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Short term reactions to acupuncture
– a cross-sectional survey of patient reports
Hugh MacPherson, Kate Thomas

Hugh MacPherson senior research fellow Department of Health Sciences University of York Kate Thomas professor School of Healthcare University of Leeds Correspondence: Hugh MacPherson hm18@york.ac.uk

Abstract Objective To explore the type and frequency of short term reactions associated with a single acupuncture treatment. Methods As part of recruitment to a large-scale prospective survey of the safety of acupuncture, 9408 consecutive patients each completed one survey form soon after receiving treatment with acupuncture, and returned it directly to the research centre. On this form, patients were asked to report on a range of possible short term reactions relating to their most recent acupuncture treatment using a checklist of options. Results At least one short term reaction to acupuncture during or immediately after treatment was reported by 94.6% (CI 94.2 to 95.1) of patients, an average of 1.8 reactions per patient. The most common experiences reported were feeling ‘relaxed’ (79.1%) followed by feeling ‘energised’ (32.7%). A total of 24.4% of patients reported ‘tiredness’ or ‘drowsiness’, with obvious implications for safety if the patient intended to drive after treatment. ‘Negative’ reactions, such as pain and bruising at the site of needling, were reported by 29.7% of patients who were more likely to be female patients (OR 1.58), patients under the age of 40 (OR 1.62), patients who had consulted their GP or hospital specialist beforehand (OR 1.30), patients consulting their acupuncturist for the first time (OR 1.24), and patients treated by an acupuncturist with less than two years’ experience since qualification (OR 1.24). Only 13 patients were unwilling to have acupuncture again as a result of these short term reactions. Conclusion In this large cross-sectional study, extensive patient reports showed that ‘positive’ reactions to acupuncture treatment were very common. Tiredness, drowsiness and a range of ‘negative’ reactions were also frequently reported. Almost all patients were willing to experience these reactions again.

Introduction Recent research into the safety of acupuncture has usually been conducted via large-scale surveys where the type and frequency of adverse events associated with acupuncture have been recorded. Studies have either been retrospective or prospective, the latter providing more robust data, and have involved either acupuncturists in monitoring the effects of their treatments on patients, or patients in reporting their experience of adverse events. While these safety studies have necessarily focused on adverse events, questions have been raised as to whether all adverse reactions were necessarily experienced as negative by patients. Previous research has found that some negative short term reactions to treatment were what might be called ‘aggravations’, where, although symptoms were aggravated (became worse after treatment), a strong improvement of symptoms followed, so that the

patient was much better than prior to the treatment that caused the aggravation. In our recent practitioner survey of adverse events, 2.8% of treatments were reported as causing a worsening of symptoms, but in the majority of cases (2.4%) a subsequent improvement in symptoms was reported. 1 Acupuncturists sometimes describe this type of aggravation as a ’healing crisis’, known in Japan as the ‘Menken phenomenon’.2 Our interest in all short term reactions to treatment, not just aggravations to symptoms, informed our first safety study,1 which we conducted with members of the British Acupuncture Council. Acupuncturists monitored more than 30 000 treatments over a one-month period in 2001, and recorded on standardised documentation 10 920 short term reactions to treatment as reported by their patients. We labelled these as ‘mild’ and ’transient’, with the most common reports being of feeling

