Acupuncture Side Effects & Adverse Reactions (List)

Although there’s zero evidence to substantiate the existence of acupuncture points and meridians, it is understood that stimulation of the skin and peripheral nerves [as is induced by acupuncture], may significantly alter physiology and neurobiology.  The physiological and/or neurobiological alterations that occur following acupuncture are theorized to enhance health and/or alleviate symptomatic severity of medical conditions.  Whether a legitimate therapeutic effect can be attained from acupuncture is somewhat unclear.

Data published in Chinese, Japanese, and Taiwanese journals report that acupuncture is an effective intervention for an array of medical conditions.  However, a critical look at these data reveals that they: were published in journals with an impact factor of zero, of low methodological quality, and subject to significant bias.  Conversely, data attained from reputable scientific journals (e.g. Cochrane) suggests that acupuncture is largely ineffective for a myriad of medical conditions.

The technique may provide modest short-term therapeutic benefit in combatting post-surgical emetic symptoms, certain types of pain, as well as headaches.  Despite its non-existent efficacy for most conditions, an estimated 21 million Americans (6.5% of the United States population) have tried acupuncture.  When practiced properly by a licensed professional, acupuncture is associated with few unwanted side effects and/or adverse events.

Acupuncture Side Effects & Adverse Reactions (List)

Data from randomized controlled trials and large-scale practitioner surveys suggests that when performed by a professional, acupuncture isn’t likely to provoke many side effects nor adverse reactions.  Likelihood of side effects and serious adverse events increases when the technique is performed by an unlicensed practitioner.  The most common acupuncture side effects include: infections, central nervous system injuries, organ and/or tissue injuries, as well as irritation around stimulation sites.  Side effects are estimated to occur in around 10% of individuals.

Understand that the specific side effects, severity of side effects, and the total number of side effects that you experience will be subject to individual variation.  In other words, you may experience mild bruising and a headache after acupuncture, while another person may report lightheadedness and nausea.  Included below is a comprehensive list of side effects and adverse reactions that may occur as a result of acupuncture.

Anxiety: Though many individuals utilize acupuncture as an alternative therapy to attenuate anxiety disorders (e.g. GAD) and stress, some may find that the technique unexpectedly induces or amplifies preexisting anxiety.  Exacerbation of anxiety in response to acupuncture may occur for numerous reasons, and the causative underpinnings may be individualized.  One cause of anxiety as a side effect may be associated with an upregulation in sympathetic nervous system function.

An increase in sympathetic nervous system function may facilitate a stimulatory effect, thereby activating the fight-or-flight response to induce anxiety.  Another cause of anxiety as a side effect of acupuncture may be related to alterations in neurobiology as mediated by nerve signaling.  As acupuncture needles penetrate the skin, nerve signals transmitted to the brain may yield differences in production of catecholamines and peptides, ultimately causing anxiety in a subset of those receiving acupuncture.

It may also be that, during and/or after an acupuncture session, individuals may ruminate upon the possibility of contracting an infectious disease and/or seriously damaging tissue/organs as a result of needle penetration – causing heightened anxiety.  Those with preexisting psychiatric disorders may be more likely to report experiencing increased anxiety as a side effect of acupuncture.  Moreover, it could be speculated that relaxation-induced anxiety may occur in a subset of those receiving acupuncture as a result of a sudden, uncomfortable reduction in arousal [from a hyperaroused state].

Bleeding: Individuals receiving needle-based acupuncture may end up bleeding, especially if the technique is performed by an unlicensed practitioner.  Most people understand that when the skin is penetrated with an acupuncture needle, minor bleeding may occur.  Those with certain medical conditions and/or taking blood thinner medications should be cognizant of this side effect – as their blood may fail to properly clot, possibly resulting in a medical emergency.

Acupuncture practitioners may suggest that bleeding or “bloodletting” during acupuncture is completely normal.  While some bleeding may be normal as a side effect, if you’re bleeding significantly each time you receive the therapy, this should be a cause of concern.  It is possible that you are bleeding as a result of an incompetent and/or unlicensed practitioner who isn’t using proper acupuncture needles and/or who lacks knowledge regarding depth of insertion.

If you bleed, it is important that wounds are properly cleaned and that all equipment is sterilized.  Suboptimal sterilization of equipment, sanitation of the environment, and/or cleaning of a bloody wound may lead to serious infection.  Those who dislike bleeding as a side effect may wish to pursue other formats of acupuncture stimulation such as electrical or laser.

Bruising: Within several days after an acupuncture session, you may notice that your skin has bruised in multiple areas.  Bruising as a side effect of acupuncture occurs when the needle-induced stimulation causes blood vessels (capillaries) to break near the surface of your skin.  The breakage of these blood vessels results in a leakage of red blood cells, and ultimately a disconcerting appearance of “black and blue” or “purplish-red” patches.  These bruises may be highly sensitive and painful to touch.

While minor bruising may be common as an acupuncture side effect, it should be recommended to discontinue all forms of acupuncture until bruises heal.  Continuation of acupuncture despite preexisting bruises may lead to additional damage and a longer recovery period.  Furthermore, if you are bruising from acupuncture, you may want to confirm that your practitioner has a valid license; an unlicensed practitioner may use suboptimal technique that causes bruising.

Those experiencing severe bruising from acupuncture may derive benefit from application of an ice pack immediately after bruise formation.  Nevertheless, if you bruise easily from acupuncture with needles, you may want to consider testing alternative non-needle formats involving electrical pulses and/or lasers.  Assuming you take a break from acupuncture as soon as bruises are noticed, your body will metabolize the blood cells and the bruise will eventually fade in color and disappear.

Death: Though uncommon, a small percentage of individuals receiving acupuncture end up dying.  In a 2010 publication by Edzard Ernst entitled “Acupuncture: A Treatment to Die For?” – deaths resulting from acupuncture were discussed.  The publication noted that approximately 90 individuals have died as a result of acupuncture-induced complications, indicating that acupuncture may be more dangerous than many other forms of alternative therapies.

In developed Western countries such as the United Kingdom, zero deaths associated with acupuncture have been documented.  However, in Eastern countries such as China, deaths resulting from acupuncture may be more common, especially with unlicensed acupuncture practitioners.  Ernst presented multiple cases in his report, including one of a 44-year-old Chinese woman and another of a 26-year-old Chinese woman.

The 44-year-old died as a result of an acupuncture needle being inserted too far within her heart, ultimately puncturing her right ventricle and leading to a rapid death.  The 26-year-old died as a result of an acupuncture needle entering her lung and causing tension pneumothorax.  Overall, although the risk of death associated with acupuncture is extremely low, likelihood of death can be minimized by receiving acupuncture from properly-trained, licensed professionals.

• Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951167/
• Source: http://www.ncbi.nlm.nih.gov/pubmed/20890170

Dizziness: Interestingly, while there’s some evidence suggesting that acupuncture is likely to be an effective intervention for reducing dizziness, some individuals may experience dizziness as a side effect of acupuncture.  It isn’t known exactly why some individuals feel dizzy during and/or after an acupuncture session.  In some cases, dizziness may be a reaction from stimulating certain nerves around the head and/or neck that mediate equilibrium.

Those that feel dizzy during acupuncture, may want to evaluate head and/or body position during the treatment.  If your head was tilted in an awkward position and/or at a downward angle, the dizziness may have been induced by changes in blood flow.  You may also experience some dizziness immediately after finishing an acupuncture session if you transition too rapidly to a standing position from lying down.

The dizziness that you experience as a side effect of acupuncture may be accompanied by lightheadedness, and in more extreme cases, nausea.  It is plausible that dizziness may also be related to queasiness at the feeling of acupuncture pins entering the skin, anxiety associated with the needles, and/or excessive bleeding.  Individuals with medical conditions may be at increased risk of dizziness during and/or after an acupuncture session.

To reduce the likelihood of dizziness, be sure that you are in a comfortable position during your acupuncture session.  If any particular sites of stimulation provoke the dizziness more than others, you may want to tell your acupuncture practitioner to avoid stimulating those areas in the future.  Moreover, be sure to stay hydrated, take a few deep breaths, and gradually transition to an upright position if you’ve been lying down for awhile.

Drowsiness: Acupuncture may induce such a profound feeling of relaxation, that you notice drowsiness as a side effect.  Though not everyone will become drowsy during and/or after acupuncture, the drowsiness may be related to an enhancement of parasympathetic nervous system function associated with increased vagus nerve activity.  Some individuals may notice initial tension when acupuncture needles enter their skin, followed by a relaxation response thereafter – resulting in drowsiness.

In the event that electrical or laser acupuncture subtypes are used, drowsiness may be induced as a result of a soothing, massage-like effect.  Clients may feel extremely comfortable, almost as if they are lulled to sleep.  Keep in mind that it may be natural to feel drowsy if lying down on a comfortable position with your eyes closed – especially if the room temperature is warm.

Those that are receiving herbal supplements and/or inhaling essential oils during their therapy may be drowsy as a result of those, as well as the acupuncture itself.  In any regard, most individuals will not experience drowsiness nor complain that it’s a bothersome effect.  If you feel drowsy after acupuncture and are too groggy to function, consider drinking a cup of coffee and/or just waiting a day or two for your energy to return.

