Serious Complications of Acupuncture: Pneumothorax, Nerve and Organ Injury

Call 911 first for these signs

After acupuncture, call 911 in the United States for trouble breathing, sharp chest pain, a sudden severe headache or stiff neck, new weakness, numbness or loss of bladder or bowel control, or fainting that does not pass quickly. Do not drive yourself. Tell the emergency team you recently had acupuncture. For less urgent symptoms, see warning signs after acupuncture.

What large counts show

• In a prospective study of 229,230 patients receiving about 10 treatments each, two patients had a pneumothorax (collapsed lung): one needed hospital treatment and the other observation only. [2] The longest-lasting side effect in that study was a nerve lesion of the lower limb that lasted 180 days. [2]
• A review of nine prospective surveys likewise found pneumothorax was rare, occurring only twice in nearly a quarter of a million treatments. [3]

What case reports show

• Chinese-language literature, 1980 to 2009. A review published in the Bulletin of the World Health Organization covered 115 articles (98 case reports and 17 case series) and described 479 cases of adverse events, with 14 deaths. The most frequent were pneumothorax, fainting, subarachnoid haemorrhage (bleeding around the brain) and infection. [4] The most serious were cardiovascular injuries, subarachnoid haemorrhage, pneumothorax and recurrent cerebral haemorrhage. [4] The authors said most of these events were owing to improper technique. [4]
• Chinese-language literature, 1956 to 2010. Another review found 167 articles with 1,038 cases, including 35 deaths. The most common were fainting (syncope, 468 cases), pneumothorax (307) and subarachnoid hemorrhage (64). [5] The authors attributed events mainly to patient anxiety, improper operation by the practitioner and incomplete sterilization. [5]
• China, 1980 to 2013. A review of 182 incidents in 133 papers found internal organ, tissue or nerve injury was the main complication, especially pneumothorax and central nervous system injury. [6]
• Traumatic injuries (2001 review). Pneumothorax and spinal cord lesions were the most frequently reported complications, with nerve and blood vessel injuries seemingly very rare. [1] The authors argued that all the injuries they described could have been avoided with better anatomical knowledge. [1]
• Overview of 17 systematic reviews (2017). Organ or tissue injuries were reported in 13 reviews, with a median of 36 cases and 4 deaths per review. [7] The authors said serious events are rare but need significant attention because mortality can be associated with them. [7]
• Family medicine summary (2021). Reports of serious adverse effects are rare but include pneumothorax, infection, organ or tissue injuries and seizures. [8]

What these findings do and do not mean

A published case report is only a story; it is not a rate. Reviews of case reports count the cases that were written up, not the total number of treatments given, so they cannot give a rate.

Why training matters

Because many described injuries were linked to improper technique and poor anatomical knowledge, reviewers recommend good training. [1] [7] Cleveland Clinic says an untrained provider can cause infections, organ punctures and central nervous system injuries. [9] See licensing and training and how to choose an acupuncturist.

Children and special groups

A systematic review of needle acupuncture in children found 25 serious events among 279 adverse events; they included a pneumothorax and a case of cardiac rupture, and the authors noted that many might have been caused by substandard practice. [10] See who should avoid or take extra care.

What to do if you are harmed

Get care first. Later, you may report the event; see reporting an acupuncture adverse event or complaint. The wider safety summary is on the side effects and precautions page.