Adverse events related to electroacupuncture: a systematic review of single case studies and case series

Abstract

Objective

Electroacupuncture (EA) is used in the treatment of various diseases through the use of electrical stimulation. Reports of adverse events (AEs) associated with acupuncture are relatively consistent, but the safety of EA has been less well reported. In this systematic review, we provide a summary of the types of AEs related to EA in clinical practice.

Methods

Twelve electronic databases, including those in English (PubMed, Ovid-EMBASE, CENTRAL), Korean (KMbase, KISS, NDSL, KISTI, OASIS), Chinese (CNKI, Wanfang, Weipu) and Japanese (J-STAGE), were systematically searched for single case studies and case series through April 2018. There were no language restrictions. We included clinical studies in which EA was used as a key intervention and in which AEs that may have been causally related to EA were reported.

Results

Thirty-seven studies, including 27 single case studies and 10 case series, were evaluated. The most frequently reported AEs were pallor (eight cases), skin pigmentation (eight cases), vertigo (seven cases), chest tightness (six cases), vomiting (six cases) and unconsciousness (five cases). Thirty-one cases (62%) achieved full recovery and three cases (6%) achieved partial recovery. There were also three cases of death (6%).

Conclusion

AEs related to EA included acupuncture-related AEs and serious AEs induced by electrical stimulation. Currently, specific stimulation conditions associated with EA-specific AEs are not identifiable due to inappropriate reporting. However, skin pigmentation, syncope or spasm, implantable cardioverter-defibrillator shock, cardiac emergencies, electrical burns, and potential internal organ injury are potential EA-specific AEs regarding which physicians should be cautious in clinical practice.

Keywords

acupuncture electroacupuncture adverse events case report case series

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References

Mayor

DF.

Introduction. In: Mayor

(ed.) Electroacupuncture: A Practical Manual and Resource. Edinburgh: Churchill Livingstone, 2007, p. 3.

Langevin

Schnyer

MacPherson

, et al. Manual and electrical needle stimulation in acupuncture research: pitfalls and challenges of heterogeneity. J Altern Complement Med 2015; 21(3): 113–128.

Ulett

Han

JS.

Electroacupuncture: mechanisms and clinical application. Biol Psychiat 1998; 44: 129–138.

Zhang

Lao

Ren

, et al. Mechanisms of acupuncture–electroacupuncture on persistent pain. Anesthesiology 2014; 120(2): 482–503.

Lytle

Thomas

Gordon

, et al. Electrostimulators for acupuncture: safety issues. J Altern Complement Med 2000; 6(1): 37–44.

Ernst

White

Life-threatening adverse reactions after acupuncture: a systematic review.

Pain 1997; 71(2): 123–126.

Zhang

Shang

Gao

, et al. Acupuncture-related adverse events: a systematic review of the Chinese literature. Bull World Health Organ 2010; 88(12): 915C–921C.

Wang

Cooper

, et al. Adverse events of acupuncture: a systematic review of case reports. Evid Based Complement Alternat Med 2013; 2013: 581203.

Cummings

Report of adverse event with electroacupuncture.

Acupunct Med 2011; 29(2): 147–151.

10.

Zheng

Zhang

Shang

Electro-acupuncture-related adverse events: a systematic review. Medical Acupuncture 2012; 24: 77–81.

11.

Mayor

DF.

Electroacupuncture. In: Filshie

White

Cummings

(eds) Medical acupuncture: A western scientific approach. 2nd ed. New York: Elsevier, 2016, pp. 167–185.

12.

Spilker

Interpretation of adverse reactions. In: Spilker

(ed) Guide to clinical trials. New York: Raven Press, 1991, pp. 565–587.

13.

World Health Organization. The use of the WHO-UMC system for standardized case causality assessment, 2005, http://who-umcorg/Graphics/24734pdf (accessed 5 June 2018).

14.

Park

Yim

Lee

J-H

, et al. Risk associated with bee venom therapy: a systematic review and meta-analysis. PLoS ONE 2015; 10(5): e0126971.

15.

Guangxi Baise District Hospital Acupuncture Anesthesia Group. Report of two cases about vagus nerve reaction by electroacupuncture at the Futu acupoint. J New Med 1972; 12: 9.

16.

Maintenance Support Services Organization. Medical Dictionary for Regulatory Activities, https://www.meddra.org/ (accessed 3 January 2018).

17.

Cummings

Safety aspects of electroacupuncture.

Acupunct Med 2011; 29(2): 83–85.

18.

Inoue

Katsumi

Itoi

, et al. Direct current electrical stimulation of acupuncture needles for peripheral nerve regeneration: an exploratory case series. Acupunct Med 2011; 29(2): 88–93.

19.

Miao

EY.

Skin changes after manual or electrical acupuncture.

Acupunct Med 2011; 29: 143–146.

20.

Xin

Two cases about adverse event in clinical treatment of electroacupuncture. Jilin J Chin Med 1999; 19: 44.

21.

Y Li S

Ruan

J. Analysis on a case of electrolysis phenomenon caused by electroacupuncture. Chin Acupunct Moxibust 2011; 31: 747–748.

22.

Wang

ZZ.

A case of shock induced by acupuncturing in carotid sinus. Chin J Pract Surg 1987; 7: 66.

23.

JF.

Two cases about emergency treatment for severe syncope caused by acupuncture. J Third Militar Med Univ 2012; 34: 2100.

24.

Chen

YZ.

Analysis on one case of nape spasm induced by electroacupuncturing in GB20-fengchi and Ex-HN17-yiming. J Clin Acupunct Moxibust 1992; 1: 50.

25.

Zhou

ZQ.

Report of one case about femoral neck fracture induced by electroacupuncture. Chin J Nerv Mental Dis 1980; 3: 153.

26.