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‘Given this experience.6 Patients were then asked. whether they were consulting their acupuncturist for the first time.3 Of these patients. all of whom were UK based members of the British Acupuncture Council currently in practice. would you be willing to have acupuncture treatment again?’ Patients then returned the form direct to the research centre using a Freepost envelope. an average of 15 per participating practitioner. coded using the International Classification of Primary Care.htm 113 .3 and the adverse events reported by the same group of patients three months after baseline.com on January 18. sex.Downloaded from aim.7%). and their primary reason for consulting. not seen by their acupuncturist.1) with an average of 1.4 In this paper we described patients’ reports of short term reactions to treatment.2 to 95. five to 10 years. but we do not know the precise number of these handed out to patients. that we hope adds to our understanding of how patients experience acupuncture. The breakdown of the type ACUPUNCTURE IN MEDICINE 2005.6%). 10 to 15 years and over 15 years experience. This study was part of a large safety research project. Results A total of 9408 patients returned a completed questionnaire.bmj. who were able to complete the form and who gave consent. two parts of which are already reported: the profile and characteristics of the 9408 participants.8%). We asked them to hand out forms as soon as possible to all consecutive patients who were over 18 years old. Confidence intervals for proportions were calculated using Confidence Interval Analysis (CIA).6 %) reported experiencing 15 745 short term reactions associated with their acupuncture.co. our survey did not link individual patients to specific practitioners. However. including their sex. by using colour coded consent forms. We collected information on acupuncturists who agreed to participate as well as those who declined. we were interested in collecting data on the frequency and type of short term reactions reported by patients during or immediately after treatment. as well as a range of negative reactions (6. did you experience during or immediately after your acupuncture any of the following?’ We provided a checklist of possible short term reactions drawn from the results of two recently published practitioner surveys. 8904 (94. Each patient was included once only. In order to maximise the involvement of practitioners. two to five years. This corresponds to a rate of 94.9% of treatments) and feeling energised (6.1.uk/aimintro.8 reactions per patient. After the acupuncture session. presenting the type and frequency of reactions and related data including reports of aggravations. binary logistic regression was used to estimate relative risk in the form of adjusted odds ratios for those variables that showed a statistically significant association (P<0. In the study we report here. However we also received reports of tiredness or drowsiness (3. These data provided the primary outcome for the study we report here. Other characteristics are presented in Table 1 (these are submitted for publication elsewhere). we sent each one between 20 and 60 survey forms. 2013 . requires accredited training colleges to provide a minimum of three years’ full-time training or equivalent. participating patients recorded age. The patients’ mean age was 51 years and 74% were female. To control for confounding.medical-acupuncture. A total of 22 200 forms were distributed to practitioners. and 638 (33%) agreed to participate. where they trained and the number of patients they were treating a week. The British Acupuncture Council.05) in the univariate analysis. years in practice.Published by group. whether they had had acupuncture before and whether the National Health Service was paying for their acupuncture treatment.bmj. Based on number of patients normally seen by the practitioner.23(3):112-120. patients were recruited through their acupuncturists. The Statistical Package for the Social Sciences (SPSS) was used for data analysis. a self-regulating professional body for acupuncturists practising in the UK. Ethical approval for this study was given by the Northern & Yorkshire Multi-centre Research Ethics Committee.com Papers relaxed (reported in 11. categorised as less than two years. we were able to determine the number of years that the patient’s practitioner had been in practice. by answering the question: ‘Thinking about the visit at which you were given this form. Methods In a large-scale national survey.7 % of patients experiencing at least one reaction (95% CI 94. 5 Patients also provided us with information on their pathway to care. All 1955 members were invited to assist with this survey. Patients were asked to report short term reactions. www. whether they were first time acupuncture patients.