Some reports suggest that the drowsiness from acupuncture may be serious enough to impair driving.  Should you feel unfit to drive after an acupuncture session, you may want to walk around a bit to increase your alertness or take a nap before driving.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/15551936
• Source: http://aim.bmj.com/content/22/3/122.full.pdf

Fainting: It is reported that certain individuals may end up fainting during acupuncture treatment.  Among those who faint during acupuncture treatment, some may claim to have fainted for a variety of reasons including: awkward body and/or head position, emotional upheavals (i.e. swooning), and/or acupuncture needles.  According to the medical reports, a majority of fainting episodes that occur during acupuncture are triggered by acupuncture needles (“needle fainting”).

Many individuals have a phobia of needles and when they see and/or feel the needle inserted into their skin, they become dizzy, lightheaded, nauseous – and end up fainting.  Others may faint upon the sight of bleeding [following needle insertion].  If you have an aversion to the sight of needles or thought of needles penetrating your skin, you may want to avoid needle-based acupuncture and opt for electrical pulse or laser formats.

A clinical study was conducted by Chen et al. over the course of 9 months (from 1988 to 1989) to determine the incidence of syncope (fainting) as an adverse event associated with acupuncture.  The study revealed that 52 patients fainted 55 times in total over the span of 28,285 procedures, suggesting that fainting is relatively unlikely.  In all cases of fainting episodes during acupuncture, individuals were in upright positions and recovered quickly upon lying down.

Fainting during acupuncture is thought to occur as an adverse event more frequently among those with certain medical conditions and/or among pregnant women.  No deaths and/or serious injuries have been reported as a result of acupuncture-related fainting episodes.  That said, it is important to recognize that a serious head injury could result from sudden fainting during acupuncture.

It is also necessary to acknowledge that, in the rare event that an acupuncture needle is inserted too deeply by an unlicensed practitioner, excessive bleeding may occur.  This excessive bleeding could lead to a dangerously low blood count (anemia), ultimately causing you to faint.  Those on blood thinners and/or with certain medical conditions should evaluate their risks of excessive bleeding prior to pursuing treatment.

To reduce likelihood of fainting during acupuncture, it may be useful to opt for electrical pulse or laser stimulation – as opposed to needle-based acupuncture.  You’ll also want to recognize warning signs that may lead to fainting such as dizziness, lightheadedness, and/or nausea, and take proactive measures to prevent fainting such as: staying hydrated, understanding non-pharmacological countermaneuvers (e.g. applied tension), lowering the room temperature, and lying down (as opposed to sitting upright).

• Source: http://www.ncbi.nlm.nih.gov/pubmed/1978502
• Source: http://aim.bmj.com/content/early/2014/02/19/acupmed-2013-010480.full

Fatigue: While many people pursue acupuncture specifically to reduce symptoms of idiopathic and chronic fatigue, some individuals report experiencing fatigue as a side effect of acupuncture.  In most cases, fatigue experienced as an acupuncture-related side effect is transient and will diminish within an hour or two after a session.  The exact causes of fatigue as a side effect of acupuncture aren’t clear and are presumably subject to individual variation.

Among a subset of individuals experiencing fatigue as a side effect, the fatigue may occur as a result of enhanced parasympathetic nervous system function.  Enhancement of parasympathetic tone may reduce arousal, shift brain waves, and induce a profound state of relaxation – possibly to such an extent that the relaxation is perceived as tiredness and/or fatigue.  In fact, during acupuncture therapy, some individuals feel so relaxed that they fall asleep.

If you fall asleep early an in acupuncture session, and are asleep in excess of 20 minutes, your brain will have transitioned from a stage of light sleep to deeper sleep.  When awoken from your slumber upon completion of an acupuncture session, you will predictably feel fatigued and/or groggy as a result of sleep inertia – failure to complete a full sleep cycle.  Fatigue as a side effect of acupuncture may also be related to release of central and peripheral neurotransmitters, neurohormones, and/or neuropeptides – as triggered by transcutaneous stimulation.

In other cases, fatigue from acupuncture may result from the release of pent up emotion (e.g. an upheaval) during stimulation.  Moreover, fatigue attributed to acupuncture may be related to factors other than the stimulation itself, including: usage of essential oils, ingestion of herbal supplements given by a practitioner, lying down with eyes closed, and/or warm room temperature.  Don’t expect the fatigue to linger for more than a few days after therapy, and if it does, consider that you may be experiencing a nocebo effect.

Headaches: Though acupuncture is a popular intervention for the treatment of headaches and migraines, some individuals report experiencing headaches as a side effect of the acupuncture therapy.  The exact reasons as to why headaches may occur as a result of acupuncture remain unclear.  It is possible that, in a subset of individuals, headaches may be triggered as a result of directly stimulating the head – especially if needles were inserted too deeply and/or if excessive pressure was applied upon insertion.

In other cases, stimulation of highly-sensitive areas of the head such as the face (lips, cheeks, forehead) or scalp may cause you to tense up during your entire session, and this prolonged tension may lead to a headache.  Even if you were to receive stimulation in other areas such as the ears, neck, or chest – you may unknowingly tense up in reaction to needle insertion and develop a headache from the tension.  Another reason headache may occur during acupuncture could be an indirect result of acupuncture-related anxiety (such as from seeing needles).

Since heightened anxiety is known to trigger headaches, it is reasonable to consider that anxiety during your acupuncture session may the chief culprit.  Head positioning during acupuncture, as well as the comfort of the surface upon which the head is resting – may generate sufficient discomfort as to induce a headache.  From a neurobiological perspective, headaches may occur during acupuncture as a result of an upregulation in nitric oxide, which in turn initiates a vasodilatory response to provoke a migraine.

It is also necessary to consider that headaches associated with acupuncture may be more related to anxiety than a side effect of the stimulation – anxiety is often implicated in headache.  Moreover, you should know that poor oxygenation in an acupuncture room, noxious fumes from burning scented candles, and or ingesting herbal supplements (as given by your practitioner) – may induce headache.  Fortunately, most headaches induced by acupuncture will abate within a day or two after the session and can be mitigated with increased water intake and/or NSAIDs.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/17242084

Hemoptysis: An extremely rare adverse reaction that may occur as a result of acupuncture is hemoptysis, or coughing up blood.  This adverse reaction has been reported in pediatric populations, but not adults – suggesting that pediatrics may be at increased risk for acupuncture-induced hemoptysis.  Since pediatrics are of smaller size compared to adults, it is much easier to damage and/or puncture their throat lining with an acupuncture needle, and any damage could lead to coughing of blood.

Based on data compiled in a systematic review by Adams et al. (2011), the likelihood of hemoptysis as a result of acupuncture is extremely low.  Analysis of hundreds of reports documenting adverse events associated with acupuncture in pediatrics revealed that hemoptysis occurred on just 1 occasion.  A 15-year-old boy with encephalopathy had an acupuncture needle lodged within his bronchus, causing him to cough up blood following acupuncture.

The needle had presumably entered his bronchus via an incision following a tracheostomy.  Upon removal of the acupuncture needle, the hemoptysis subsided and infection cleared up.  Those who receive acupuncture following surgery may be most at risk for experiencing hemoptysis as induced by an acupuncture needle – especially if wounds are not fully healed.

Risk of hemoptysis as an adverse reaction may be greatest among those receiving needle-based stimulation from an unlicensed practitioner.  An unlicensed practitioner may not know proper technique for needle insertion (pushing it too far within your neck), leading you to cough up blood.  Unlicensed practitioners may fail to take proper precaution with patients after a surgery, performing acupuncture on the area that is recovering from surgery.

If you’re concerned about hemoptysis as an adverse effect, consider avoiding stimulation of your neck and/or upper chest, and be sure to inform your acupuncture practitioner if you feel any pain during treatment.  Also avoiding needle-based stimulation and opt for laser stimulation instead – this will minimize likelihood of internal bleeding and punctures.  Should you experience hemoptysis from acupuncture, seek immediate medical attention from a licensed professional.

• Source: https://www.researchgate.net/publication/266249241
• Source: http://www.ncbi.nlm.nih.gov/pubmed/22106073

Infection: It is widely documented that infections are among the most common side effects of acupuncture.  Infections are most commonly caused by reusing needles, improper needle sterilization, and/or poor sanitation within an acupuncture clinic.  Many acupuncture practitioners fail to recognize the importance of needle sterility and maintaining a sanitary environment for clients, and as is predictable, patients contract bacterial and/or viral infections.

A review published by Xu et al. (2013) noted that the most common infections associated with acupuncture were bacterial, namely: mycobacterium and staphylococcus.  Prior research suggested that hepatitis infections were among the most common adverse effects associated with acupuncture – resulting from reused needles.  An investigation by Reynolds and McKee (2008) discovered that most acupuncture needles [used by clinics in a province of southwest China] were reused and disinfected with alcohol – as opposed to being sterilized.

They believe that these practices significantly increase risk of blood borne viruses such as hepatitis B from acupuncture.  A systematic review by Ernst and Sherman (2003) noted a modest association between acupuncture and hepatitis C.  In addition to mycobacterium and staphylococcus infection, numerous case reports document infection with:  Herpes simplex virus (HSV), Escherichia coli, Gemella morbillorum, and tuberculosis – as caused by acupuncture.

Due to the fact that acupuncture may naturally cause redness and/or changes in skin appearance as a result of stimulation, the infection may be difficult for individuals to detect quickly.  It may take several days and/or weeks before an individual realizes that their skin remains discolored, itches, and/or exhibits a rash.  Failure to promptly address infection could result in complications such as paraplegia or neurological impairment.

