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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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we sent each one between 20 and 60 survey forms. 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. In the study we report here. ‘Given this experience. To control for confounding.6 %) reported experiencing 15 745 short term reactions associated with their acupuncture.23(3):112-120.1. In order to maximise the involvement of practitioners. 5 Patients also provided us with information on their pathway to care. as well as a range of negative reactions (6.bmj. five to 10 years. Confidence intervals for proportions were calculated using Confidence Interval Analysis (CIA). www.com Papers relaxed (reported in 11. coded using the International Classification of Primary Care. by using colour coded consent forms.Downloaded from aim.8%). All 1955 members were invited to assist with this survey. who were able to complete the form and who gave consent.7 % of patients experiencing at least one reaction (95% CI 94. by answering the question: ‘Thinking about the visit at which you were given this form. patients were recruited through their acupuncturists. 8904 (94. all of whom were UK based members of the British Acupuncture Council currently in practice. and their primary reason for consulting.co. whether they were consulting their acupuncturist for the first time.3 and the adverse events reported by the same group of patients three months after baseline.uk/aimintro. we were interested in collecting data on the frequency and type of short term reactions reported by patients during or immediately after treatment.2 to 95. Patients were asked to report short term reactions.05) in the univariate analysis.9% of treatments) and feeling energised (6. This study was part of a large safety research project. presenting the type and frequency of reactions and related data including reports of aggravations.6%). categorised as less than two years. We collected information on acupuncturists who agreed to participate as well as those who declined. This corresponds to a rate of 94.medical-acupuncture.7%). and 638 (33%) agreed to participate. whether they were first time acupuncture patients. our survey did not link individual patients to specific practitioners. Results A total of 9408 patients returned a completed questionnaire. After the acupuncture session. two to five years. requires accredited training colleges to provide a minimum of three years’ full-time training or equivalent. participating patients recorded age. not seen by their acupuncturist. would you be willing to have acupuncture treatment again?’ Patients then returned the form direct to the research centre using a Freepost envelope. The breakdown of the type ACUPUNCTURE IN MEDICINE 2005.1) with an average of 1. including their sex. an average of 15 per participating practitioner. However. that we hope adds to our understanding of how patients experience acupuncture. sex.Published by group. These data provided the primary outcome for the study we report here. years in practice. 2013 .htm 113 . 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.bmj. where they trained and the number of patients they were treating a week. The British Acupuncture Council. Each patient was included once only. 10 to 15 years and over 15 years experience. The Statistical Package for the Social Sciences (SPSS) was used for data analysis. A total of 22 200 forms were distributed to practitioners.com on January 18. However we also received reports of tiredness or drowsiness (3. Methods In a large-scale national survey. whether they had had acupuncture before and whether the National Health Service was paying for their acupuncture treatment. a self-regulating professional body for acupuncturists practising in the UK.8 reactions per patient.6 Patients were then asked. Based on number of patients normally seen by the practitioner. but we do not know the precise number of these handed out to patients. two parts of which are already reported: the profile and characteristics of the 9408 participants. Ethical approval for this study was given by the Northern & Yorkshire Multi-centre Research Ethics Committee. We asked them to hand out forms as soon as possible to all consecutive patients who were over 18 years old. Other characteristics are presented in Table 1 (these are submitted for publication elsewhere).3 Of these patients. The patients’ mean age was 51 years and 74% were female. we were able to determine the number of years that the patient’s practitioner had been in practice.4 In this paper we described patients’ reports of short term reactions to treatment.

