Adverse effects associated with acupuncture therapies: An evidence mapping from ۳۱۰ systematic reviews

Considering that physicians and patients widely use acupuncture, it is necessary to explore its adverse effects during treatment. Herein, an evidence map was generated based on published studies to identify acupuncture-induced adverse effects and assess their severity, with the overarching goal of providing references for safe and effective implementation.MethodsA comprehensive literature search was performed in four public databases (PubMed, Embase, Web of science, and the Cochrane Library) to identify relevant studies published up to ۱۵th June ۲۰۲۲. In addition, relevant studies were explored in the Epistemonikos database and reference lists were retrieved as a supplement. A MeaSurement Tool to Assess systematic Reviews, Version ۲ (AMSTAR-۲) quality assessment tool was applied to determine the methodological quality of included systematic reviews (SRs) and/or meta-analysis (MAs), whereas Microsoft Excel ۲۰۱۹ tool was used for data extraction and coding. Heatmaps were generated to display disease type, countries of origin for the first authors, and the sample sizes of original studies. Moreover, bubble charts comprehensively presented intervention categories, adverse reaction types, and evidence levels.ResultsA total of ۳۱۰ SRs involving ۳۳ adverse reactions were included. Among them, ۲۲ studies were rated as high quality, ۲۸ as moderate, ۱۰۶ as low, and the rest were of critically-low quality. Numerous adverse effects were described in the studies, including syncope (۸۶ SRs), organ or tissue injury (۱۸۲SRs), systemic reactions (۷۰ SRs), infection (۱۰ SRs), and other adverse events ۱۷۰ SRs). Importantly, these adverse reactions were mainly associated with ۱۹ acupuncture techniques, including electroacupuncture (n = ۶۷), manual acupuncture (n = ۴۷) and acupoint catgut embedding (n = ۴۱). Furthermore, the ۵۳۵ SRs described ۲۳ diseases, among which symptoms, signs or clinical findings (۸۳ SRs), mental, behavioral or neurodevelopmental disorders (۶۷ SRs), and diseases of the nervous system (۶۶ SRs) had the highest incidence.ConclusionThis evidence mapping explores the adverse effects of acupuncture, showing that there are multiple types of adverse reactions to acupuncture, with milder symptoms. The methodological assessment revealed that most of the included studies were of low- or critically low-quality. Therefore, there is a need for future randomized controlled trials and SRs to comprehensively analyze acupuncture-related adverse events in order to provide reliable and credible evidence.

Keywords:

acupuncture therapies , Adverse effects