they were asked to rate how much their clinical condition had improved or
worsened over a specified period of time.
The BMJ Group has taken over the publishing of Acupuncture in Medi-
cine, a quarterly title medical journal on acupuncture from 2009. This will
be the first complementary medicine title that the BMJ Group has published
and aims to build the evidence base for acupuncture.
Safety
A study that investigated the incidence and severity of acupuncture reactions
has been carried out in Japan.^43 In 1441 treatment sessions involving 30 338
insertions in 391 patients, 9 episodes of failure to remove the needle were
reported and classified as negligence rather than an adverse reaction. The
most common systemic reactions were tiredness and drowsiness (11%),
aggravation of symptoms (2.8%), irritation (1%), vertigo (0.8%) and
fainting (0.8%). The most common local effects were bleeding (2.6%) and
pain (0.7%). The authors concluded that there were some adverse reactions
associated with acupuncture, but that they were generally transient and
mild. However, serious complications have been reported.^44
There is some evidence from a lack of recent cases in the literature that
the situation is improving, i.e. the incidence of adverse reactions is
decreasing, particularly in the west.
As fainting and drowsiness are commonly reported,^45 patients should be
advised not to drive immediately after treatment if affected, and to exercise
particular care if any prescribed or over-the-counter (OTC) medication is
being taken that might enhance these effects. It has been suggested that a fall
in blood sugar could be involved^46 and this might be a problem for patients
with diabetes using insulin or oral hyperglycaemic drugs. Advice from a
pharmacist on the rescheduling of administration would be appropriate.
The adverse effects that may be attributed to acupuncture have also been
catalogued.47,48Examples of potential dangers identified in the reviews
include infection during needling and trauma.
Infection during needling
Hepatitis
Re-using needles with inadequate sterilisation has been the source of hepa-
titis in a number of patients, although the literature refers mainly, but not
exclusively, to the 1980s and earlier.49–51
HIV
Human immunodeficiency virus (HIV) infection has been linked to
acupuncture. In one case a patient became HIV positive after a 6-week
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