A range of ‘negative’ reactions were also reported (30%).23(3):112-120. we present the results for short term tiredness or drowsiness reactions in Table 4 and ‘negative’ short term reactions in Table 5. 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. followed by feeling energised (33%).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.co. 2013 .1 8.14 patients per 100 consultations. and ‘negative’ reactions.2 9. likely to be considered a good experience. In addition 24% of patients reported experiences of tiredness or drowsiness. b) tiredness or drowsiness (which could be interpreted as either positive or negative). Surprisingly there was no 114 ACUPUNCTURE IN MEDICINE 2005. **Additional category and frequency of these reactions is presented in Table 2. especially a feeling of relaxation (79% of patients). From this analysis. In Table 6. A worsening of their existing condition was reported by 1. ‘Positive’ reactions were most common. ‘Negative’ reactions were more likely to be reported by female patients.medical-acupuncture. or patients consulting their acupuncturist for the first time. patients who had consulted their GP or hospital specialist beforehand. patients under the age of 40.7 Receiving acupuncture for the first time (n=9381) 1253 13. Tiredness or drowsiness was associated more with female patients.8 Previously consulted their GP or hospital specialist about their main problem or symptom (n=9337) 7257 77. tiredness or drowsiness reactions.bmj. or patients who had consulted their GP or hospital specialist beforehand. most commonly an experience of pain at the site where a needle was inserted.7 *Coded and classified according to the International Classification of Primary Care.com on January 18.7 4. Table 3 shows the results of the multivariate analysis for patients who reported ‘positive’ short term reactions compared with those who did not. www. patients under the age of 40. These data are presented in the same three categories as discussed above: ‘positive’ reactions. or for general wellbeing.2 7.6 5. The overall rate of unwillingness was only 0.uk/aimintro.bmj. or had had acupuncture previously. Similarly. likely to be considered an unwanted experience.4 Treatment paid for by NHS (n=9337) 441 5 4. but not if they were consulting for a musculoskeletal condition or they had consulted their GP or hospital specialist beforehand.1 11. and c) ‘negative’.Published by group. or had consulted their acupuncturist before.Downloaded from aim. gynaecological or obstetric condition. We classified each reaction as: a) ‘positive’.htm . or were presenting with a psychological.8%. patients were more likely to report ‘positive’ short term reactions if they were male. we present the numbers willing and unwilling to have acupuncture treatment again.

4 3. it may not always be positive to be ‘energised’ or ‘relaxed’.9 0. 0. 1. 3.5.8 reactions per patient.3 4.3. then clearly excessive tiredness or drowsiness must be seen as a risk factor.0 4.9 0.5 significant difference between the three categories.6. aggravation of symptoms was only reported by 1. In Table 7 we use a binary logistic regression model and find that only two factors were significantly (P<0. With regard to the ‘positive’ category for example.8% of patients.4. Our post hoc classification of adverse events into three major categories has been useful in some ways. 2.6. some people might experience being energised or relaxed as ‘negative’.6. were reported by 29. 79.0.8 31. ‘Negative’ reactions.5. 0. If one takes the view that patient safety is the key issue.1 Tiredness or drowsiness reactions 2295 24.2. www.4 0. with an average of 1.4 0.7 11.7 0.7.8 113.5 0.htm 115 . 12. providing evidence that ‘negative’ short term reactions did not affect people’s willingness to have acupuncture again.6 1.5 0. 25.6.Downloaded from aim.9 3. 2.8 0. This was an unexpectedly high proportion. 30.1%) followed by feeling ‘energised’ (32.5 78. 4.4% of patients reported feeling tired or drowsy.7 1.6. 4.4 2.23(3):112-120.0 1.6 1.2. 33.3 ‘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 12.0 0.4 23.bmj.2.medical-acupuncture.5.4 Total 15745 167. In addition individual reporting ACUPUNCTURE IN MEDICINE 2005.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 79.1 32. Similarly. 0.0 2.co.uk/aimintro.2 0.2 to 95.4 28. 0.com on January 18. or physiotherapist) and having acupuncture for the first time.2. with the most common experiences being reported as feeling ‘relaxed’ (79. nurse. 1. 0.05) associated with an unwillingness to have acupuncture again: having had acupuncture recommended by an NHS practitioner (such as a GP. 2013 . Discussion Our main result was that 94.7.7%).5.bmj.8 1.1) of patients reported experiencing at least one short term reaction to acupuncture during or immediately after treatment.7 0. A total of 24.7 0. 0. such as pain and bruising at the site of needling.0 1.6% (CI 94.3 29.4 0.Published by group. but also has limitations.5 0. however. We had difficulty in categorising ‘tiredness or drowsiness’ as either ‘positive’ or ‘negative’ and therefore created a separate category.7% of patients.

13.23(3):112-120.002 1.07. 1.51) P=0.0001 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. 2. 1.22. 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.Published by group.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.005 1.58 (1.com on January 18.32.008 1.041 1. 1.46. 1.48 (1.65 (1. 2013 . www.htm .0001 1.53) P=0.53) P=0.medical-acupuncture.23 (1. 2.Downloaded from aim. 1.00) P<0.45 (1.02.60 (1.24 (1.95) P=0.bmj. 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) 1.06.76) P<0.70 (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%) 1.004 1.43.41 (1.27 (1. No associations were found for the other known variables.15. 1.10.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) 1.0001 1. 1.uk/aimintro.75) P=0. 1.39) P=0. No associations were found for the other known variables.85) P<0.72) P<0. 2.bmj.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. 116 ACUPUNCTURE IN MEDICINE 2005.co.62 (1.44) P=0.14.

