Acupuncture Safety Quick Reference

If something feels wrong

In an emergency in the United States, call 911. If you feel very unwell after a treatment, contact the clinic that treated you; a UK hospital leaflet advises that outside clinic hours you contact your own doctor or the local hospital emergency department. [1] Read Warning Signs After Acupuncture for the longer list. Do not stop taking any prescribed medicine without first talking to your doctor. [2]

The short version

A review of nine safety surveys concluded that minor adverse events may be considerable but serious ones are rare. [3] NCCIH says relatively few complications have been reported, yet when acupuncture is not delivered properly it can cause serious effects, including infections, punctured organs and injury to the central nervous system. [4] These are information summaries, and they cannot replace advice from your own clinician.

Risks at a glance

Serious events in published case reports are often linked to training or technique. A review of Chinese case reports (1,038 cases, 35 deaths) said adverse events were mainly caused by mental tension of the patient, improper operation by the doctor and incomplete sterilization. [8] A review of other reviews said serious adverse events are rare but need significant attention. [9] See Serious Complications of Acupuncture and Infection Risk and Clean Needle Technique.

Check first if you

• Take blood thinners or bleed easily. The NHS says acupuncture may not be safe if you take blood thinning medicine or are at increased risk of bleeding. [2] A review of 384 anticoagulated patients found one moderate bleeding event in 3,974 treatments, and concluded acupuncture appears safe with appropriate needling location and depth, while calling for prospective trials. [10] Full guide: Bleeding and Bruising After Acupuncture.
• Have a pacemaker or other implant. Tell the practitioner. [1] In a test using the authors themselves, currents from needles on opposite arms might trigger an abnormal heart rhythm or activate a pacemaker, and they advised that electroacupuncture current should not traverse the heart. [11] See Electroacupuncture, Pacemakers and Implanted Devices.
• Might be pregnant. Tell the practitioner. [1] A review of 105 studies found few adverse events when acupuncture during pregnancy was correctly applied, but it excluded studies of acupuncture for delivery. [12] See Acupuncture in Pregnancy: Safety Summary.
• Have a skin condition or skin infection. The NHS lists this as a reason acupuncture may not be safe. [2]
• Are having chemotherapy or radiation. The National Cancer Institute says these patients are immunocompromised, so precautions and strict clean-needle techniques must be applied. [6]
• Feel faint around needles. Say so before starting; see Fainting, Dizziness and Other Common Reactions.

Choosing safely

• In the United States the FDA regulates acupuncture needles as medical devices and requires them to be sterile and labeled for single use only. [4]
• Licensing is decided state by state, and being licensed or certified is not always a guarantee of being qualified. [13][4]
• In England, other complementary therapists need not be registered by law; the NHS suggests choosing one registered with an organisation accredited by the Professional Standards Authority. [2]
• Do not try at-home needles or pens. See At-Home Acupuncture Kits and "Acupuncture Pens". Reviewers of reported injuries said unsupervised self-treatment should be discouraged. [7]
• Use the checklist for choosing an acupuncturist and the list of red flags. We do not list or recommend practitioners.

More: Side Effects and Precautions is the full overview.