, from mild, fleeting discomfort—such as localised pain, bruising or transient dizziness—to rare but serious complications including organ or nerve injury, pneumothorax and infection. The likelihood and severity of such events are shaped by practitioner training, choice of needling technique and adherence to aseptic protocols. Although most adverse reactions are minor and self-limiting, under-reporting and variable study quality hinder a clear estimation of true incidence. Strengthening surveillance systems, standardising clean-needle techniques and integrating safety parameters into clinical trials are pivotal steps towards enhancing patient protection and maintaining public confidence in acupuncture therapies.

Research from Nature Portfolio

A recent overview of systematic reviews has distilled four principal categories of acupuncture-related adverse events: organ or tissue injuries, infections, local reactions and vasovagal responses. While serious incidents are uncommon, they carry a non-negligible risk of mortality, underscoring the importance of vigilance. The analysis covered modalities such as manual and electroacupuncture, finding that many reviews suffer from moderate to low methodological rigour. This work advocates for the incorporation of robust safety endpoints in trial protocols, consistent adverse-event reporting standards and enhanced practitioner credentialling to further mitigate risks.

Safety and Adverse Events in Acupuncture Practices publication trend

The graph below shows the total number of articles in safety and adverse events in acupuncture practices across all publications each year (not limited to Nature Index journals).

Technical terms

Adverse event (AE): Any unintended or harmful occurrence associated with a medical intervention, ranging from mild discomfort to serious complications.

Electroacupuncture: A form of acupuncture in which a low-level electrical current is applied to paired needles to potentiate therapeutic effects.

Evidence mapping: A systematic method for categorising and visualising the breadth and characteristics of existing research on a specific topic.

Organ or tissue injury: Damage to internal structures—such as lungs, nerves or blood vessels—resulting from improper needle placement or depth.

Systematic review: A structured synthesis of findings from multiple studies, following predefined criteria to minimise bias and summarise evidence.

References

1. Safety of Acupuncture: Overview of Systematic Reviews. Scientific Reports (2017).
2. Adverse effects associated with acupuncture therapies: An evidence mapping from 535 systematic reviews. Chinese Medicine (2023).
3. Publication status and reporting quality of case reports on acupuncture-related adverse events: A systematic reviews of case studies. Heliyon (2023).