or were presenting with a psychological.6 5. patients who had consulted their GP or hospital specialist beforehand. years (n=9315) 51 Reason for consultation most commonly reported:* Musculo-skeletal Psychological General Neurological Gynaecological/obstetric Respiratory General wellbeing** 3560 1047 852 763 713 533 446 38. we present the results for short term tiredness or drowsiness reactions in Table 4 and ‘negative’ short term reactions in Table 5.Published by group.2 7.8%. we present the numbers willing and unwilling to have acupuncture treatment again.7 4. patients under the age of 40. or patients who had consulted their GP or hospital specialist beforehand. Surprisingly there was no 114 ACUPUNCTURE IN MEDICINE 2005. 2013 . most commonly an experience of pain at the site where a needle was inserted. likely to be considered a good experience. gynaecological or obstetric condition. These data are presented in the same three categories as discussed above: ‘positive’ reactions.7 *Coded and classified according to the International Classification of Primary Care.bmj. Similarly.23(3):112-120.2 9.co. Tiredness or drowsiness was associated more with female patients. The overall rate of unwillingness was only 0.com Papers Table 1 Characteristics of patients who participated in the survey (total responses = 9408) Number Sex (n=9403): Male Female 2442 6961 Percentage 26 74 Average age.4 Treatment paid for by NHS (n=9337) 441 5 4. patients under the age of 40. likely to be considered an unwanted experience. We classified each reaction as: a) ‘positive’. or had had acupuncture previously.Downloaded from aim. but not if they were consulting for a musculoskeletal condition or they had consulted their GP or hospital specialist beforehand.14 patients per 100 consultations.uk/aimintro.medical-acupuncture. A range of ‘negative’ reactions were also reported (30%). or for general wellbeing. ‘Positive’ reactions were most common.1 11. **Additional category and frequency of these reactions is presented in Table 2. especially a feeling of relaxation (79% of patients).bmj. In Table 6. In addition 24% of patients reported experiences of tiredness or drowsiness. www.htm . ‘Negative’ reactions were more likely to be reported by female patients. Table 3 shows the results of the multivariate analysis for patients who reported ‘positive’ short term reactions compared with those who did not. From this analysis. or had consulted their acupuncturist before.com on January 18. and c) ‘negative’. followed by feeling energised (33%).1 8. or patients consulting their acupuncturist for the first time.7 Receiving acupuncture for the first time (n=9381) 1253 13. A worsening of their existing condition was reported by 1. patients were more likely to report ‘positive’ short term reactions if they were male. b) tiredness or drowsiness (which could be interpreted as either positive or negative). and ‘negative’ reactions. tiredness or drowsiness reactions.8 Previously consulted their GP or hospital specialist about their main problem or symptom (n=9337) 7257 77.

0 1. In Table 7 we use a binary logistic regression model and find that only two factors were significantly (P<0. 0. 0.5 0. This was an unexpectedly high proportion. 2. 25. www. 4. 12. some people might experience being energised or relaxed as ‘negative’.6. 3.4 0. 1. such as pain and bruising at the site of needling.0 2.6.5 significant difference between the three categories.uk/aimintro.0. Similarly.5.7 0.5. but also has limitations.6% (CI 94.8 113. 2.5. 30.4 28. then clearly excessive tiredness or drowsiness must be seen as a risk factor.6. 0.7 0. ‘Negative’ reactions. were reported by 29.7% of patients.7.6.5 0.4 23. 0.8 0.1 Tiredness or drowsiness reactions 2295 24.7 1. If one takes the view that patient safety is the key issue.bmj.6 1. providing evidence that ‘negative’ short term reactions did not affect people’s willingness to have acupuncture again.bmj. 0.4. 0. 4. With regard to the ‘positive’ category for example.2. however.8 31.0 0.5 0.7 11.9 3.05) associated with an unwillingness to have acupuncture again: having had acupuncture recommended by an NHS practitioner (such as a GP.4 0.6.3 4.com Papers Table 2 Type and frequency of short term reactions associated with acupuncture (n=9408) Type of event Number of reported reactions Short term reaction rate per 100 treatments 95% CI ‘Positive’ reactions Relaxed Energised Other ‘positive’ Sub Total 7436 3072 166 10674 79.9 0.7.0 4. 79. it may not always be positive to be ‘energised’ or ‘relaxed’.4% of patients reported feeling tired or drowsy.co.23(3):112-120. Discussion Our main result was that 94.Published by group.2. 2013 .3.5 78. with the most common experiences being reported as feeling ‘relaxed’ (79. Our post hoc classification of adverse events into three major categories has been useful in some ways. 33. or physiotherapist) and having acupuncture for the first time.3 ‘Negative’ reactions Pain where needle was inserted Bruising Pain other than at site of needling Faint / dizzy Worsening of condition Nauseous Sweating Bleeding Disorientation / anxiety / nervousness / insomnia / emotional Ache/discomfort other than at needle point Other ‘negative’ Itching / pins & needles / tingling / burning sensation Irritation / ache at needle point Sub Total 1154 378 373 248 165 111 79 66 63 49 33 33 24 2776 12. A total of 24.4 2. nurse.4 3. We had difficulty in categorising ‘tiredness or drowsiness’ as either ‘positive’ or ‘negative’ and therefore created a separate category.8% of patients.5.1 32.1%) followed by feeling ‘energised’ (32.8 1.4 Total 15745 167.6 1.Downloaded from aim.medical-acupuncture.1) of patients reported experiencing at least one short term reaction to acupuncture during or immediately after treatment. In addition individual reporting ACUPUNCTURE IN MEDICINE 2005.2 to 95. aggravation of symptoms was only reported by 1.2.com on January 18.7%).0 1.3 29. 1.4 0.2 0.7 0.8 reactions per patient.htm 115 . with an average of 1.9 0.2.