To avoid infection as a side effect, it is recommended to only work with a licensed acupuncture professional who keeps the environment clean and uses fresh needles for each client.  If you are concerned that you may have contracted an infection from acupuncture, consult immediate medical attention and discontinue further acupuncture.  To be on the safe side, you may also want to avoid needle-based acupuncture and choose pulsed electrical or laser acupuncture.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/19072660
• Source: http://www.ncbi.nlm.nih.gov/pubmed/14535978
• Source: http://www.ncbi.nlm.nih.gov/pubmed/16412228
• Source: http://www.ncbi.nlm.nih.gov/pubmed/21738366
• Source: http://www.ncbi.nlm.nih.gov/pubmed/25606500
• Source: http://www.ncbi.nlm.nih.gov/pubmed/16151454
• Source: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0055430/

Inflammation: It is understood that transcutaneous stimulation of the skin with an acupuncture needle is bound to induce some inflammation.  That said, severe inflammation may occur if acupuncture is performed improperly and/or with excessive pressure – ultimately injuring tissue at the site of needle insertion.  Among sensitive populations such as pediatrics, the elderly, and individuals with certain medical conditions – acupuncture-induced inflammation may cause significantly more inflammation than usual.

If you notice significant inflammation after acupuncture, your best bet would be consulting a licensed medical doctor for further evaluation.  Inflammation may be a result of acupuncture-induced infection (bacterial or viral), internal bleeding, or another type of needle-induced injury.  Some may find it helpful to apply an icepack to the areas of inflammation and take NSAIDs (non-steroidal anti-inflammatory drugs) to decrease some of the inflammation.

Assuming you’ve already had the inflammation evaluated by a professional, you may want to discontinue acupuncture therapy until it improves.  Continuing acupuncture despite preexisting inflammation may result in a more substantial inflammatory response in the future.  If you are particularly sensitive to needles, try alternative formats of acupuncture that may be less likely to induce inflammation such as laser or electrical stimulation.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/19186719

Intestinal obstruction: A rare adverse effect of acupuncture that has been documented in a standalone case is that of intestinal obstruction.  A 2-year-old boy received acupuncture at a Chinese clinic and following treatment, he exhibited an array of symptoms including: constipation, crying, diminished appetite, lack of gas, and vomiting.  It was discovered that the acupuncture had induced a hematoma the size of an egg, causing intestinal obstruction.

After a section of his intestine was surgically removed, he recovered.  In this case it was unclear as to whether the boy may have had preexisting intestinal issues prior to the acupuncture that made him more susceptible to the hematoma.  Nonetheless, it could be speculated that insertion of needles in 2-year-old pediatrics could provoke extreme adverse effects such as intestinal obstruction.

While rare, intestinal obstruction as an adverse effect of acupuncture may occur in adults.  A case report of a 47-year-old woman documented that a needle (2.5-cm) penetrated her stomach and interfered with gastrointestinal processes.  Upon removal of the needle, the woman recovered.  Those receiving traditional needle-based acupuncture should beware of intestinal obstruction as a potential outcome.

• Source: http://www.ncbi.nlm.nih.gov/pubmed/24944991

Lightheadedness: You may notice lightheadedness as a side effect of acupuncture that emerges during or after treatment.  Should you feel lightheaded during acupuncture, consider that it may be related to the specific sites on your body that were subject to stimulation.  If you have an aversion to needles and/or blood, the lightheadedness that you’re experiencing may be related to this aversion, possibly a prodromal sign of vasovagal syncope (a sudden drop in heart rate and blood pressure that leads to fainting).

Some individuals may feel lightheaded during acupuncture from something as simple as their head position during treatment.  If you are lying down in a decline position and/or with your head in an awkward position, the positioning may alter cortical blood flow and lead you to feel lightheaded.  Also realize that transitioning too quickly from lying down on an acupuncture table to standing upright [after your session ends] may result in temporary lightheadedness.

By slowly transitioning from lying down to an upright position, you can minimize any post-treatment lightheadedness.  Other obvious causes for lightheadedness during acupuncture include: hot room temperature, poor ventilation (oxygenation), usage of scented candles, and/or ingestion of any herbal remedies during treatment.  Adjusting the room temperature, increasing air flow, and avoiding scented candles or herbal recommendations may also help.

Mood swings: For some acupuncture patients, the stimulation received alters their emotional state to a significant extent.  Alterations in emotional state may be unpredictable, resulting in outbursts of anger, feelings of anxiety, crying spells, and/or resurgence of depression.  Since acupuncture is thought to affect physiological arousal and neurobiological processes, it is believable that mood swings and/or emotional release can occur during acupuncture therapy.

It should also be considered that individuals with preexisting neuropsychiatric disorders may be at highest risk to experience mood swings during acupuncture.  Individuals with psychiatric disorders are often more sensitive than average to subtle changes in neurobiology [as induced by acupuncture].  Furthermore, it is necessary to consider that emotional reactions attributed to acupuncture could be nothing more than the symptomatic flare up of a preexisting neuropsychiatric disorder.

Some individuals may wrongfully attribute their emotional release to acupuncture therapy.  That said, if you notice unpleasant or unpredictable changes in mood during acupuncture, it is recommended to consult an appropriate professional (e.g. psychotherapist).  If each time you receive acupuncture your mood changes for the worse (i.e. is negatively affected), it wouldn’t make much sense to continue with the therapy.

Muscle pain: Some individuals may report heightened muscle pain as a side effect of an acupuncture session.  Increased muscle pain may emerge during acupuncture stimulation and linger for awhile after, or may not be noticeable during the session, but could emerge in the hours or days after.  Muscle pain can occur as a direct result of stimulating already-sore muscles such as from intense exercise, medical conditions, post-surgery, or an existing injury.

Though many believe that acupuncture will decrease muscle pain, some may find that it exacerbates the pain.  Exacerbation of muscle pain may be related to: application of excessive pressure to a particular muscle for an extended duration (e.g. an hour), stimulating an inflamed area, or inserting needles deeply beneath the skin.  If you had no prior pain before an acupuncture procedure, but experience substantial pain after, realize that poor technique from an unskilled practitioner could be the culprit.

Also realize that a modest amount of transient pain is bound to occur upon transcutaneous insertion of acupuncture needles.  However, if you notice intense lingering pain, you may want to discontinue acupuncture until it ceases.  Be sure to listen to your body and stop acupuncture if it continually worsens your pain.

Communicate any pain you experience during acupuncture to a practitioner and seek medical attention if your pain becomes unbearable.  If the only source of your pain is the acupuncture needles, and you want to continue acupuncture, you may want to test an alternative form of stimulation (e.g. electro or laser).  You may also want to consult a different acupuncture practitioner with more skill and/or experience to minimize likelihood of pain induced by suboptimal technique.

Myocardial rupture: An extremely uncommon adverse effect from acupuncture that has been reported is myocardial rupture.  The myocardial rupture occurred in a pediatric patient (9 years of age) who received acupuncture in China.  The acupuncture practitioner targeted the patient’s chest and abdomen for stimulation, and the patient had a myriad of other medical conditions including: heart disease, pulmonary tuberculosis, and malnutrition.

After receiving acupuncture stimulation for a 6^th time, the patient died.  Upon examination of the autopsy, the appeared as though the heart of the patient was enlarged.  Due to his enlarged heart, as well as pediatric status, the acupuncture needles penetrated his diaphragm pericardium and right ventricular wall, causing rupture and consequently, death.

There’s only one documented case of myocardial rupture resulting from acupuncture, and it is unclear as to whether the acupuncture practitioner in this case was properly licensed and/or trained.  Nonetheless, if you have an enlarged heart and/or other cardiac abnormalities, receiving acupuncture stimulation around the chest region may be contraindicated.  Additionally, to reduce your likelihood of such a reaction, it would be recommended to only receive stimulation from a highly-skilled professional.

• Source: http://pediatrics.aappublications.org/content/pediatrics/early/2011/11/16/peds.2011-1091.full.pdf

Nausea: Despite the usage of acupuncture as an intervention for reducing emetic symptoms such as nausea and vomiting (e.g. post-chemotherapy), a small percentage of individuals may experience nausea as a side effect induced by acupuncture.  Nausea could occur as a result of stimulating particular areas of the body and/or highly sensitive regions.  Some may also report feeling nauseous at the sight of an acupuncture needle or upon its insertion; this is common among those with a phobia of needles.

Seeing a bit of blood leaking from sites of acupuncture needle insertion may also cause someone to feel nauseous during the session.  If you know that acupuncture makes you feel nauseous, you may want to opt for some sort of alternative therapy.  Should you insist on continuing acupuncture in spite of the nausea, you may want to consider using an antiemetic agent and/or using non-needle stimulation (if the needle is the primary culprit).

You could also tell your acupuncture practitioner that you’d like stimulation in different regions if certain ones are causing your nausea.  Keep in mind that nausea may lead to vomiting, and that nausea could also be a sign that you’re about to faint.  Always communicate any nausea you experience to the acupuncture practitioner as soon as it is noticed.

Nerve damage: An unlikely, but reported adverse effect that may occur from acupuncture is nerve impairment.  A standalone case of nerve impairment occurred in a 16-year-old Japanese boy who pursued acupuncture to alleviate symptoms of fatigue, tachycardia, and constipation.  The boy received needle-based stimulation and following his acupuncture, a total of 70 needles were discovered to be embedded within his body.

