Abstract
The editors of Medical Acupuncture are pleased to present this special issue, “Acupuncture Safety—A Global Perspective.” We are so grateful for the help of the guest editors for this special issue in helping to bring it together for our readers. We truly have a global representation in this issue with articles from Indonesia, Japan, China, India, Israel, and the USA. We hope you will enjoy reading their reports and discussions on safety in their countries and regions.
We have seen in the literature that acupuncture is safe in general; very few adverse effects are reported in clinical trials, but not all techniques used by acupuncturists are safe if performed without adequate training. Some techniques used by acupuncturists overlap with surgery and require specific training, which is common in medicine. Acupuncture-related techniques that require specific training include (a) deep periosteal needling, 1 (b) acupotomy—a minimally invasive surgical procedure done in a surgical setting that combines acupuncture and surgery for spinal stenosis, 2 (c) wet cupping—involves lancing skin prior to cupping to extract blood, and (d) pharmacopuncture—injection of pharmaceutical grade herbal extracts into acupuncture points. Though acupotomy is usually performed by surgeons, periosteal needling, wet cupping, and pharmacopuncture are commonly provided by both Medical Acupuncturists and the licensed and certified acupuncturists in many countries. Several U.S. states allow licensed acupuncturists to perform pharmacopuncture acupoint injection therapy with advanced training. The U.S. board certifying agency for licensed acupuncturists, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), offers training and a certificate in injection therapy for NCCAOM board-certified acupuncturists. 3
Some medical specialties treat medically fragile or vulnerable patients. Fields that require extensive training to ensure safety for patients and practitioners include (a) pediatric acupuncture, (b) oncology acupuncture, (c) acupuncture for addiction and psychiatric disorders, (d) acupuncture in the perinatal setting. Evidence supports the use of acupuncture for symptoms associated with pregnancy even though many acupuncture points induce labor. With specific training on which point combinations to avoid, acupuncture is helpful for symptoms associated with pregnancy. Acupuncture can be helpful in reducing the symptoms of chemotherapy and radiation but can also be harmful if providers are untrained in working with cancer patients with a compromised immune system or if providers are untrained in herbal/natural product interactions with chemotherapy agents. Advanced training programs in oncology acupuncture are available. Memorial Sloan Kettering Cancer Center, NY, USA, hosts basic and advanced training in oncology acupuncture for eligible providers 4 and in Israel, TCM Academy in Tel Aviv provides a 38-h certificate course. 5
Conversely, I fear that more conservative acupuncturists in the field can be overly concerned with safety and might rob the patient of care that is safe and effective. For example, many licensed acupuncturists still avoid needling the arm of patients with postmastectomy lymphedema despite multiple studies reporting safety in the literature. Hou et al. reported in their 2019 meta-analysis of 13 studies, including 747 patients, that needling the affected limb in breast cancer patients with postmastectomy lymphedema is safe, relieves pain, and reduces circumference. 6
Advanced acupuncture techniques and specialties are practiced by skilled acupuncturists worldwide, but if the treatment is delivered by an unskilled provider, safety cannot be assured.
Techniques that acupuncturists use are usually safe, but not always. Advanced techniques that overlap with surgery can be more effective for some conditions than basic acupuncture, but to ensure patient safety, those techniques should be delivered by providers who have specific training in the advanced techniques.