Two hundred and two cases, identified from 98 papers, were included.
Infections.
Between 1974 and 1988, hepatitis was the most common complication. In all 94 cases, unsterile techniques were employed. No cases were identified post 1988. Nine cases of auricular infection were reported between 1975 and 1987. No information on sterilisation was available; however, needles were left in the pinna for weeks. Fifteen additional cases of infection that were possibly related to acupuncture were also identified. The diagnoses were human immunodeficiency virus infection, staphylococcal septicaemia (2), spinal infection with prolapsed disc, chronic osteomyelitis, bacterial endocarditis, pseudoaneurysm, posterior tuberculous spondylitis, bacterial meningitis and epidural haematoma, glenohumeral pyarthrosis, cervical spinal epidural abscess, and peritemporomandibular abscess.
Internal organ or tissue injuries.
Twenty-six cases of pneumothorax were associated with acupuncture. Thirteen cases of spinal cord and nerve injury were identified, the majority of which were linked with a Japanese needling technique that involved the permanent insertion of needles into paraspinal subcutaneous tissues. Twenty-one further cases of injury were reported. In some the Japanese method of embedding needles was used, while four were the result of self-puncturing.
Other complications.
Eleven other complications were detailed in the case reports, of which two were third-degree burns and two were asthmatic attacks.
Adverse reactions.
Between 1972 and 1991, 7 cases of contact dermatitis were found. Upon testing, 6 of these cases were found to be allergic to certain metals used in acupuncture needles. In addition, 6 individuals treated with acupuncture reported petechiae, cutaneous herpes, interference with a cardiac pacemaker, hypotension, fainting or recurrent fainting, vomiting and sweating.
Overall, of the 144 cases for which follow-up information was available, there were 7 deaths and 25 suffered permanent consequences. The frequency of reported complications and adverse effects appears to be declining over time.