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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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However. Patients were asked to report short term reactions. To control for confounding. We asked them to hand out forms as soon as possible to all consecutive patients who were over 18 years old. an average of 15 per participating practitioner. whether they were first time acupuncture patients. The Statistical Package for the Social Sciences (SPSS) was used for data analysis. but we do not know the precise number of these handed out to patients. 10 to 15 years and over 15 years experience.1.uk/aimintro. These data provided the primary outcome for the study we report here. a self-regulating professional body for acupuncturists practising in the UK. presenting the type and frequency of reactions and related data including reports of aggravations. categorised as less than two years. including their sex.htm 113 .Published by group. sex. www. all of whom were UK based members of the British Acupuncture Council currently in practice. Results A total of 9408 patients returned a completed questionnaire.23(3):112-120. 5 Patients also provided us with information on their pathway to care. After the acupuncture session. we were able to determine the number of years that the patient’s practitioner had been in practice. Confidence intervals for proportions were calculated using Confidence Interval Analysis (CIA). coded using the International Classification of Primary Care. two parts of which are already reported: the profile and characteristics of the 9408 participants.7 % of patients experiencing at least one reaction (95% CI 94. In the study we report here. and 638 (33%) agreed to participate.2 to 95. requires accredited training colleges to provide a minimum of three years’ full-time training or equivalent. The breakdown of the type ACUPUNCTURE IN MEDICINE 2005. would you be willing to have acupuncture treatment again?’ Patients then returned the form direct to the research centre using a Freepost envelope. 8904 (94.com Papers relaxed (reported in 11. by answering the question: ‘Thinking about the visit at which you were given this form.bmj. Other characteristics are presented in Table 1 (these are submitted for publication elsewhere). The patients’ mean age was 51 years and 74% were female. A total of 22 200 forms were distributed to practitioners.Downloaded from aim. not seen by their acupuncturist. who were able to complete the form and who gave consent. whether they were consulting their acupuncturist for the first time. where they trained and the number of patients they were treating a week. 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.co. by using colour coded consent forms. Ethical approval for this study was given by the Northern & Yorkshire Multi-centre Research Ethics Committee.bmj. we sent each one between 20 and 60 survey forms. All 1955 members were invited to assist with this survey. two to five years. 2013 . In order to maximise the involvement of practitioners. our survey did not link individual patients to specific practitioners.9% of treatments) and feeling energised (6.6 Patients were then asked. However we also received reports of tiredness or drowsiness (3. The British Acupuncture Council. and their primary reason for consulting.3 Of these patients. ‘Given this experience. Methods In a large-scale national survey. that we hope adds to our understanding of how patients experience acupuncture. patients were recruited through their acupuncturists.3 and the adverse events reported by the same group of patients three months after baseline.4 In this paper we described patients’ reports of short term reactions to treatment. as well as a range of negative reactions (6.05) in the univariate analysis.6%). Each patient was included once only. This study was part of a large safety research project. 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. This corresponds to a rate of 94. we were interested in collecting data on the frequency and type of short term reactions reported by patients during or immediately after treatment.com on January 18.medical-acupuncture. five to 10 years.8 reactions per patient.1) with an average of 1.8%).6 %) reported experiencing 15 745 short term reactions associated with their acupuncture.7%). Based on number of patients normally seen by the practitioner. years in practice. We collected information on acupuncturists who agreed to participate as well as those who declined. participating patients recorded age. whether they had had acupuncture before and whether the National Health Service was paying for their acupuncture treatment.