WF.

A case of subluxation of wrist caused by improper electroacupuncture. Guangxi J Tradition Chin Med 1994; 1: 45.

27.

Graf

Pruvot

Inappropriate ICD shocks.

BMJ Case Rep 2009; 2009: bcr2006106286.

28.

Lau

Birnie

Lemery

, et al. Acupuncture triggering inappropriate ICD shocks. Europace 2005; 7(1): 85–86.

29.

Fujiwara

Taniguchi

Takeuchi

, et al. The influence of low frequency acupuncture on a demand pacemaker. Chest 1980; 78(1): 96–97.

30.

Huang

Wei

SH.

A case of eye damage in treating trigeminal nerve pain with electroacupuncture. Chin J Ocular Trauma Occupat Eye Dis 1997; 19: 307.

31.

Tang

Fang

QP.

Aggravation of infranuclear facial palsy induced by strong stimulation of electroacupuncture. People Milit Surg 1986; 6: 69.

32.

Jeong

Lee

MH.

Two cases of factitial panniculitis induced by electroacupuncture.

Clin Exp Dermatol 2009; 34(5): e170–e173.

33.

Huang

LH.

A case of gastric ulcer with perforation caused by needling in ST36-Zusanli. J Clin Acupunct Moxibust 1999; 15: 43.

34.

Tang

i Q

CGao

JX.

A case about clinical acupuncture accident. Chin Acupunct Moxibust 2006; 26: 459–460.

35.

Hou

Gao

Two cases about cardiac emergencies induced by intermittent wave of electroacupuncture. J Clin Acupunct Moxibust 1997; 13: 39.

36.

Gao

YZ.

Report of one case about locally burn caused by electroacupuncture. Shanghai J Acupunct Moxibust 1989; 4: 15.

37.

Peng

YG.

Report of one case about allergy induced by electroacupuncture. Jiangxi J Trad Chin Med 1982; 3: 19.

38.

Fan

JL.

Five cases about night sweats after acupuncture. J Clin Acupunct Moxibust 1998; 14: 50–51.

39.

Zhou

Jin Y

B. Report of two cases about similar pneumothorax caused by acupuncture. J Clin Acupunct Moxibust 2012; 28: 40.

40.

Ruan

KJCMZ.

A case about hydropneumothorax caused by needling supraclavicular fossae. J New Chin Med 1992; 4: 33.

41.

Chen

Analysis on four cases about acupuncture accident. Shanghai J Acupunct Moxibust 2009; 28: 112–113.

42.

Huang

GM.

Two cases of lag syncope induced by acupuncture. Chin Acupunct Moxibust 2009; 29: 732.

43.

Liu

YZ.

Analysis of two cases about abnormal condition induced by improper position during acupuncture. Lishizhen Med Materia Med Res 2007; 18: 1756.

44.

Liu

XJ.

Four cases accidents of schizophrenia treated by acupuncture. Chin J Nerv Mental Dis 1981; 5: 317.

45.

Shi

YK.

Four cases reports about adverse events caused by acupuncture on napex area. People Milit Surg 1979; 7: 78–79.

46.

Dai

Two cases of epilepsy caused by acupuncture. Jiangxi J Trad Chin Med 2012; 43: 38.

47.

Zhou

Wang

YU.

A case of epilepsy caused by electroacupuncture. China Naturopath 2003; 11: 53–54.

48.

Gao

Jheng

ZY.

Two cases about acupuncture allergy. Chine Acupunct Moxibust 2008; 28: 818.

49.

Fang

Zhou

LZ.

Case report of hyperventilation syndrome induced by acupuncture. J Emerg Trad Chin Med 2010; 19: 486–488.

50.

Quan

Jiang

One case report of infusion-like reaction caused by acupuncture. Jilin Med J 2008; 29: 79.

51.

Wang

CH.

A case of adverse reaction induced by acupuncture for sequelae due to nasopharyngeal carcinoma radiotherapy. Shanghai J Acupunct Moxibust 2010; 29: 536–537.

52.

Jiang

JM.

A case about misdiagnosis of intracranial hypotension syndrome. Chin J Misdiagnos 2006; 6: 1004.

53.

Omura

Electro-acupuncture: its electro-physiological basis and criteria for effectiveness and safety—part I. Acupunct Electr Therapeut Res 1975; 1: 157–181.

54.

Tang

Katsuma

Fujimoto

, et al. Electrochemical study of type 304 and 316L stainless steels in simulated body fluids and cell cultures. Acta Biomater 2006; 2(6): 709–715.

55.

Hwang

Yang

Ryu

, et al. Electrochemical corrosion of STS304 acupuncture needles by electrical stimulation. J Acupunct Meridian Stud 2010; 3(2): 89–94.

56.

Vasilakos

Fyntanidou

BP.

Electroacupuncture on a patient with pacemaker: a case report.

Acupunct Med 2011; 29(2): 152–153.

57.

Kho

van Egmond

Zhuang

, et al. Acupuncture anaesthesia observations on its use for removal of thyroid adenomata and influence on recovery and morbidity in a Chinese hospital. Anaesthesia 1990; 45(6): 480–485.

58.

Wang

Kain

White

Acupuncture analgesia: I. The Scientific Basis. Anesth Analg 2008; 106: 602–610.

59.

Hahm

TS.

Electroacupuncture.

Korean J Anesth 2009; 57: 3–7.

60.

Wang

P Yang H

Y. Compilation experience of national standard standardized manipulation of acupuncture and moxibustion, part 11, Electroacupuncture. Zhongguo Zhen Jiu 2010; 30(5): 413–416.

61.

Kwon

Choi

Cho

, et al. The corrosiveness evaluation according to the needle material in the electroacupuncture operation. Korea J Acupunct 2012; 29: 216–223.

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