Who Should Avoid or Take Extra Care With Acupuncture

Check with a clinician first if any of these apply

This page is information, not medical advice for your situation. If you have a health condition, take prescribed medicines or are pregnant, talk with your doctor or specialist before starting acupuncture, and tell the acupuncturist about everything on your health history. The NHS advises telling any therapist about medical conditions, medicines and other treatments. [1] Call 911 in the United States for trouble breathing, chest pain or collapse after treatment.

There is no single list

A family medicine review says there are no absolute contraindications to acupuncture, and lists relative contraindications such as frailty and febrile (feverish) illness. [2] "Relative" means a reason for extra caution and a conversation, not a ban. Most of the guidance below comes from small studies, case reports and expert opinion, so the strength of evidence for each point is limited.

Summary table

Blood thinners and bleeding disorders

The NHS says acupuncture may not be safe if you take blood-thinning medicine or are at higher risk of bleeding. [1] Studies of anticoagulated patients found few serious bleeds, but they are small. [3] Do not stop a prescribed medicine to have acupuncture. See bleeding and bruising after acupuncture.

Skin infection or broken skin

The NHS lists a skin condition or skin infection as a reason acupuncture may not be safe. [1] The family medicine review says acupuncture should not be used in areas of skin infection or breakdown. [2]

Pacemakers, defibrillators and electroacupuncture

In electroacupuncture, a small electric current is passed between needles. A study in which the authors measured the currents on themselves found that when needles were placed far apart, the currents spread widely; when needles were close together in a limb there was little or no detectable spread into the chest. [5] The authors concluded that electroacupuncture should not be applied so that the current is likely to traverse the heart. [5] The family medicine review says serious electroacupuncture adverse effects, such as pacemaker or defibrillator dysfunction, are limited to case reports. [2] Proper evidence not found on how often real patients with devices are affected. Tell the practitioner about any implanted device. See electroacupuncture, pacemakers and implanted devices.

Lymphedema and cancer-related swelling

A systematic review notes that clinical guidelines recommend avoiding needling in the upper arm affected by lymph node dissection. [6] The same review pooled eight trials in women with breast cancer-related lymphedema (189 participants, 2,965 treatments) and found only one grade 2 skin infection, including treatments in the affected limb. [6] A small pilot trial chose to treat the unaffected arm. [11] Because these are small trials, the question is not settled. Ask your lymphedema or cancer team; see acupuncture in modern health care and cancer centers.

Weak immune system and cancer treatment

The National Cancer Institute says people having chemotherapy or radiation are immunocompromised, so strict clean-needle technique is required. [7] A case report described septic arthritis presumed linked to acupuncture in a man on treatment for multiple myeloma. [8] A low platelet count is covered in the bleeding page. Cleveland Clinic advises against using acupuncture to delay seeing a healthcare provider about a health problem. [12]

Children

A review of needle acupuncture in children found most events were mild, but 25 were serious, and many might have come from substandard practice. [9] See therapies for children and older adults.

Older or frail adults

The family medicine review lists frailty as a relative contraindication. [2] A report of two older patients who had convulsive syncope during acupuncture concluded caution is needed with older and debilitated people. [10] See fainting and dizziness.

Related pages

Side effects and precautions and serious complications cover the wider picture. Coordinating acupuncture with medical care covers talking with your doctor.