com on January 18. These data are presented in the same three categories as discussed above: ‘positive’ reactions.2 7.1 8. we present the results for short term tiredness or drowsiness reactions in Table 4 and ‘negative’ short term reactions in Table 5. patients under the age of 40.23(3):112-120. 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 38.8 Previously consulted their GP or hospital specialist about their main problem or symptom (n=9337) 7257 77. In Table 6. The overall rate of unwillingness was only 0. tiredness or drowsiness reactions. ‘Positive’ reactions were most common.7 *Coded and classified according to the International Classification of Primary Care. or had consulted their acupuncturist before. patients under the age of 40. but not if they were consulting for a musculoskeletal condition or they had consulted their GP or hospital specialist beforehand. Similarly. Surprisingly there was no 114 ACUPUNCTURE IN MEDICINE 2005. especially a feeling of relaxation (79% of patients). likely to be considered an unwanted experience.medical-acupuncture.4 Treatment paid for by NHS (n=9337) 441 5 4.uk/aimintro. A range of ‘negative’ reactions were also reported (30%).Published by group.7 4. and ‘negative’ reactions.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. **Additional category and frequency of these reactions is presented in Table 2.1 11. 2013 .7 Receiving acupuncture for the first time (n=9381) 1253 13. In addition 24% of patients reported experiences of tiredness or drowsiness.co. and c) ‘negative’. www. From this analysis.htm . we present the numbers willing and unwilling to have acupuncture treatment again. patients were more likely to report ‘positive’ short term reactions if they were male.bmj. or for general wellbeing.Downloaded from aim.14 patients per 100 consultations. or had had acupuncture previously. likely to be considered a good experience. ‘Negative’ reactions were more likely to be reported by female patients. or patients who had consulted their GP or hospital specialist beforehand. Table 3 shows the results of the multivariate analysis for patients who reported ‘positive’ short term reactions compared with those who did not. A worsening of their existing condition was reported by 1.bmj. or patients consulting their acupuncturist for the first time. We classified each reaction as: a) ‘positive’. b) tiredness or drowsiness (which could be interpreted as either positive or negative). gynaecological or obstetric condition. Tiredness or drowsiness was associated more with female patients. or were presenting with a psychological. followed by feeling energised (33%).2 9. patients who had consulted their GP or hospital specialist beforehand.8%. most commonly an experience of pain at the site where a needle was inserted.6 5.

6.6 1.8% of patients.5 78.7.6. 0.7 0. 0. If one takes the view that patient safety is the key issue. www. 30.6. 0.4 2.4 0. 0. ‘Negative’ reactions. it may not always be positive to be ‘energised’ or ‘relaxed’.co.Published by group. but also has limitations.6% (CI 94.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 79.5 0. 79.5.4 28.0 1.23(3):112-120. some people might experience being energised or relaxed as ‘negative’.4 3.6. 33.2.2. however.medical-acupuncture.4 0.0.7%). 2.1) of patients reported experiencing at least one short term reaction to acupuncture during or immediately after treatment.2. aggravation of symptoms was only reported by 1.uk/aimintro. 2013 .0 2.1 32.3. nurse.05) associated with an unwillingness to have acupuncture again: having had acupuncture recommended by an NHS practitioner (such as a GP.7 0.bmj.8 0.8 reactions per patient.6 1.2. 0. with the most common experiences being reported as feeling ‘relaxed’ (79. 1. A total of 24.5. 3. Our post hoc classification of adverse events into three major categories has been useful in some ways.4 0.5 significant difference between the three categories.2 to 95.0 4. We had difficulty in categorising ‘tiredness or drowsiness’ as either ‘positive’ or ‘negative’ and therefore created a separate category.5. with an average of 1. 4.4% of patients reported feeling tired or drowsy.1 Tiredness or drowsiness reactions 2295 24. 2.8 113. Discussion Our main result was that 94.bmj. In Table 7 we use a binary logistic regression model and find that only two factors were significantly (P<0.2 0. 1. 4. or physiotherapist) and having acupuncture for the first time.8 1. were reported by 29.4 23.7% of patients. 12. This was an unexpectedly high proportion.4. providing evidence that ‘negative’ short term reactions did not affect people’s willingness to have acupuncture again.9 3.5.3 29. 25.6.1%) followed by feeling ‘energised’ (32.7 11.9 0.5 0.com on January 18.7.8 31.0 1.9 0.3 4.5 0.htm 115 . 0.3 ‘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. With regard to the ‘positive’ category for example. then clearly excessive tiredness or drowsiness must be seen as a risk factor.7 1. In addition individual reporting ACUPUNCTURE IN MEDICINE 2005.0 0.4 Total 15745 167.7 0.Downloaded from aim. such as pain and bruising at the site of needling. Similarly.

