Pneumothorax acupuncture

On a global basis, acupuncture is one of the most commonly used forms of complementary and alternative medicine. It is used predominantly to alleviate pain, but many other indications have been proposed. Contrary to prevailing public opinion it is not entirely risk free (47). Several review articles have addressed this issue, and it has been pointed out that tissue trauma (for example pneumothorax) and infections (for example hepatitis B) are the most common comphcations of acupuncture (48). Both are rare and both could be avoidable with adequate training and experience of acupuncturists. 

In a survey of 1100 Australian providers of traditional Chinese medicine the adverse events of acupuncture were also monitored (65). There were 3222 events, including 64 cases of pneumothorax and 80 convulsions. No deaths were recorded. 

A systematic review of case reports from the Japanese literature yielded 105 cases of suspected acupuncture adverse effects not previously reported in Western publications (66). These included 21 spinal lesions, 21 cases of pneumothorax, 19 infections, 15 cases of foreign bodies in organs, 10 instances of argyria, 10 neural injuries, and 11 other adverse events, including two cases of cardiac tamponade. 

A systematic review of aU prospective studies of adverse effects associated with acupuncture included nine primary investigations (67). The most commonly reported adverse events were needle pain (1-45%), tiredness (2-41%), and bleeding (0.03-38%). Pneumothorax was the only serious complication in these studies it was reported twice in about 250 000 patients. 

A systematic review of aU adverse events associated with acupuncture in the Japanese medical literature located 124 cases (70). These included 25 cases of pneumothorax, 18 cases of spinal cord injury, 11 cases of hepatitis B, and 10 cases of localized argjria. 

An 82-year-old woman was scheduled for gastrectomy with an epidural anesthetic (71). She had previously had many acupuncture treatments with a Japanese technique (okibari), in which small needles are left in situ. Her preoperative chest and abdominal X-rays showed hundreds of needles around the vertebrae. The anesthesiologists feared that an epidural anesthetic might lead to spinal cord injury or pneumothorax, and general anesthesia was chosen instead. 

Pneumothorax has been reported in association with acupuncture (74,75). 

A 30-year-old woman developed bilateral chest pain and dyspnea after paraspinal acupuncture resulted in bilateral pneumothorax she recovered fully within 2 days (76). 

If acupuncture, which entails tissue trauma, is performed properly and on the correct acupuncture points, trauma will affect only the skin and the connective tissue below. If, however, acupuncture needles are inserted at the wrong site or penetrate too deeply, other tissues or organs can be affected. Traumatic complications of acupuncture have been reviewed (108). They have been described in relation to the thoracic and abdominal viscera, in the peripheral and central nervous systems, and in blood vessels. Several deaths have been reported from pneumothorax and cardiac tamponade. The anatomical tissues at several acupuncture points are such that needles can injure vulnerable structures. Thus, good knowledge of anatomy is an essential precondition for acupuncturists. 

Kelsey JH. Pneumothorax following acupuncture is a generally recognized complication seen by many emergency physicians. J Emerg Med 1998 16(2) 224-5. 

Systematic reviews The published literature and several main Chinese databases have been reviewed [85 ]. The search yielded 115 articles (98 case reports and 17 case series) that reported 479 cases of adverse events after acupuncture, among which 14 patients died. The most frequent adverse events were pneumothorax, fainting, subarachnoid hemorrhage, and infections the most serious events were cardiovascular injuries, subarachnoid hemorrhage, pneumothorax, and recurrent. Many acupuncture-related adverse events were due to improper techniques. 

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