One of the 70 needles was lodged between the first and second cervical vertebrae within his spinal canal, thereby causing nerve impairment.  His symptoms of impairment were noticeable shortly after completing the acupuncture session, but he failed to seek a professional opinion and determine the underlying cause.  Unfortunately, proper medical evaluation and treatment wasn’t sought in a timely manner and the nerve impairment progressed.

Within 2 years, the boy was reportedly numb in both legs and one of his arms.  Thereafter, he was evaluated by a licensed medical professional and the needle-induced nerve impairment was discovered.  Upon surgical removal of the cervical needle, muscle weakness improved but his sensation was permanently impaired.

Although this case was clearly an outlier, it highlights the possibility of permanent nerve impairment or damage as induced by acupuncture.  Working with a skilled, licensed acupuncture practitioner should minimize likelihood of nerve impairment associated with needle-based stimulation.  Nonetheless, if you’re concerned about potential nerve impairment, realize that the odds of this occurring are extremely low – and that you can always opt for alternative forms of stimulation.

Numbness: You may experience a bit of numbness in the area of acupuncture stimulation.  The numbness may be a pleasant feeling associated with the release of beta-endorphin and enkephalin, or changes in blood flow upon insertion of needles.  Other times, numbness may be a reaction to stimulation of nerve endings with needles and/or electricity via acupuncture procedures.

Usually if numbness results from stimulation of specific nerves, the numbness diminishes quickly after the acupuncture session.  If you were working with an unskilled acupuncture practitioner, it’s possible that the numbness you’re experiencing may be related to acupuncture-induced nerve impairment.  In the event that you experience nerve impairment, the numbness may fail to subside after your acupuncture session.

Numbness as a symptom of nerve impairment may gradually worsen over time, spreading throughout your body.  If your numbness doesn’t seem to diminish, consult a medical professional to evaluate this numbness and explain that it occurred after acupuncture.  In rare cases, the cause may be an acupuncture needle stuck beneath the skin.

Organ injury: While certainly not common, some individuals may endure an organ injury as a result of acupuncture stimulation.  Organ injuries are most likely to be sustained in vulnerable populations such as pediatrics, those with a medical condition, or among individuals with an unhealed injury.  As an example, someone with an enlarged organ is more susceptible to puncture and/or injury with acupuncture needle stimulation to that area.

Additionally, acupuncture should be considered contraindicated around the site of an abnormally functioning and/or enlarged organ.  For example, someone with cardiac abnormalities may want to avoid acupuncture stimulation around the chest, as this could lead to damage.  Even among less vulnerable populations such as healthy adults, organ injury may occur as a result of improper stimulation technique (by the practitioner), needle-induced infection near an organ, and/or a mistake by the practitioner (e.g. inserting a needle too far).

Individuals who have unhealed wounds such as from a prior injury or surgical procedure should avoid acupuncture until the areas are fully healed.  Organ injury is more likely to occur if an individual receives acupuncture stimulation to a site before it’s fully recovered.  If you have any organ abnormalities, report these to your acupuncture practitioner.

Tell your acupuncture practitioner to avoid stimulating and/or applying pressure to any vulnerable areas, especially with needles.  If you suspect that an organ may have been injured by acupuncture – do not hesitate to contact a credible medical doctor.  Warning signs of an organ injury from acupuncture may include: abnormal sensations, numbness, spasms, and/or weakness in the afflicted area.

Pneumothorax: Among the more common adverse reactions associated with acupuncture is pneumothorax, or the abnormal accumulation of air/gas within the pleural space (a thin fluid-filled area between 2 pulmonary pleurae of each lung).  This causes the lung to be displaced from the chest wall and interferes with normative breathing patterns; it is sometimes referred to as “collapsed lung.”

As reported by Chauffe and Duskin (2006), a review suggested that 9 cases of acupuncture-induced pneumothorax were documented in the literature from 1985 to 2006.  The occurrence rate of acupuncture-induced pneumothorax ranges between 0.8 and 2 out of 100,000 procedures.  Individuals at greatest risk for experiencing pneumothorax from acupuncture are those who receive stimulation to one or both sides of the chest.

It should be noted that acupuncture-induce pneumothorax can be unilateral (affecting one lung) or bilateral (affecting both lungs).  Experts suggest to seek medical evaluation for pneumothorax if you experience shortness of breath and/or chest pain after acupuncture.  Since pneumothorax is difficult to detect, to verify or dismiss its occurrence, a chest X-ray or CT scan of the chest will be required.

Pneumothorax is thought to also occur more commonly among those who receive acupuncture from an unlicensed practitioner and/or among those with poor technique.  Correcting pneumothorax may require surgery and/or insertion of a breathing tube.  Though your chances of experiencing pneumothorax from acupuncture are low, if left untreated, the condition can be fatal.

• Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4677943/
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Shortness of breath: Experiencing shortness of breath as a side effect during acupuncture stimulation could be related to changes in activation of your autonomic nervous system.  You may also experience shortness of breath during acupuncture as a result of anxiety associated with the stimulation and/or procedure.  Anxiety associated with acupuncture may be related to the needles or an unfamiliarity with the process (such as if it was your first time receiving stimulation), and this anxiety may lead to temporary shortness of breath.

In other cases, such as occurs in acupuncture-induce pneumothorax, shortness of breath may be more severe.  As was already discussed, acupuncture can cause pneumothorax or the accumulation of air/gas in your pleural space, leading you experience shortness of breath, as well as chest pain.  Failure to address pneumothorax with a licensed medical professional could result in death.

Assuming pneumothorax is ruled out as a cause of your shortness of breath, and you don’t suspect anxiety as a cause, you may want to consider other factors that may have contributed to this side effect.  Things as simple as: allergic reactions, candles along with acupuncture, poor oxygenation within the room, your head position, and certain areas of stimulation – may cause shortness of breath.  Also realize that persistent shortness of breath could be entirely unrelated to acupuncture and should be assessed by a medical professional.

Skin rash: A side effect of acupuncture that’s commonly reported is that of a skin rash.  A skin rash resulting from acupuncture may be caused by transmission of an infection (e.g. bacterial or viral) or may be associated with relatively benign contact dermatitis from needle stimulation.  Should you develop a skin rash after receiving acupuncture, it is recommended to seek immediate medical evaluation to rule out and/or treat any infection.

The rash that you experience after acupuncture may be characterized by patches of redness, bumps, and/or itchiness.  It may be localized to specific sites of the acupuncture stimulation or widespread throughout the entire body.  Assuming the rash you developed was not caused by an infection, it may be nothing more than a benign reaction to receiving needle stimulation – but may take a few days or weeks to fully heal.

Excessively scratching any rashes may worsen its appearance and/or prolong recovery.  Realize that you may have been allergic to the material of the acupuncture table and/or that your acupuncture practitioner may need to brush up on his/her sanitization within the office.  If your rash doesn’t seem to improve within a few days and/or worsens, consult a dermatologist.

Skin redness: As was mentioned, skin redness may be a hallmark sign of an acupuncture-induced skin rash.  However, skin redness may not necessarily indicate that you have a rash.  Your skin may turn red as a result of transcutaneous needle stimulation and/or pressure applied by the acupuncture practitioner during treatment.

This skin redness may be also accompanied by bruising or scabbing, especially in areas that were previously bleeding as a result of stimulation.  It may take a few days for your skin to fully recover from the red markings that commonly occur from acupuncture.  Also realize that regular acupuncture sessions (e.g. multiple times per week) may increase likelihood of skin redness.

Give your skin some time between sessions to fully recover before you receive another round of stimulation.  You may also want to utilize laser acupuncture or electro acupuncture as alternatives to needle-based stimulation – these formats are less likely to provoke skin redness and irritation.

Skin irritation: Experiencing skin irritation is usually regarded as a mildly uncomfortable, yet benign reaction to acupuncture.  Anytime you receive transcutaneous acupuncture stimulation with a needle, some skin irritation will occur.  Even if you receive stimulation with laser or electrical modalities of acupuncture, it is possible that your skin could become irritated.

Skin irritation can be caused by improper technique such as inserting needles too deeply and/or stimulating an area with high intensity.  To minimize severity of skin irritation associated with acupuncture, it is necessary to work with a highly-skilled, licensed practitioner.  That said, some skin irritation from acupuncture is unavoidable, but should improve within a few days of the procedure.

To expedite your recovery from acupuncture-induced skin irritation, you may want to ask a dermatologist whether you’d benefit from topical skincare products.  In the meantime, avoid additional acupuncture sessions until irritated areas have fully recovered.  Continued stimulation to already-irritated areas may exacerbate the irritation and prolong recovery.

Soreness: Many individuals that receive acupuncture report soreness during and/or after their sessions.  The soreness may occur upon insertion of the needles for stimulation, but may subside as the body adapts to the stimulation.  In other cases, the soreness may worsen throughout an acupuncture session and could be a sign that the acupuncture practitioner is unexperienced in delivery of stimulation.

Any extreme soreness experienced from acupuncture stimulation should be immediately communicated to the practitioner.  Slight soreness may be normal, but extreme soreness and/or discomfort is likely a sign that you are unable to tolerate the particular stimulation and/or that the practitioner lacks experience.  Keep in mind that soreness is somewhat subjective due to genes associated with nociception – some individuals may report extreme soreness from the same stimulation that only causes mild soreness in another.