07.45 (1.008 1. 116 ACUPUNCTURE IN MEDICINE 2005. 1.co.58 (1.06. 1.13. 1. 1.00) P<0.60 (1.14.22.uk/aimintro.15.0001 1. 1.10. No associations were found for the other known variables. 1.75) P=0.bmj.39) P=0.48 (1.htm . No associations were found for the other known variables.65 (1.011 ** All variables in the left hand column were used in the logistic regression model and were shown to have an independent effect on the likelihood of patients reporting short term reactions.0001 Male patients vs Female patients Patients aged 40 years and over vs Patients age under 40 years Patients who had not consulted their GP or specialist about their condition vs Patients who had consulted their GP or specialist about their condition 436/2442 (18%) vs 1859/6957 (27%) 1528/6942 (22%) vs 739/2369 (31%) 445/2080 (21%) vs 1837/7257 (25%) 1. 2.41 (1.72) P<0.62 (1.001 *All variables in the left hand column were used in the logistic regression model and were shown to have an independent effect on the likelihood of patients reporting short term reactions. 1.46.medical-acupuncture.27 (1.com Papers Table 3 Adjusted odds ratios for ‘positive’ short term reactions* (n=9408) Response variable Proportions experiencing a ‘positive’ reaction* Adjusted relative risk:** Odds Ratio (95% CI) 1.Published by group.bmj.23 (1. www.70 (1. Table 4 Adjusted odds ratios for short term reactions of tiredness or drowsiness (n=9408) Response variable Proportions experiencing tiredness or drowsiness Adjusted relative risk:* Odds Ratio (95% CI) 1.43.85) P<0. 1.51) P=0.23(3):112-120.44) P=0. 2.041 1.02.32.005 1.Downloaded from aim.0001 Female patients vs Male patients Patients who were having acupuncture for the first time vs Patients who had had acupuncture previously Patients who were consulting their current acupuncturist for the first time vs Patients who had consulted their current acupuncturist before Patients who had not consulted for a psychological condition vs Patients who had consulted for a psychological condition Patients who had not consulted for a gynaecological or obstetric condition vs Patients who had consulted for a gynaecological or obstetric condition Patients who had consulted for a musculoskeletal condition vs Patients who had not consulted for musculoskeletal condition Patients who had not consulted for general wellbeing vs Patients who had consulted for general wellbeing Patients who had consulted their GP or specialist about their condition vs Patients who had not consulted their GP or specialist about their condition *‘Positive’ reactions are listed in Table 2.76) P<0.95) P=0.004 1.002 1.53) P=0.com on January 18.0001 1.24 (1. 2. 6228/6957 (90%) vs 2247/2442 (92%) 1046/1253 (83%) vs 7417/8128 (91%) 1014/1204 (84%) vs 7360/8085 (91%) 7446/8290 (90%) vs 977/1047 (93%) 7971/8856 (90%) vs 452/ 481 (94%) 3133/3558 (88%) vs 5290/5779 (92%) 8055/8958 (90%) vs 424/ 446 (95%) 6496/7257 (90%) vs 1920/2080 (92%) 1. 2013 .53) P=0.

