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Ask an expert - about acupuncture - side effects

134 questions

We have very good evidence in the form of several published surveys and research studies that acupuncture treatment is not only safe but also that the majority of side effects are transient, minor and tend to disappear within 48 hours. However, that does not mean that there are not occasionally more serious side effects.

Where the majority of serious side effects occur, and these remain very rare, it is most often because of a direct effect of the needling in the form of a pneumothorax or nerve damage. We do hear of the occasional case of both, and the BAcC has had to deal two or three such cases in the last decade. Injuries such as you have experienced are much more rare, where the damage arises not from the needling itself but from a physical reaction to the needling, like fainting from needling and then getting bruises from falling.We suspect that your physiotherapist has called it correctly insofar as the reaction to the needle insertion has caused the twisting of the lower back and induced sciatica. Strong reactions to needling are possible, and some people do have electric shock sensations as a genuine consequence of mobilising the energy. This is generally recognisable because it does not fall along nerve pathways as understood in conventional medicine. If the problem has been induced by a kind of physical twist injury it is almost certain that it will resolve quite quickly. Further treatment would help, but we can quite easily imagine that this is not likely to be an option for you.As far as the second occasion is concerned, we suspect that the practitioner may have under-estimated your sensitivity to treatment and used points which do tend to have a higher risk of generating physically painful reactions,. Clearly it would not be fair for us to comment on someone's work without knowing a great deal more  of the case history, and we have all experienced cases where someone has had unexpected and unpleasant reactions to points which we have used thousands of times. The skill of the practitioner lies in then adjusting the treatment to a pitch which the patient can bear by reducing the number of needles, reducing the depth of insertion and the amount of needle manipulation.Where people do have an unpleasant experience of treatment it can induce a kind of 'shock' which may well undo some of the good work already done and cause the overall pattern to become a little disturbed again, bringing back symptoms which had been under control. Our experience, however, is that these episodes rarely result in a permanent loss of progress, and the system usually restores to the point which it had reached before.We are very sorry to hear of your experience, and equally sorry to hear that acupuncture treatment is unlikely to be an option for you in future.  There are many variations within the 2500 year tradition which use minimally invasive techniques, but we can understand how this would probably not be reassurance enough. We do hope that you manage to regain the place which you had reached before this episode occurred, and that you manage to continue to progress from there.

Q: I have been for 3 acupuncture session over the last week. I am going for various reasons, CFS/ME, anxiety and the flu amongst some other moans and groans. After the first session I was pretty ill with indigestion and nausea and aching. Nothing much after the second session but a headache. After the third session however I am feeling very strange, I feel almost out of it for lack of a better description. I cant seem to get myself to focus at work no matter what I do and had a panick attack which I don't usually suffer from. I am spaced and feel removed. I am also a bit nauseous. Is this normal and has anyone else described this. When will it pass? I need to work and I am getting anxious. Is it a good sign.

A: It's always very difficult for us to comment when we do not have a full case history in front of us, and better still, an actual patient. We are always aware that if we take issue with what someone has done without knowing the full picture we might make an unfair criticism for which we might be held to account.

What we do wonder, though, is whether it is entirely wise to do as much treatment in a week to someone with a background of MS/CFS who has reacted very strongly to the initial session. In people whose immune systems have been weakened by long term illness it is always wisest to start slowly with the strength of treatment and to row back if they throw quite severe reactions. This is not a universal rule, but it is impossible to tell after a single session whether the effects are a clearing of imbalances or an adverse reaction to treatment.

We suppose that since the second treatment didn't really cause anything over-dramatic the practitioner decided that it was the former, a mild-ish reaction which could indicate the beginning of the process of healing, and treated again. In the event, the further reactions after the third session might call for a review of that judgement.