Preexisting soreness such as from an injury or medical condition (e.g. arthritis) may be exacerbated by acupuncture.  Should you feel extremely sore after each acupuncture session, you may want to consider discontinuing acupuncture for awhile and determining whether the soreness improves.  It may also be helpful to find another acupuncture practitioner with more experience and/or who delivers stimulation with less pressure.

Spaced out: Certain individuals will report feeling extremely spaced out after acupuncture, sometimes to the extent that they cannot think clearly.  If you feel as if you’ve become a space-cadet and/or have major “brain fog” following your acupuncture session, you’re not alone.  Acupuncture is understood to affect physiological activation, as well as neurobiological processes (e.g. release of neurotransmitters) – each of which could make you feel spacey.

Realize that the spaced-out feeling that you experience during or after an acupuncture session may be related to decreased arousal from increased parasympathetic function.  However, numerous other subtle factors completely unrelated to the stimulation itself may be responsible for your spaciness.  These other factors include: warm room temperature, drifting off to sleep during the acupuncture session, or essential oils in the room (which can affect brain waves).

For those that dislike feeling spacey after acupuncture, consuming caffeine may be of benefit.  You may also find it helpful to go for a jog or perform some sort of physical exercise (even if you don’t feel like it) to ramp up sympathetic nervous system function.  If the spaciness from acupuncture becomes overly problematic, it would be advised to stop the acupuncture.

Subarachnoid hemorrhage: A systematic review of adverse effects resulting from acupuncture by Wu et al. (2015) documented 27 cases of subarachnoid hemorrhage [as induced by acupuncture].  In these cases, subarachnoid hemorrhage was provoked by needling certain areas around the head and/or neck, resulting in bleeding within the space between the brain and the tissue that covers it.  Subarachnoid hemorrhage is considered a medical emergency that may lead to brain damage or death without early treatment.

Those who experience subarachnoid hemorrhage from acupuncture are likely to report symptoms of severe headaches, possibly accompanied by dizziness, nausea, and vomiting.  If you received acupuncture needling to sites on the head and/or neck, and believe you may have endured a subarachnoid hemorrhage, prompt medical intervention is necessary.  Treatment for the hemorrhage may require surgery.

The likelihood that you’ll endure subarachnoid hemorrhage from acupuncture may be low, but other types of hemorrhage such as intracranial and/or cerebral may occur.  To avoid any sort of acupuncture-induced brain damage, you may want to avoid head and/or neck stimulation.  Moreover, you may want to avoid the usage of needles and demand

Sweating: A side effect of acupuncture that some patients report is sweating.  There are numerous reasons that you may end up sweaty during an acupuncture session, but the most obvious is anxiety or nervousness associated with stimulation.  The first couple sessions you receive acupuncture, you may feel slightly uncomfortable and end up worrying about things like needle pain or bleeding.

This excessive worry may trigger a fear/anxiety response that causes you to sweat more than usual.  It is also possible that acupuncture alters your physiology or neurobiology in such a way, that your body increases the secretion of sweat from sweat glands.  Realize that another, more obvious cause of increased sweating during acupuncture could be an abnormally warm room temperature.

An increase in sweat production during acupuncture is not generally bothersome for most.  Taking a shower after your session and getting a fresh set of clothes may be necessary.  Chances are that your sweat production will normalize within a few hours of stimulation.

Tingling sensations: Tingling may occur as a side effect of acupuncture both during a session, as well as after.  Upon insertion and stimulation delivered by an acupuncture needle, it is normal to feel slight prickling or stinging, possibly accompanied by goose bumps across the skin.  For a majority of those that experience this side effect, the tingling sensations will subside within a day or two of your acupuncture session.

Any mild tingling you experience may be related to skin irritation and/or healing of your skin following an acupuncture-induced wound.  Tingling may also be a sign of something more serious such as a needle lodged underneath the skin following treatment and/or stimulation-induced nerve damage.  If the tingling you’re experiencing from acupuncture becomes more noticeable and severe over an extended duration, seek evaluation from a medical professional.

Twitching or spasms: You may experience some twitching or spasms as a side effect of acupuncture, especially during the act of stimulation.  A report by Chu and Schwartz (2002) suggests that muscle twitches can occur as a side effect of classical needle-based acupuncture or electroacupuncture.  This report also suggested that twitching may be used by some practitioners as a diagnostic tool in determining which areas of the body would benefit most from stimulation.

It is thought that twitching that occurs during stimulation may also be a sign of myofascial release, or the relaxation of the fascia from a previously contracted state.  This is associated with improved blood flow and circulation, pain relief, and comfort.  Certain individuals may have an easier time coping with twitching or spasms during stimulation compared to others.

That said, the twitching can be alarming to some, leading to speculation that acupuncture caused some sort of nerve damage.  If twitching or spasms persist following stimulation, it may be nothing more than a benign reaction that eventually subsides.  However, if twitching or spasms never occurred until acupuncture stimulation and fail to subside, you may want to consult a medical professional to rule out potential nerve damage or abnormalities.

Weakness: During an acupuncture session, some individuals report feeling extreme muscle weakness as a side effect.  This weakness may result from stimulating certain nerves or pressure applied to a particular region of the body.  Sometimes the weakness may linger for awhile after the acupuncture session and could be accompanied by drowsiness and/or fatigue.

If you feel weak, it could be that the stimulation applied was too intense and may have caused some sort of harm.  Another explanation may be that you feel so fatigued from your acupuncture session, that the weakness is more related to the post-acupuncture fatigue than the stimulation.  Understand that if you had a preexisting injury or medical condition prior to acupuncture that caused you to feel weak, it could be that the acupuncture exacerbated it.

In rare case, extreme weakness could be a result of nerve damage from acupuncture stimulation; a medical professional can rule this out.  If you are feeling weak because the acupuncture made you feel drowsy or fatigued, taking proactive steps to increase your arousal should help mitigate this weakness.  Sometimes it may take a few days before your body returns to full strength following an acupuncture session.

Vomiting: Acupuncture is commonly used as an intervention to attenuate nausea and reduce likelihood of vomiting, especially when received after chemotherapy.  Furthermore, there’s evidence to suggest that acupuncture is capable of controlling the pharyngeal reflex (gag response), another way by which it may decrease likelihood of vomiting.  That said, a small percentage of individuals may experience vomiting as a side effect of acupuncture.

There is a myriad of potential reasons that could explain why vomiting occurs in a subset of acupuncture patients as a side effect.  A major reason some individuals may vomit during acupuncture is a result of stimulation to sites on the throat and/or jaw.  Stimulation around the throat could trigger pharyngeal spasms and vomiting, especially if received on a full stomach.

Perhaps the most common reason someone may vomit during acupuncture is related to a fear of needles and/or blood.  A person who has a needle phobia may become so anxious, that the anxiety induces nausea, vomiting, and possibly leads them to faint.  Similar outcomes of nausea, vomiting, and fainting may occur among those with a fear of bleeding from the acupuncture stimulation – especially in the event that they see, feel, or smell the blood.

A lesser common explanation for vomiting as a result of acupuncture is awkward body positioning during stimulation.  Most acupuncture practitioners deliver stimulation while a client is lying down comfortably.  However, it is reasonable to suspect that if a client is positioned awkwardly (e.g. in a decline position), he/she may end up feeling lightheaded and vomit primarily due to that particular position.

Should vomiting remain unexplained by the site of stimulation, anxiety, and/or awkward positioning – it may be that the vagus nerve is to blame.  It is known that acupuncture stimulates the vagus nerve, and that vagus neurocircuitry is implicated in nausea and vomiting, so we may speculate that this stimulation triggers a vomiting reaction in a select number of acupuncture recipients.  A logical, but extremely rare occurrence could be that an acupuncture needle is dropped inside the mouth and the individual vomits as a result of the pharyngeal reflex.

If you’re prone to acupuncture-induced vomiting, consider altering the site(s) of stimulation, your body positioning during the therapy, or even opting for a different form of stimulation.  Some may benefit from taking an antiemetic agent – as these drugs tend to attenuate nausea [which can lead to vomiting].  Since it’s difficult to vomit on an empty stomach, it may be your best option to avoid consumption of a large meal immediately before an acupuncture session.

Weight loss: Many anecdotal reports suggest that acupuncture helps with weight loss.  This has lead numerous people to specifically pursueacupuncture for weight loss – hoping that it’ll help burn excess body fat and improve their appearance without going to the gym or eating healthier.  There’s some preliminary evidence to suggest that acupuncture may increase satiety by enhancing smooth muscle tone of the stomach – perhaps leading some to lose weight as a side effect.

Though certainly not everyone will lose weight as a result of acupuncture, there’s reason to believe that some individuals could lose a few extra pounds after a month or two of regular acupuncture stimulation.  Since most people wouldn’t mind losing a few extra pounds from acupuncture, it is not generally perceived as an unwanted side effect.  If you believe acupuncture is causing significant weight loss, and you dislike this reaction because you’re already underweight, you can always discontinue acupuncture.

Note: Upon experiencing any unwanted side effects or adverse reactions, it is highly recommended to consult a licensed medical professional rather than your acupuncture practitioner.  While an acupuncture practitioner should be notified of any unwanted effects that occur during stimulation (e.g. pain in a specific area), a follow-up consultation with a medical doctor is often necessary.  A medical doctor is trained to recognize serious complications that may occur from acupuncture and is qualified to treat them.