17.47.rate per 100 treatments 95% CI ‘Positive’ short term reactions (n = 8428) Tiredness or drowsiness short term reactions (n=2284) ‘Negative’ short term reactions (n =3726) All cases (n = 9346) 8421 2281 3719 9333 7 3 7 13 0. 1.41) P=0.139 0.013 Patients who had acupuncturists who had been in practice more than two years vs Patients who had acupuncturists who had been in practice less than two years Male patients vs Female patients Patients aged 40 years and over vs Patients aged under 40 years Patients who had not consulted their GP or specialist about their condition vs Patients who had consulted their GP or specialist about their condition Patients who had consulted current acupuncturist before vs Patients who had consulted current acupuncturist for first time *‘Negative’ reactions are listed in Table 2.58 (1.0001 1.com on January 18.3. For example.Downloaded from aim.09. 0. due perhaps to a loyalty to their chosen approach to health care.045. 1.30 (1.com Papers Table 5 Adjusted odds ratios for ‘negative’ short term reactions*(n=9408) Response variable Proportions experiencing a ‘negative’ reaction* Adjusted relative risk:** Odds Ratio (95% CI) 1.040. because the user-friendly checklist we provided in the questionnaire encouraged the ACUPUNCTURE IN MEDICINE 2005.medical-acupuncture.43.388 0.Published by group.24 (1. and one person’s relaxation may be another’s tiredness. 1.001 ** All variables in the left hand column were used in the logistic regression model and were shown to have an independent effect on the likelihood of patients reporting short term reactions. The potential clinical relevance of these associations therefore needs to be considered and interpreted in each case. In our two previous publications we discussed the practitioners and patients responding to this survey.23(3):112-120.0001 1.uk/aimintro. when patients provide reports of their experiences in a questionnaire.091.188 0.co.172 0. and the disease being treated. it is possible that some biases will intrude. No associations were found for the other known variables. and this variation may be influenced by many factors such as culture. 2013 . 1.62 (1.44) P<0.081.bmj.47) P=0.0001 1.4 concluding that the sample obtained is reasonably representative of the population it aims to describe with respect to known characteristics. Table 6 Patients’ willingness to have acupuncture treatment again Reported experience of short term reactions Number willing to have acupuncture again Number unwilling to have acupuncture again Those unwilling to have acupuncture again . expectations.78) P<0.bmj.131 0. With other patients there might be a counter tendency to over-report.htm 117 .24 (1.238 will vary. However. 0.083 0. 0. Another caveat concerning the data presented here is that the large sample size inevitably led to associations that are statistically significant but not necessarily clinically meaningful. for some patients there might be a tendency to under-report the negative reactions in order to protect their acupuncturist or acupuncture generally. as the differences observed may be small in absolute terms. 0.386 0. 3462/8787 (39%) vs 282/ 616 (46%) 779/2442 (32%) vs 2964/6957 (43%) 2544/6942 (37%) vs 1160/2369 (49%) 733/2080 (35%) vs 2990/7257 (41%) 3167/8085 (39%) vs 539/1204 (45%) 1. 1. www.92) P<0.05.