24 (1.47. due perhaps to a loyalty to their chosen approach to health care.92) P<0.388 0. 0. 0. it is possible that some biases will intrude.Published by group.medical-acupuncture.bmj.44) P<0.083 0.24 (1. 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%) 1.58 (1.78) P<0.139 0.3.09.17.040. and this variation may be influenced by many factors such as culture.131 0.188 0. In our two previous publications we discussed the practitioners and patients responding to this survey.045.30 (1. 2013 .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. 1.081. 1.386 0.htm 117 . No associations were found for the other known variables. as the differences observed may be small in absolute terms. 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 .091. because the user-friendly checklist we provided in the questionnaire encouraged the ACUPUNCTURE IN MEDICINE 2005.41) P=0. when patients provide reports of their experiences in a questionnaire.4 concluding that the sample obtained is reasonably representative of the population it aims to describe with respect to known characteristics.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. 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. 1.0001 1. expectations.bmj.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. and the disease being treated.uk/aimintro.com on January 18. for some patients there might be a tendency to under-report the negative reactions in order to protect their acupuncturist or acupuncture generally.238 will vary.Downloaded from aim. 1. 0. and one person’s relaxation may be another’s tiredness.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. With other patients there might be a counter tendency to over-report. The potential clinical relevance of these associations therefore needs to be considered and interpreted in each case. 1.05. However.0001 1.co. For example. www.23(3):112-120.43.0001 1.172 0.47) P=0.62 (1.

Patients report short term reactions approximately five times more frequently than practitioners. reports of ‘positive’ reactions were associated with returning acupuncture patients. and in the same order of frequency.66) P=0. www. or whether the dull ache usually experienced when de qi is obtained at an acupuncture point.Downloaded from aim.77 (1. the patient populations are different.90. is associated with patient characteristics. In contrast. and found variations on a number of counts.8% reported in two other surveys.1 While the practitioners in both studies were drawn from the same professional association. the difference is nearer tenfold. is reported by some patients as pain.12.htm . namely feeling relaxed.com on January 18. 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. feeling energised and feeling tired or drowsy.09%) vs 6/1240 (0. The difference overall might be related to the known tendency among healthcare practitioners to underreport adverse events.8% of our patients reported an aggravation to their condition.8. the estimates of tiredness after treatment have been wide-ranging: as high as 41%.95 (1.48%) 5. and with nonmusculoskeletal reasons for consulting (including psychological conditions and general wellbeing). Immediately following a single session of acupuncture. For negative reactions related to pain. would have provided the study with different data.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. it is worth noting that in both our surveys.11 compared to 24% in this survey.11 In terms of safety.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.co. or non-participating patients of participating practitioners.10%) vs 4/ 913 (0. lower than clinical anecdotes had led us to expect. physiotherapist. We have also compared our results with other surveys. suggesting that pain at the site of needling is not linked to the presentation of painful conditions per se. 18.6 Our data suggest that the risk of ‘negative’ short term reactions.medical-acupuncture.Published by group. 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. For example.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. We cannot know whether patients of non-participating practitioners. These results are not incompatible with studies that 118 ACUPUNCTURE IN MEDICINE 2005. practitioner characteristics and consulting behaviour. 12. No associations were found for the other known variables.bmj. etc) vs Patients who had acupuncture recommended by an NHS practitioner 8/8129 (0. nurse. This raises the question as to whether practitioners are unaware of the pain they cause. however. as it could compromise a patient’s ability to drive home safely after acupuncture.10 but more commonly around 3%.23(3):112-120.bmj.1. particularly reported pain at the site of needling.uk/aimintro.032 Patients having had acupuncture before vs Patients having acupuncture for the first time 7/8089 (0.9 Nevertheless.11 and the 1% in another. the British Acupuncture Council. We found no association between reported ‘negative’ reactions and particular reasons for consulting.44%) Adjusted relative risk*: Odds Ratio (95% CI) 3. ticking of boxes. tiredness and drowsiness seems likely to be the most worrying potential risk.61) P=0. the most common three types of reactions reported were the same. only 1. including being new to acupuncture. which most acupuncturists in the British Acupuncture Council regard as a requirement for a treatment. This result lies between the 2. 2013 .

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

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com/content/23/3/112#related-urls Receive free email alerts when new articles cite this article.1136/aim.bmj.com/subscribe/ .23.bmj.Downloaded from aim. Notes To request permissions go to: http://group.112 Updated information and services can be found at: http://aim.com/cgi/reprintform To subscribe to BMJ go to: http://group.com/content/23/3/112 These include: References Email alerting service Article cited in: http://aim.bmj.bmj.3.Published by group.bmj.bmj.com on January 18. 2013 . Sign up in the box at the top right corner of the online article.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.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.

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