Variables that influence Acupuncture side effects

There are numerous variables that influence side effects that you may experience from acupuncture.  These variables include things like: skill of your acupuncturist, acupuncture specifics (e.g. type of stimulation), time between acupuncture sessions, cumulative duration over which you’ve received acupuncture, as well as various individual factors.  Whenever contemplating the side effects you’re experiencing or attempting to predict the side effects you’re likely to experience, it may help to evaluate these variables.

1. Acupuncturist skill level

The skill level and experience of your acupuncturist will influence whether you’re more or less likely to experience unwanted side effects from stimulation.  An acupuncture practitioner with proper licensing and years of experience should be associated with a reduced risk of adverse effects.  Conversely, an inexperienced acupuncture practitioner without a valid certification should be associated with an increased risk of adverse effects.

• Skilled acupuncturist: A highly-skilled acupuncture practitioner could be considered someone who has attained an NCCAOM license, has excellent motor skills (for needle insertion), and has practiced for several years. A skilled acupuncturist should know which areas to stimulate (and which to avoid) and the amount of pressure to apply.  He/she will work with clients to minimize likelihood of adverse events and ensure client comfort.  Skilled practitioners are also more likely to use clean needles and perform acupuncture in a sanitary environment to mitigate risk of infectious disease.
• Unskilled acupuncturist: An unskilled acupuncture practitioner may not have attained an NCCAOM license to legally perform acupuncture. He/she may also be inexperienced (or a novice practitioner) and may have poor motor skills necessary to properly insert acupuncture needles.  Those who are unskilled may also perform acupuncture on patients for whom acupuncture should be contraindicated – and [mistakenly] believe they are promoting “healing.”  Unskilled acupuncturists may reuse needles, fail to sterilize needles, and/or perform acupuncture in an unsanitary environment – increasing your risk of infectious disease.

To legally perform acupuncture in 45 of the United States, practitioners require certification as given by the NCCAOM (National Certification Commission for Acupuncture and Oriental Medicine).  An acupuncturist without NCCAOM licensing should be considered unskilled and more likely to provoke an adverse effect.  That said, it should be emphasized that just because someone has received an NCCAOM license does not necessarily indicate that they’re highly skilled – all this signifies is that they’ve acquired a certification to legally practice acupuncture.

While someone with an NCCAOM license should be considered more skilled than someone without, factors such as: experience (number of years performing acupuncture) and fine motor skills should be taken into account.  Someone may have an acupuncture license but remain unskilled at the practice due to poor motor skills (as are useful in needle-based acupuncture).  The more experienced and coordinated your acupuncture practitioner, the lower your risk of adverse events.

2. Acupuncture specifics

The specific parameters associated with your acupuncture session can also influence the side effects that you experience.  These parameters include: type of stimulation, sites/regions stimulated, duration of your acupuncture session, and intensity of stimulation.  Other parameters that may influence side effect occurrence and/or severity include: body positioning and/or therapeutic adjuncts (e.g. essential oils).

• Type of stimulation: The type of stimulation that is administered during an acupuncture session may increase or decrease risk of certain side effects. Traditional acupuncture (as is performed with a needle) may result in bleeding, skin redness, and irritation – whereas laser acupuncture (as is performed with low-level lasers) may not irritate the skin, cause redness, or bleeding.  Due to the fact that acupuncture needles penetrate the skin transcutaneously, more side effects should be expected from this particular format.  Nonetheless, electroacupuncture (performed without needles) may be more likely to cause a different set of side effects (e.g. heart rhythm changes) that wouldn’t result from standalone needle stimulation.
• Specific site(s) of stimulation: The specific region subject to acupuncture stimulation, as well as the particular sites (acupuncture points) within the region – may influence side effects from acupuncture. Stimulating a particular region such as the chest is known to increase risk of pneumothorax, whereas other regions aren’t.  For this reason, it is necessary to consider that some side effects and/or adverse events are contingent upon the site stimulated.  Additionally, some regions of the body contain a greater number of nerve endings, resulting in heightened sensitivity.  Stimulating areas with high densities of nerve endings may alter your physiology and/or neurobiology more substantially compared to another area – triggering certain side effects that wouldn’t have occurred from stimulating a region with a lower density of nerve endings.
• Localized vs. Widespread stimulation: The stimulation delivered in acupuncture may be localized to a specific region (e.g. the ears) or widespread (e.g. chest, shoulders, forearms). It may be that localized stimulation of a specific region leads to fewer side effects than widespread stimulation (throughout the body).  Or it could be that somehow side effects are of reduced severity as a result of widespread stimulation throughout multiple regions of the body.  Obviously the side effects resulting from localized and widespread stimulation may be contingent upon the specific sites or regions stimulated (as was already mentioned).
• Number of needles used (stimulation sites): During a single acupuncture session, the number of acupuncture needles used may range from 2 to 20 – most practitioners are thought to use between 6 and 8. Patients receiving acupuncture for multiple conditions often receive stimulation from a greater number of needles compared to those being treated for just one condition.  It should be speculated that the greater number of needles used per session (and stimulation sites), the more likely side effects are likely to occur.  More needles increases risk of error during insertion, stimulation, or upon removal.
• Session duration: The duration of your acupuncture session may slightly affect the side effects you experience. For example, a long session (e.g. over 60 minutes) may result in increased bleeding or heightened pain compared to a shorter session (e.g. 30 minutes).  In other cases, longer sessions may result in fewer side effects due to the fact that the body may require a set amount of time to adapt to the needle stimulation [in certain areas] and/or once a time threshold is reached – pain lessens and/or bleeding stops.  Keep in mind that sometimes the duration of the session may have negligible impact on side effect occurrence.
• Intensity of stimulation: The skill of an acupuncturist will dictate whether stimulation is properly delivered to your body from needles, lasers, and/or electricity. In general, the greater the intensity of stimulation received, the more side effects you should expect.  Pressing needles deeper beneath the skin may result in excessive bleeding, organ puncture, or nerve damage.  Lower pressure should reduce risk of various adverse events and minimize severity of side effects.
• Body positioning: The position of your body during an acupuncture session could be the root cause of many side effects. For example, if you’re positioned in a decline such as that your head is hanging beneath the rest of your body, you may become lightheaded and dizzy.  On the other hand, receiving stimulation while lying on your back (supine) may yield different side effects than had you been lying on your stomach (prone) or side (lateral) – or sitting upright in a chair.  An experienced acupuncture practitioner should know which positions are therapeutic and comfortable for the patient, as well as those that may increase likelihood of injury or adverse events.
• Therapeutic adjuncts: Some acupuncturists may enhance the acupuncture experience by recommending that a client ingest certain herbs during the experience. Assuming you take an herbal supplement from an acupuncturist during the intervention, realize that this supplement may mitigate certain side effects (e.g. pain) associated with acupuncture.  Certain herbs may also exacerbate side effects of acupuncture (e.g. drowsiness).  In other cases, it may be that the side effects attributed to acupuncture are really caused by an adjunctive herbal remedy given to the client.  Moreover, if a room is laden with incense or essential oil diffusers – these may also cause side effects.

3. Time Between Sessions

Should you receive acupuncture on a regular basis (or multiple times), it may be that the amount of time between each sessions influences the side effects you experience.  Most would speculate that the less time between acupuncture sessions, the more severe certain types of side effects (e.g. skin-related) may become.  An extended period of time between acupuncture sessions may give the body more time to recover from side effects experienced during prior sessions, resulting in fewer total side effects.

• Minimal: A minimal amount of time between acupuncture sessions (e.g. days) indicates that you’re receiving acupuncture on a frequent basis. This may be suboptimal in terms of healing of wounds and/or soreness from prior needle insertion, resulting in cumulative exacerbation of side effects.   For example, if you receive acupuncture just days after a prior session, and experienced significant skin irritation and/or bleeding – the skin irritation and/or bleeding may become worse as a result of insufficient recovery time between sessions.
• Prolonged: An extended amount of time between acupuncture sessions (e.g. weeks or months) suggests that you receive acupuncture infrequently. Those who receive acupuncture, and then take a break (at least for several weeks) are more likely to fully recover from any minor damage and/or complications that may have occurred in a prior session. If your muscles are sore or you’re emotionally overwhelmed from the process, taking some time off generally would be considered beneficial – rather than booking another session just days later.

Keep in mind that there may not always be a predictable relationship between “time between sessions” and side effects.  In some cases, more frequent acupuncture (less time between sessions) may result in some sort of physiological adaptation that buffers the severity of certain side effects (e.g. pain).  An extended duration between sessions may not yield this same physiological adaptation that buffers pain, resulting in a greater number of specific side effects with infrequent stimulation.

4. Cumulative duration

The cumulative duration over which you’ve received acupuncture may also influence whether you experience side effects, as well the severity.  A person that’s been receiving acupuncture over a period of years should be familiar with the process, feel less anxious about receiving stimulation, and relatively adapted to the stimulation.  On the other hand, someone that just began acupuncture may be less familiar with the process, experience anxiety-related side effects, and may not have adapted to any stimulation.