tiredness and drowsiness seems likely to be the most worrying potential risk. 18.1 While the practitioners in both studies were drawn from the same professional association.8% of our patients reported an aggravation to their condition.bmj.032 Patients having had acupuncture before vs Patients having acupuncture for the first time 7/8089 (0.10 but more commonly around 3%. www. etc) vs Patients who had acupuncture recommended by an NHS practitioner 8/8129 (0.co. physiotherapist. however.23(3):112-120. would have provided the study with different data. nurse. the most common three types of reactions reported were the same. 12.8.bmj. feeling energised and feeling tired or drowsy.95 (1.77 (1. This raises the question as to whether practitioners are unaware of the pain they cause. We found no association between reported ‘negative’ reactions and particular reasons for consulting. which most acupuncturists in the British Acupuncture Council regard as a requirement for a treatment. suggesting that pain at the site of needling is not linked to the presentation of painful conditions per se.11 In terms of safety. ticking of boxes.11 compared to 24% in this survey.com on January 18. namely feeling relaxed. Immediately following a single session of acupuncture. is associated with patient characteristics. or non-participating patients of participating practitioners. No associations were found for the other known variables.002 * All variables in the left hand column were used in the logistic regression model and were shown to have an independent effect on the likelihood of patients reporting short term reactions. particularly reported pain at the site of needling.61) P=0.11 and the 1% in another. Patients report short term reactions approximately five times more frequently than practitioners. reports of ‘positive’ reactions were associated with returning acupuncture patients. including being new to acupuncture.Downloaded from aim. and with nonmusculoskeletal reasons for consulting (including psychological conditions and general wellbeing). and found variations on a number of counts. The difference overall might be related to the known tendency among healthcare practitioners to underreport adverse events.09%) vs 6/1240 (0. and in the same order of frequency. is reported by some patients as pain. We cannot know whether patients of non-participating practitioners.48%) 5.uk/aimintro. These results are not incompatible with studies that 118 ACUPUNCTURE IN MEDICINE 2005. it is worth noting that in both our surveys. as it could compromise a patient’s ability to drive home safely after acupuncture.8% reported in two other surveys. the difference is nearer tenfold. lower than clinical anecdotes had led us to expect.90. the patient populations are different. 2013 .44%) Adjusted relative risk*: Odds Ratio (95% CI) 3.1. or whether the dull ache usually experienced when de qi is obtained at an acupuncture point. This result lies between the 2.Published by group.12 One of our lines of enquiry in this study was to explore the frequency that patients reported a worsening of their symptoms as a result of acupuncture. the estimates of tiredness after treatment have been wide-ranging: as high as 41%. In contrast.htm . only 1.9 Nevertheless. We have also compared our results with other surveys.10%) vs 4/ 913 (0.12. It is possible to compare our patient reports of short term reactions with practitioner reports of their patients’ short term reactions from the previous survey conducted in 2001.medical-acupuncture. Our evidence does not support a report in the literature that tiredness or drowsiness occurs more commonly after a patient’s first session of acupuncture. the British Acupuncture Council. For negative reactions related to pain.6 Our data suggest that the risk of ‘negative’ short term reactions. For example. practitioner characteristics and consulting behaviour.com Papers Table 7 Adjusted odds ratios for patients’ unwillingness to have acupuncture treatment again (n=9346) Proportions unwilling to have acupuncture again Patients who did not have acupuncture recommended by an NHS practitioner (GP.66) P=0.