It is highly likely that if you have been slightly overtreated the effects will not last that long. Acupuncture is a remarkably safe therapy, and the only serious incidents involve the penetration of organs with needles, and these occasions are very rare. If someone has a strong reaction to treatment then it normally lasts no more than 48 hours at most, and usually less. We suspect that by the time you receive this you will already be feeling a great deal more 'normal'.

It may, of course, be that the problems are not at all connected to the treatment; CFS issues can often come up at any time. However, it does look like the treatment is implicated, so it is really important that you discuss this with your practitioner in determining how to proceed. This might mean less frequent or less powerful treatment, and we are sure that a properly trained and qualified practitioner will listen to your concerns and respond accordingly.

We did say, though, that without looking at you and the case history we could not say for sure whether the practitioner was in any way at fault, and it may well be that he or she is surprised by this outcome and well able to respond positively to the feedback you are providing. Treatment is sometimes like a voyage of discovery where a practitioner can only find out what the best strategy is by setting off as normal and then reacting if the signs are that the treatment is too much for the patient. The practitioner may well have made a judgement that you needed frequent treatment based on your case notes, but your reactions might suggest that this is not the best way forward.

Q: I went to see a physiotherapist after having severe spasms in my side from a pulled muscle.
He recommended acupuncture to "reset my nervous system" and put about 6 or 8 needles in my lower back. The first session was fine, I hardly felt anything. I went back a week later and my side was 90% better so he recommended more acupuncture. This second session was kind of uncomfortable and for hours afterward I had a feeling like a bee was stinging me in the lower back. The next day this was gone but I then I kept feeling like I had little electrical shocks in my lower back. The feeling lasted one day and then was gone, but I have had a throbbing ache in my lower back ever since. This is about 4 weeks now.
I went to see my family physician and she thinks he hit a nerve and I have inflammation and that this pain could be permanent.
I saw my physiotherapist last night. He thinks it is unlikely that he hit a nerve and said that some people just don't take to acupuncture well. He has given me some exercises to do.
I am really concerned that this pain won't go away......I am a self employed (female 56) house painter and have not worked in a month due to this pain.
Any suggestions?
Thank you.

A: First, let us say that we are sorry to hear of your experience. Adverse events after acupuncture treatment are relatively rare, and the vast majority of them are transient, wearing off after a day or two at most.

From what you report we would be very surprised if the practitioner had hit a nerve. This is a generally unmistakable sensation (this expert has been on the receiving end!), and there is absolutely no doubt when it happens. What can happen, though, is that a needle inserted deeply into the tissue of the back or elsewhere can cause a small internal bruise which forms beneath the skin and then becomes more condensed. If this sits near a nerve then every time you move it is going to impinge the nerve and cause pain or discomfort. That certainly sounds like what the 'little electric shocks' could be.

However, these would, or should, have subsided well before four weeks have passed, and certainly would not account for a pain of sufficient intensity to stop you working for this time. There are two possibilities. The first is that the treatment has been a little too successful. The physios'professional association warns its members that occasionally deep needling can relax muscles which, while tense, are actually guarding the back. When these stop doing this job it can mean a back problem which has been under control can suddenly cease to be so. This is quite rare; the BAcC keeps records of reported adverse events and insurance claims, and there have only been a couple of instances over the last twenty years where this may have been the case.

The other possibility is that this problem is unconnected with the treatment, and has just happened coincidentally. This is not so odd as it sounds; with over four million treatments being administered every year there are going to be a few cases where something happens after a treatment which has nothing to do with it. The problem is that patient and practitioner can get then get into debate about whether the treatment caused the problem while it goes undealt with. We always advise members to get their patients checked by the GP and referred on if need be, because eventually the diagnosis will point clearly to the probable cause.

The fact that you may have told the GP that the pain was caused by the treatment may have discouraged them from further investigation. We tend to think that if something is bad enough to keep you off work for a month it needs to be checked out immediately.