• Short-term: If you’ve only received acupuncture once or twice over an extremely short-term, you may feel anxiety about the needle-based stimulation and/or blood associated with the technique. This anxiety may trigger an array of symptoms such as nausea, vomiting, or even cause you to faint.  Additionally, someone who’s relatively new to acupuncture may not know what to look for in a quality acupuncture practitioner – and settle for an unskilled acupuncturist, increasing your odds of a negative reaction.  Moreover, it is possible that the brain and/or body learns over time to adapt to the stimulation received from acupuncture in such a way that side effects are reduced over an extended duration.
• Long-term: If you’ve been using acupuncture for years with some regularity, you know what to expect and are unlikely to feel anxious about needle-based stimulation or a little bit of bleeding. Since you won’t feel as anxious, you may not experience anxiety-induced side effects such as nausea, vomiting, or fainting.  With a longer-term of experience, you’ll likely have located a highly-skilled acupuncturist, minimizing your odds of an adverse reaction and maximizing odds of therapeutic effects.  Furthermore, it is necessary to consider that your brain and/or body may adapt to acupuncture-induced stimulation over a long-term, resulting in fewer side effects.

5. Individual factors

Multiple individuals may receive the acupuncture from the same practitioner, stimulating the same area of the body, with the same time between sessions, and for the same cumulative duration – yet one may report totally different side effects than the other.  One person may end up experiencing extreme nausea, while the other may report severe pain.  The differences in side effects may be due to individual factors such as: age, food consumption, injuries, medical conditions, pain sensitivity, phobias, prior surgery, substance use, and time of day acupuncture was received.

• Age: Evidence suggests that pediatrics are at greatest risk of adverse events from acupuncture compared to adults. This is likely due to the fact that pediatrics, especially young children, are highly sensitive to any forms of stimulation – especially stimulation induced by needles.  If the same amount of pressure is applied to a pediatric patient during acupuncture as is normally applied to an adult, it may puncture organs, impair nerves, or damage tissue.  Individuals over the age of 18 are likely at lesser risk of any serious complications due to the fact that their body has matured.  However, elderly individuals (over 65 years of age) with declining strength may be more sensitive than usual to the effects of acupuncture, possibly resulting in adverse reactions.
• Food consumption: Whether you ate a large meal before acupuncture or not may dictate whether you experience some side effects. Those who consumed a sizable amount of food before acupuncture may experience some gastrointestinal distress from the position they are in during treatment, as well as from stimulating areas of the body such as the stomach.  Stimulating areas of the body such as the neck may also trigger the pharyngeal reflex, possibly causing someone to vomit if they have a full stomach.  Those who are on an empty stomach should be thought to experience fewer side effects during acupuncture – especially those such as GI distress, nausea, and vomiting.
• Injuries: If you have any serious injuries and are receiving acupuncture, there’s a chance that it could further aggravate the injury. You may be more likely to experience significant pain, muscle twitching, spasms, bruising, or even increased bleeding – depending on the extent of the injury and sensitivity of your practitioner.  Individuals devoid of injuries shouldn’t experience as significant of side effects as a result of stimulation as those who are injured in any way.
• Medical conditions: Those with medical conditions such as arthritis, chronic pain, or fibromyalgia – may be at increased risk for certain side effects compared to those without a medical diagnosis. Certain medical conditions may make the body more prone to side effects than those without them.  For example, someone with arthritis may find that needles are much more painful than a person without arthritis.  Someone with cardiomegaly (enlargement of the heart) may be at increased risk for needle-induced puncture upon chest stimulation and further complications than an individual without any organ abnormalities.
• Pain sensitivity: A person’s sensitivity to pain may determine how many pain-related side effects they report from an acupuncture session. Someone with a low pain threshold may be highly sensitive to needle insertion and stimulation, causing them to report significant pain as a side effect.  This significant pain may also lead the individual to feel anxiety about needle insertion, which could lead to nausea, lightheadedness, and in extreme cases – vomiting.  Those with lower pain thresholds may also be more likely to report soreness and/or achiness for days after an acupuncture session.  On the other hand, someone with a high pain threshold may report zero pain-related side effects during and/or after acupuncture.  While many argue that pain sensitivity is subjective, it is understood that variants in the SCN9A gene (encoding for Nav1.7 sodium channels) affect nociception.  The SCN9A gene may be one of many genes implicated in determining how well you are able to tolerate transcutaneous stimulation from acupuncture needles.
• Phobias: If you have a phobia of needles and/or blood, you may experience a significant number of anxiety-related side effects during an acupuncture session as a result [of the phobia]. Since acupuncture is most commonly performed with needles that penetrate the skin, those with a phobia of needles will likely avoid it.  However, cases of individuals fainting (vasovagal syncope) either before or during an acupuncture session upon sight of needles have been documented.  Others may end up fainting as a result of seeing or feeling blood on their skin.  Even if your phobia isn’t extreme enough to cause fainting, you may experience a host of anxiety-related side effects such as: dizziness, lightheadedness, nausea, sweating, and/or vomiting.  Though these side effects may be attributed to acupuncture, they are more accurately a result of your needle and/or blood phobia.
• Recent surgery: If you’ve recently undergone surgery, you should expect an increase in the number and severity of side effects – especially if you receive acupuncture in the area that was operated upon. Nevertheless, some individuals believe that acupuncture enhances post-operative recovery so they pursue it against medical recommendations.  Cases in which acupuncture needles fall into unhealed surgical wounds, ultimately causing permanent nerve damage and/or other serious adverse complications – have been documented in the literature.  Acupuncture following surgery may also increase side effects such as: bleeding, bruising, infection, muscle pain, and skin irritation.
• Substance use: You may want to reflect upon whether you’ve used any substances prior to acupuncture such as alcohol, illicit drugs, medications (prescription or over-the-counter), or even dietary supplements. Since it is known that acupuncture is capable of altering physiology and neurobiology, it is reasonable to suspect that a subset of acupuncture side effects may be enhanced by a particular substance.  As an example, someone taking a benzodiazepine may find that they are extremely drowsy following acupuncture.  This extreme drowsiness may be related to the fact that acupuncture increases parasympathetic tone, which bolsters the drowsiness induced by the benzodiazepine.  Other substances such as caffeine may attenuate side effects of acupuncture such as needle-induced pain – (caffeine elicits a hypoalgesic effect).  Those using other substances prior to, during, or after acupuncture should reflect upon whether the side effects they are attributing to acupuncture could be from the other substances they’re taking.
• Time of day: What time of the day did you receive acupuncture? It is reasonable to suspect that receiving acupuncture early in the morning may yield an entirely different set of side effects (or particular side effect) – compared to receiving acupuncture in the afternoon or evening.  While a majority of side effects should be similar regardless of timing, some are likely to differ based on your pre-treatment physiology/neurobiology (as dictated by your circadian rhythm).  For example, you may find that you only feel nauseous receiving acupuncture in the morning, but not at night.  Also keep in mind that certain side effects such as drowsiness may be more noticeable in the morning compared to at night [when your circadian biology has shifted to decrease arousal for sleep].

Acupuncture: Do the benefits outweigh the side effects?

If you’re regularly receiving acupuncture, it is important to evaluate whether the therapeutic benefits you’re attaining [from stimulation] outweigh the unwanted side effects.  Since acupuncture is relatively safe with a low incidence of side effects, many of those that receive acupuncture will report significant benefits without any drawbacks.  For example, someone may claim to experience decreased anxiety, improved cognitive function, and mood enhancement – without any side effects.

Those that derive therapeutic benefit without tolerability issues should be referred to as utopian responders.  If you are a utopian responder to acupuncture, it makes logical sense to continue investing time and money in future acupuncture sessions.  Another subset of individuals may experience zero side effects from acupuncture, but may find that stimulation fails to provide any sort of therapeutic effect (e.g. relaxation).

These individuals could be classified as indifferent responders in that despite experiencing no side effects, acupuncture has no favorable effect upon their functioning.  If you are an indifferent responder, acupuncture may be nothing more than a waste of your time and money.  Another subset of those who try acupuncture may experience severe side effects and/or adverse reactions to the stimulation, yet experience zero therapeutic benefit.

If you struggle to tolerate acupuncture (as a result of side effects) and the stimulation fails to improve your wellbeing (by any measure), you could be classified as a dystopian responder.  A dystopian responder may experience: bleeding, bruising, lightheadedness, nausea, and/or vomiting – and likely won’t need any convincing to avoid acupuncture in the future.  That said, most individuals are unlikely to experience the fully dystopian outcome of no benefit plus side effects.

Instead, a majority of acupuncture recipients will report experiencing a mix of therapeutic effects plus some side effects.  Since acupuncture isn’t associated with a high rate of severe side effects [when compared to pharmacological drugs], acupuncture recipients commonly report that the benefits significantly outweigh the unwanted side effects.  In this case, even though a person may experience some side effects, it makes sense to continue acupuncture because the benefits are of greater magnitude.

However, it should be speculated that some individuals may attain such a modest therapeutic effect from acupuncture, that even one side effect of moderate severity outweighs the benefit.  Ultimately though, it remains a personal decision as to whether you think it would be best to continue acupuncture or avoid it in the future.  Since acupuncture isn’t a legitimate medical treatment for any medical condition, anyone experiencing moderate-to-severe unwanted side effects from acupuncture stimulation should be advised to avoid it in the future.