it is interesting to speculate what physiological responses might explain such marked positive short term reactions. and Richard Blackwell and Jennifer Dale who contributed to the interpretation of the results. Given that drowsiness and tiredness are likely to be the most serious of the common risk factors. how they integrate this knowledge into their treatments for example to modify their choice of points.15 Is it possible then that without these short term reactions.23 Secondly. further research is indicated to explore patients’ and practitioners’ experiences.co. use machinery. Conclusion In a large-scale prospective patient survey. Lines of enquiry include patients’ perceptions of pain from needling.23(3):112-120.medical-acupuncture.16-18 These effects have been demonstrated to last up to 12 hours. an unexpectedly high level.com Papers have shown patient reports of relaxation following acupuncture for musculoskeletal conditions such as low back pain.bmj. www. Research could also usefully explore why so few patients were unwilling to have acupuncture again after experiencing short term reactions. hopefully helping to explain why new patients and patients who had been recommended by an NHS practitioner are less willing to continue. From our data. Tony Scullion who managed much of the data collection. almost all patients were willing to have acupuncture again. and serotonin. and it has been suggested that these are fundamentally different from short term ones. in some way compensating for the low level of ‘gold standard’ evidence to support acupuncture’s reputation for effectiveness. as well as oxytocin. we found that 95% of patients reported reactions to acupuncture during or immediately after a single session.20.13 What we have shown is that patients with these conditions are significantly less likely to report a relaxation response. further data could be collected to give a more accurate picture of the real risk. Previous research has indicated that it takes on average the first six or so treatments before substantial benefits of treatment are experienced. a possible mediator of anti-stress effects. Given that not all reactions to treatment were ‘positive’. compared to patients with other conditions.21 and may be responsible for longer term outcomes reported in the literature.bmj. and therefore not continued with it for a sufficient number of sessions? One can also speculate that these ubiquitous and generally positive short term reactions have played a crucial role in extending acupuncture’s impact in the West in recent years. only 13 patients were unwilling to have acupuncture again because of their experience of these short term reactions. 19 However acupuncture also appears to set off longer term neurophysiological processes. the patients and practitioners who participated. 2013 .14. A qualitative study could explore in depth the reasons patients have for being willing to continue with acupuncture. for example by reporting on the extent that they felt compromised in their ability to drive.14% of treatments (95% CI 0. Acknowledgements We acknowledge the assistance of the British Acupuncture Council who funded the study. Finally. ACUPUNCTURE IN MEDICINE 2005.Downloaded from aim.com on January 18.08 to 0. While our knowledge of these processes is limited. namely feeling relaxed and feeling energised.24).13. thereby tailoring treatment more closely to the needs of the patient. cook or walk.uk/aimintro.22. many more patients might have believed that acupuncture was ineffective. this is an exceptionally low rate. we do know that acupuncture releases endogenous opioid peptides that can generate relaxed happy feelings. It is possible that short term reactions play an important role in providing some evidence for patients that acupuncture is actually doing something. where a deficiency is linked to depression. Acupuncture needles produce a range of biophysical reactions. including pain at the site of needling. and the more general question of how patients value both positive and negative reactions. A number of interesting questions for further research are raised by this study. Bin Liu who helped with the analysis. Despite patients also feeling a range of ‘negative’ reactions.Published by group. and surprisingly not related to whether the reaction was ‘positive’ or ‘negative’. we could investigate the impact short term reactions may have on practitioners. followed by feelings of tiredness or drowsiness. The most common reactions were ‘positive’. providing patients with a strong motivation to continue with acupuncture long enough to be effective. and have similarities with the physiological processes that result from vigorous physical exercise. a rate of 0.htm 119 . Firstly.