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. No associations were found for the other known variables.06. 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. No associations were found for the other known variables. 2013 .45 (1.uk/aimintro. 116 ACUPUNCTURE IN MEDICINE 2005. 2. 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.co.bmj.70 (1.39) P=0.011 ** 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.48 (1.32.Downloaded from aim.0001 1.72) P<0.23(3):112-120.005 1.0001 1.14.85) P<0.23 (1.00) P<0. 1.02.07.bmj.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. 1.24 (1. 2.15.95) P=0.46.75) P=0. www.Published by group.22.004 1.53) P=0.51) P=0. 1.43.76) P<0. 1. 2. 1.041 1.27 (1.002 1.65 (1. 1.60 (1.008 1.10.58 (1. 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. 1.0001 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%) 1.62 (1.htm .medical-acupuncture.41 (1.44) P=0.53) P=0.13.com on January 18.

0. 0.386 0.com on January 18.23(3):112-120. With other patients there might be a counter tendency to over-report.bmj. 1.24 (1. 0.bmj.188 0.43. 1. In our two previous publications we discussed the practitioners and patients responding to this survey. For example. as the differences observed may be small in absolute terms.09.0001 1.172 0. 0.Downloaded from aim.Published by group. 1.040.131 0. www.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 0.081.medical-acupuncture.41) P=0. it is possible that some biases will intrude.htm 117 .0001 1.uk/aimintro.co. for some patients there might be a tendency to under-report the negative reactions in order to protect their acupuncturist or acupuncture generally. However.045. 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. 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.62 (1.3.05. because the user-friendly checklist we provided in the questionnaire encouraged the ACUPUNCTURE IN MEDICINE 2005. The potential clinical relevance of these associations therefore needs to be considered and interpreted in each case.24 (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. when patients provide reports of their experiences in a questionnaire.091. and one person’s relaxation may be another’s tiredness.0001 1.30 (1.47.17. and this variation may be influenced by many factors such as culture. and the disease being treated.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. 1.58 (1.47) P=0. expectations.92) P<0.139 0.78) P<0.44) P<0.388 0. No associations were found for the other known variables.238 will vary.083 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. 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 . 2013 . due perhaps to a loyalty to their chosen approach to health care.4 concluding that the sample obtained is reasonably representative of the population it aims to describe with respect to known characteristics.

9 Nevertheless.61) P=0. particularly reported pain at the site of needling.bmj. suggesting that pain at the site of needling is not linked to the presentation of painful conditions per se.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. For example.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.Published by group. as it could compromise a patient’s ability to drive home safely after acupuncture. In contrast.12. the patient populations are different.htm .44%) Adjusted relative risk*: Odds Ratio (95% CI) 3.1 While the practitioners in both studies were drawn from the same professional association. and in the same order of frequency. and found variations on a number of counts. only 1.8% of our patients reported an aggravation to their condition.10 but more commonly around 3%.medical-acupuncture. The difference overall might be related to the known tendency among healthcare practitioners to underreport adverse events. We have also compared our results with other surveys.10%) vs 4/ 913 (0. namely feeling relaxed. would have provided the study with different data.11 In terms of safety. the difference is nearer tenfold. is associated with patient characteristics.co. the estimates of tiredness after treatment have been wide-ranging: as high as 41%. 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. We found no association between reported ‘negative’ reactions and particular reasons for consulting.032 Patients having had acupuncture before vs Patients having acupuncture for the first time 7/8089 (0.23(3):112-120. or whether the dull ache usually experienced when de qi is obtained at an acupuncture point. This result lies between the 2. www.48%) 5. however. tiredness and drowsiness seems likely to be the most worrying potential risk. the most common three types of reactions reported were the same.95 (1. including being new to acupuncture.11 and the 1% in another. lower than clinical anecdotes had led us to expect. or non-participating patients of participating practitioners. feeling energised and feeling tired or drowsy. 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. reports of ‘positive’ reactions were associated with returning acupuncture patients. the British Acupuncture Council. physiotherapist. 12. No associations were found for the other known variables. which most acupuncturists in the British Acupuncture Council regard as a requirement for a treatment. Patients report short term reactions approximately five times more frequently than practitioners.com on January 18. practitioner characteristics and consulting behaviour. 18.66) P=0.09%) vs 6/1240 (0. nurse. it is worth noting that in both our surveys.8% reported in two other surveys.6 Our data suggest that the risk of ‘negative’ short term reactions.8. ticking of boxes.90.1. is reported by some patients as pain. We cannot know whether patients of non-participating practitioners.11 compared to 24% in this survey. For negative reactions related to pain.Downloaded from aim. These results are not incompatible with studies that 118 ACUPUNCTURE IN MEDICINE 2005.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.bmj. This raises the question as to whether practitioners are unaware of the pain they cause. Immediately following a single session of acupuncture.77 (1. 2013 . and with nonmusculoskeletal reasons for consulting (including psychological conditions and general wellbeing). etc) vs Patients who had acupuncture recommended by an NHS practitioner 8/8129 (0.uk/aimintro.