Keep in mind that sometimes side effects of acupuncture may change as you familiarize your body to the stimulation and/or find a better practitioner.  To help decide whether you should continue or discontinue acupuncture in the future, you may want to track the therapeutic effects and side effects in a journal.  Using a journal to document your experience with acupuncture should help give you a “big picture” perspective as to whether the therapeutic benefits outweigh any unwanted side effects (or vice-versa).

Possible ways to reduce Acupuncture side effects

There are numerous ways by which you may be able to minimize acupuncture-induced side effects.  Examples of some side effect mitigation tactics include: ruling out contraindications, only receiving acupuncture from a properly-trained practitioner, and communicating any discomfort immediately to the acupuncturist.  You may also find that modifying the type of stimulation you receive or altering the area of stimulation – influences side effects that you experience.  Prior to implementing any of these mitigation strategies, verify safety and/or efficacies with a medical professional and thereafter, the acupuncturist.

1. Rule out contraindications: Perhaps the most effective way to minimize likelihood of an unwanted side effect [or adverse reaction] is to consult a medical doctor to rule out contraindications. You will want the medical doctor to ensure that acupuncture stimulation is safe for you, based on your current medical status. It may be recommended that you avoid acupuncture based on a particular medical condition, your medical history (e.g. recent surgery), or age.  For example, if you have cardiomegaly (an enlarged heart), it may be recommended to avoid acupuncture stimulation near the heart – as this could provoke injury.  Only pursue acupuncture once a medical doctor has verified that you are fit to receive the stimulation.
2. Find a qualified, skilled acupuncturist: To minimize your risk of adverse effects, you’ll want to only receive acupuncture from an acupuncturist with an NCCAOM certification, a 4-year acupuncture degree, and that has a plenty of experience delivering the stimulation. Also look for verified reviews and/or testimonials from his/her clients that vouch for skill and expertise. Working with only a top-notch acupuncturist will minimize your risk of injury (from improper technique), infection (from unsterile needles), and other side effects such as pneumothorax.
3. Communicate with acupuncturist: If you don’t communicate your experience to your acupuncture practitioner, it will be more difficult for him/her to minimize risk of side effects. For example, if you are in an uncomfortable position, are feeling extreme pain from stimulation, or are nauseous from the sight of a needle – inform the practitioner of your experience right away. Communicating may help reduce exacerbation of discomfort, pain, and may even prevent a serious injury.  Also be sure to inform your acupuncturist of medical conditions and/or pain threshold – to reduce likelihood of adverse outcomes.
4. Reduce session length: Some individuals may find that reducing the length of an acupuncture session helps minimize certain side effects. While session length doesn’t always predictably correlate with side effect severity, sometimes longer sessions can yield more significant side effects. If you always experience severe side effects after a 60-minute acupuncture session, you may want to reduce the session length to just 30 minutes and determine if side effects decrease.  If you experience worsening pain during a session or a particular unwanted side effect, you can always stop acupuncture “mid-session” and cut it short.
5. Alter stimulation format: Acupuncture stimulation can be delivered in a variety of formats, but a few of the most common include: needle, electrical, and laser. Sometimes multiple formats of stimulation are combined such as electrical currents running through needles (as occurs in electroacupuncture). If you’ve only tested one form of stimulation (e.g. needle) and are experiencing side effects, consider switching to an alternative format (e.g. laser) to determine whether side effects improve.
6. Modify targeted region & sites: Those that constantly experience side effects from stimulating particular regions (e.g. chest) may want to try stimulating another area of the body to determine whether side effects subside. While an acupuncturist may have a reason for targeting a particular region of the body, you may want to ask whether the stimulation targets can be moved. Even slight movement of the targeting may help you better tolerate acupuncture.  Also consider that the total number of sites stimulated altogether and/or throughout an entire session may increase likelihood of side effects.  By reducing the number of sites stimulated either altogether or throughout a session, you may experience fewer side effects.
7. Increase time between sessions: You may find it helpful to prolong the amount of time between acupuncture sessions. Sometimes, if a person receives a high number of acupuncture sessions within a short period of time (e.g. 5 times per week), he/she may never recover from minor side effects (e.g. bruising) induced by previous sessions. In fact, these minor side effects may worsen if they aren’t given sufficient time to fully heal before additional stimulation.  Increasing the gap between sessions from days to weeks or weeks to months may be helpful among those dealing with protracted side effects from acupuncture.
8. Recovery efforts: If acupuncture caused you to bleed, bruise, or was painful – it may help to make a proactive effort to recover from these injuries. Proactive recovery may involve: getting extra rest, cleaning any wounds, applying bandages to bloody areas, icing sore muscles, or even taking NSAIDs (non-steroidal anti-inflammatory drugs). Those that are doing whatever they can to expedite recovery from acupuncture-induced side effects should have an easier time coping than others.
9. Alter time of day: If you regularly receive acupuncture in the morning, you may want to test whether certain side effects change in the evening or mid-afternoon. On the other hand, if you typically receive acupuncture in the evening, you may want to test it in the early morning or afternoon to determine if certain side effects change (in terms of the specific side effects, as well as severity). While altering the time of day may have no impact upon the side effects you experience, it is reasonable to speculate that it could.  Your physiology (as dictated by your circadian rhythm) may respond in a different way to acupuncture in the morning than at night, hence leading to time-specific side effects.  Moreover, consider that certain side effects such as fatigue or drowsiness may be easier to manage in the afternoon than at night because you’re finished with your workday and closer to sleep.
10. Go without food: If you find that acupuncture induces significant gastrointestinal or emetic side effects (e.g. stomach ache, nausea, vomiting) – you may find that it helps to receive stimulation on an empty stomach. Lying on an acupuncture table with a full stomach may be inherently problematic in that you may feel stuffed or bloated, and when the stimulation is delivered – you may feel even worse. To reduce likelihood of gassiness, nausea, upset stomach, and/or vomiting – abstain from eating at least a few hours before your session.
11. Utilize adjunct substances: You may want to consider utilizing safe adjunct substances to minimize some acupuncture side effects. For example, if you feel nauseous each time you receive acupuncture – you may want to consider taking an over-the-counter antiemetic drug. Similarly, if the pain is a bit severe from needle stimulation, you could combat the pain by taking NSAIDs (non-steroidal anti-inflammatory drugs) prior to the session.  If you feel drowsy after acupuncture, you may want to drink a small cup of coffee for some caffeine-induced stimulation.  Be sure to check with your doctor to ensure that the adjuncts you’ve considered are safe.
12. Discontinue substances: It may also be beneficial to evaluate your current regimen of substances (supplements, medications, illicit drugs, alcohol) and consider how they may be affecting your acupuncture experience. For example, if you are taking a supplement that thins the blood, you may be at increased risk of excessive bleeding during acupuncture. Another example may be taking a supplement that decreases your pain threshold, resulting in more pain from stimulation.  Also consider that an acupuncturist may recommend that you take certain herbal supplements he/she is selling – during your session.  Realize that these supplements may be the major cause of your side effects, and that discontinuation and/or avoidance may make acupuncture more tolerable.
13. Alter body positioning: Most people receive acupuncture while lying down in a comfortable position. Nonetheless, if you somehow end up receiving acupuncture from an untrained practitioner, he/she may position your body improperly and/or have a worn down, uncomfortable acupuncture table – leading to pain and/or discomfort. Ensuring that your body is comfortable throughout the entire session may reduce likelihood of side effects such as dizziness, lightheadedness, and headache.
14. Room parameters: While an acupuncturist may not allow you to have full control over the room parameters, you may want to consider working with an acupuncturist in an environment that you like. Some acupuncturists use essential oil diffusers, light candles, and/or burn incense, while others may use nothing to alter the smell of the room. Keep in mind that the particular smell as well as the source of the aroma may impact side effects.  A natural essential oil will likely have a pleasant effect (e.g. enhancing relaxation) compared to a toxic air freshener (e.g. giving you a headache).  Also analyze the oxygenation of the room (whether there’s fresh air), the temperature of the room (this affects arousal), and whether the room is properly cleaned (to reduce risk of sterilization).  Work with a practitioner and/or find a practitioner that has the room parameters exactly how you need them to reduce risk of side effects.
15. Stop acupuncture: If side effects persist despite trying everything on this list, you may want to stop booking acupuncture sessions (perhaps forever) or take an extended hiatus. There’s no shame in telling your acupuncturist that you’re canceling all future appointments. Some people may not tolerate acupuncture as well as others and stopping may be the best decision.

Have you experienced Acupuncture side effects?

If you’ve experienced side effects and/or adverse reactions from acupuncture, be sure to share them in the comments section below.  Discuss the most problematic side effects you experienced, as the severity/intensity of each.  To help others get a better understanding of your situation, provide some additional details such as: the length of your acupuncture sessions, skill of your practitioner, sites targeted during stimulation, type of stimulation (e.g. needle), and reason for pursuing acupuncture.

What do you believe to be the cause of the side effects that you experience from acupuncture?  Hypothetical answers could include: poor technique from an unskilled practitioner, having a particular medical condition, or something as simple as a phobia of needles and/or blood.  Assuming you continue to pursue acupuncture despite these side effects, do you have any special tricks that you use to deal with them and/or cope?

Besides some minor skin irritation, possibly mild bleeding, and potential light bruising – side effects of acupuncture are generally negligible.  Risk of side effects is often greatest when receiving acupuncture from an unqualified (unlicensed)

SOURCE: MENTAL HEALTH BLOG