6(4):345-50. Kjendahl A. Survey of adverse events following acupuncture (SAFA): a prospective study of 32. Tanno Y. 22. Tsukayama H. Pain 2000. Berman B. Aronson JK et al. 23.86(3):217-25. Harrison PI.19(2):84-92. 17. Andersson S. Is acupuncture effective for the treatment of chronic pain? A systematic review. Patient perspectives on outcomes after treatment with acupuncture. 9. Helkimo M. Smith CC. 13. Acupuncture. Hart A. Fitter M. www.20(2-3):82-99. 18. Clin Rehabil 1997.11(3):192-200. Borchgrevink CF. Vincent CA. Cranio 1992. Incidence of adverse reactions associated with acupuncture. Final report submitted to NCCHTA 2005 14. Walters S. Factors that influence outcome: an evaluation of change with acupuncture. Patient reports of adverse events associated with acupuncture treatment: a prospective national survey. Med Hypotheses 1995.45(3):271-81. A one year follow-up study on the effects of acupuncture in the treatment of stroke patients in the subacute stage: a randomized. Nishijo K. 7. Scientific research into acupuncture for the relief of pain. Acupunct Med 2002. White A.13(5):349-55. Submitted for publication 2005.19(2):93-102. Thomas K. Tanno Y. 11. Churchill Livingstone. Thomas KJ.htm . Review.Published by group. Hayhoe S. Fitter M. 10.43(2):177-81.14:265-7. 2013 . Moride Y. Adverse drug reactions in a hospital general medical unit meriting notification to the Committee on Safety of Medicines. Adverse events of acupuncture and occlusal splint therapy in the treatment of craniomandibular disorders. Ezzo J. MacPherson H. 1991. Jadad AR. Longer term clinical and economic benefits of offering acupuncture to patients with persistent low back pain. Campbell M et al. Acupunct Med 1998. Lao L. Med Hypotheses 1995. Lamberts H. Scullion A. Lundeberg T. Haramburu F. Reg Anesth 1996. 19. 2. Sallstrom S. BMAS and AACP British Medical Acupuncture Society and Acupuncture Association of Chartered Physiotherapists. J Altern Complement Med 1999. Reynolds DJ. Begaud B. Acupuncture treatments: a traffic hazard? Am J Acupunct 1986.42(4):423-9.bmj. 12. Bennett PM. MacPherson H. Ernst E.medical-acupuncture.bmj.21(4): 361-70. 1987. 4. Br J Clin Pharmacol 1997. Hadhazy VA. Kimura T. Sinclair-Lian N. International Classification of Primary Care. 20.000 consultations with professional acupuncturists. Acupunct Med 2001. Brattberg G. A controlled trial of the treatment of migraine by acupuncture.2(1):53-60. J Altern Complement Med 2001. 6.5(3):229-36. Wood M. A prospective survey of adverse events and treatment reactions following 34. J Altern Complement Med 2000. Underreporting of adverse drug reactions in general practice. J Altern Complement Med 1996. Acupuncture—from empiricism to science: functional background to acupuncture effects in pain and disease. Adverse events in acupuncture and moxibustion treatment: a sixyear survey at a national clinic in Japan. A review.000 consultations.23(3):112-120. Thorpe L. Acupuncture – from empiricism to science: functional background to acupuncture effects in pain and disease. 5. Pomeranz B.Downloaded from aim. Tsukayama H. Hsu DT. Pearce HM.5(4):305-12. Bensoussan A. Hori N. Gould A. Ratcliffe J.uk/aimintro. 15. Requejo AA. Lundeberg T. Thomas KJ. MacPherson H. Oxford University Press. Osten PE. Stanghelle JK. Walters S. 8. The Vital Meridian: Modern Exploration of Acupuncture. Acupuncture mechanisms for clinically relevant long term effects—reconsideration and a hypothesis. MacPherson H. Yamashita H.com on January 18. Qual Saf Health Care 2004. 16.com Papers Reference list 1. and Thomas K. MacPherson H. Carlsson C.7(3):261-8. Patients seeking care from acupuncture practitioners in the UK: a national survey.10(4):318-24. Andersson S. Yamashita H. Brazier J. Singh BB. 21. 120 ACUPUNCTURE IN MEDICINE 2005. controlled study. 3. Br J Clin Pharmacol 1996. Macpherson H. Acupunct Med 2001.co. Clin J Pain 1989.16(1):33-9.45(3):271-81. List T.

3.bmj.1136/aim.com Short term reactions to acupuncture − a cross-sectional survey of patient reports Hugh MacPherson and Kate Thomas Acupunct Med 2005 23: 112-120 doi: 10.bmj.bmj.bmj.com/content/23/3/112 These include: References Email alerting service Article cited in: http://aim.112 Updated information and services can be found at: http://aim. Notes To request permissions go to: http://group. 2013 .bmj.bmj.Downloaded from aim.com/content/23/3/112#related-urls Receive free email alerts when new articles cite this article.com/cgi/reprintform To subscribe to BMJ go to: http://group.com on January 18. Sign up in the box at the top right corner of the online article.bmj.23.com/group/rights-licensing/permissions To order reprints go to: http://journals.com/subscribe/ .Published by group.

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