We have to say that you physio may be right insofar as acupunbcture isn't always the best treatment for someone, and we have seen several patients for whom it was too powerful an intervention. Where this has happened, though, we have never seen an adverse event lasting this long. The most that we have seen hs been a couple of days.

Hopefully your pains do derive from an accidental nerve impingement, and will subside soon. If they don't, though, we would be pushing for an X-ray or scan to find out what is going on.

Q:  I had acupuncture for the first time  and felt very energised after it. By the afternoon I was experiencing lower back pain - which I normally do not have. 2 days later and the lower back pain is still there. Could this have anything to do with toxins being released in the session and if so can I expect relief from the pain anytime soon?

A:  We have to say that we have not encountered any instances where someone has reported lower back pain as a direct consequence of acupuncture treatment, and we have searched the databases to check.

 That is not to say that it didn't come out of the session itself. Our colleagues in the physiotherapy profession who also use acupuncture do say that there are occasions when a rigid back is actually guarding and holding in place a problematic disk, so releasing the muscles by relaxing everything can actually cause problems to appear. However, in this instance there is almost always some case history of back problems before which would support this as a causal pattern.

 You don't mention whether or not you have had back pains before, but there are also occasions when a symptom which has cleared earlier in life can reappear for one last time. This is more common with problems like migraine, where someone can end up with a one-off 'special' but we have heard of the same happening with back pains. This will almost definitely be a transient reaction if this is the case. The same would apply if there were a general release of toxins, but in that case we would expect a slightly more extensive range of odd symptoms.


Of course, there can sometimes we simple mechanical reasons. We have heard of people who found that the couch on which they were treated was lumpy or unbalanced, and the back pain literally arose from the treatment because of this.

 Finally we have to say that the appearance of the back pain may be coincidental. This does sound horribly like 'it wasn't me' but with over 4 million treatments a year there are bound to be some cases where the problem appears after but not because of the treatment.

 In nearly all cases, though, the pain will be transient and probably have gone by the time you read this. If if hasn't then it is worth talking through in detail with your practitioner what they did and how this might have been implicated in what happened. If it does carry on, though, it may well also be worth talking to your GP in case it is a sign of an underlying problem which needs to be followed up, or worth seeing an osteopath trained to make precise judgements about someone's physical structure. There are a number of internal problems which can manifest as back pain, and your GP is the best placed person to see if there is anything going on. 

Q: I suffered pneumothorax secondary to accupuncture by a well trained medical doctor. The needle entered my plural space collapsing my right lung. Could this be due to a history of bronchitis? Is there documentation on PTSA? 

Q: We are always reluctant to make too definite a comment in cases such as this where there may be a possibility of either conduct proceedings or insurance claims in which we may be formally asked for a view. Without knowing a great deal more about the details of the case we can only offer a general view.

 This is that we advise members who are treating people using points around the thorax to be especially careful with the old, frail and those with a history of bronchial disease in any form, as well as with those who are seriously underweight in eating disorders. In all of these categories of patient there is a risk that the pleural cavity is a great deal nearer the skin surface than usual, and although most indications for the use of points on the thorax are for shallow insertion of the needle at an oblique angle, there are a number of points which we would consider high risk even then.

 That said, we would always, should a case arise, want to examine very closely the circumstances which led to the pneumothorax. There have been very few reported cases in the traditional acupuncture world in the last twenty years, and in one of two of this handful there was a suggestion that there may have been a spontaneous pneumothorax. This can happen, and with over 4 million treatments a year coincidences can happen.

 However, it is usually unmistakable when the cause and effect are pretty much close together, and the only issues to settle then are whether there are questions of competence or negligence to address, and then whether there is an insurance claim which can be made for the injury. As we said above, there are occasions when we are asked for a professional view as expert witnesses, so we tend to avoid specific comment about culpability, especially without knowing a great deal more than a brief outline.

 If you do come back to us with a clarification about what you intended by PTSA in your question we shall naturally respond as soon as we can.

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