Previous research has indicated that it takes on average the first six or so treatments before substantial benefits of treatment are experienced. providing patients with a strong motivation to continue with acupuncture long enough to be effective. Bin Liu who helped with the analysis.13. Acknowledgements We acknowledge the assistance of the British Acupuncture Council who funded the study. Conclusion In a large-scale prospective patient survey. use machinery.Downloaded from aim.14. we could investigate the impact short term reactions may have on practitioners. 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. further research is indicated to explore patients’ and practitioners’ experiences. A number of interesting questions for further research are raised by this study.com on January 18. where a deficiency is linked to depression.23(3):112-120. and Richard Blackwell and Jennifer Dale who contributed to the interpretation of the results. how they integrate this knowledge into their treatments for example to modify their choice of points. The most common reactions were ‘positive’. cook or walk.15 Is it possible then that without these short term reactions. thereby tailoring treatment more closely to the needs of the patient. it is interesting to speculate what physiological responses might explain such marked positive 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. compared to patients with other conditions. a possible mediator of anti-stress effects. in some way compensating for the low level of ‘gold standard’ evidence to support acupuncture’s reputation for effectiveness. an unexpectedly high level. this is an exceptionally low rate. 19 However acupuncture also appears to set off longer term neurophysiological processes. ACUPUNCTURE IN MEDICINE 2005. as well as oxytocin. and serotonin. 2013 . followed by feelings of tiredness or drowsiness.bmj.medical-acupuncture. A qualitative study could explore in depth the reasons patients have for being willing to continue with acupuncture.uk/aimintro.23 Secondly. for example by reporting on the extent that they felt compromised in their ability to drive.Published by group. further data could be collected to give a more accurate picture of the real risk. It is possible that short term reactions play an important role in providing some evidence for patients that acupuncture is actually doing something.08 to 0. many more patients might have believed that acupuncture was ineffective.htm 119 . From our data. Given that drowsiness and tiredness are likely to be the most serious of the common risk factors.bmj. Firstly.co. only 13 patients were unwilling to have acupuncture again because of their experience of these short term reactions. Tony Scullion who managed much of the data collection. almost all patients were willing to have acupuncture again. the patients and practitioners who participated. and surprisingly not related to whether the reaction was ‘positive’ or ‘negative’. and have similarities with the physiological processes that result from vigorous physical exercise.22.com Papers have shown patient reports of relaxation following acupuncture for musculoskeletal conditions such as low back pain. and the more general question of how patients value both positive and negative reactions.16-18 These effects have been demonstrated to last up to 12 hours.24). Research could also usefully explore why so few patients were unwilling to have acupuncture again after experiencing short term reactions. While our knowledge of these processes is limited. including pain at the site of needling. we do know that acupuncture releases endogenous opioid peptides that can generate relaxed happy feelings. we found that 95% of patients reported reactions to acupuncture during or immediately after a single session. Acupuncture needles produce a range of biophysical reactions. Finally.20. and it has been suggested that these are fundamentally different from short term ones. Lines of enquiry include patients’ perceptions of pain from needling.13 What we have shown is that patients with these conditions are significantly less likely to report a relaxation response. Despite patients also feeling a range of ‘negative’ reactions. a rate of 0.14% of treatments (95% CI 0. Given that not all reactions to treatment were ‘positive’. www.21 and may be responsible for longer term outcomes reported in the literature. namely feeling relaxed and feeling energised.

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com/content/23/3/112 These include: References Email alerting service Article cited in: http://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: 10.3.bmj.Published by group.bmj.23.112 Updated information and services can be found at: http://aim.com/subscribe/ .com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj. Notes To request permissions go to: http://group.bmj.bmj.com/content/23/3/112#related-urls Receive free email alerts when new articles cite this article.Downloaded from aim. 2013 . Sign up in the box at the top right corner of the online article.com/group/rights-licensing/permissions To order reprints go to: http://journals.com on January 18.1136/aim.bmj.bmj.