Adverse events<unk>  is generally safe when administered by an experienced,<unk> propriately trained practitioner using clean-needle technique and sterile single-use needles. When improperly delivered it can cause adverse effects. Accidents and infections are associated with infractions of sterile technique or neglect on the part of the practitioner. To reduce the risk of serious adverse events after<unk> ,<unk> sts should be trained sufficiently. People with serious spinal disease, such as cancer or infection, are not good candidates for<unk> . Contraindications to<unk>  (conditions that should not be treated with<unk>  include coagulopathy disorders (e.g. hemophilia and advanced liver disease), warfarin use, severe psychiatric disorders (e.g. psychosis), and skin infections or skin trauma (e.g. burns). Further, electroacupuncture should be avoided at the spot of implanted electrical devices (such as pacemakers). A 2011 systematic review of systematic reviews (internationally and without language restrictions) found that serious complications following<unk>  continue to be reported. Between 2000 and 2009, ninety-five cases of serious adverse events, including five deaths, were reported. Many such events are not inherent to<unk>  but are due to malpractice of<unk> sts. This might be why such complications have not been reported in surveys of adequately trained<unk> sts. Most such reports originate from Asia, which may reflect the large number of treatments performed there or a relatively higher number of poorly trained Asian<unk> sts. Many serious adverse events were reported from developed countries. These included Australia, Austria, Canada, Croatia, France, Germany, Ireland, the Netherlands, New Zealand, Spain, Sweden, Switzerland, the UK, and the US. The number of adverse effects reported from the UK<unk> pears particularly unusual, which may indicate less under-reporting in the UK than other countries. Reports included 38 cases of infections and 42 cases of organ trauma. The most frequent adverse events included pneumothorax, and bacterial and viral infections. A 2013 review found (without restrictions regarding publication date, study type or language) 295 cases of infections; mycobacterium was the pathogen in at least 96%. Likely sources of infection include towels, hot packs or boiling tank water, and reusing reprocessed needles. Possible sources of infection include contaminated needles, reusing personal needles, a person's skin containing mycobacterium, and reusing needles at various sites in the same person. Although<unk>  is generally considered a safe procedure, a 2013 review stated that the reports of infection transmission increased significantly in the prior decade, including those of mycobacterium. Although it is recommended that practitioners of<unk>  use disposable needles, the reuse of sterilized needles is still permitted. It is also recommended that thorough control practices for preventing infection be implemented and adapted. English-language A 2013 systematic review of the English-language case reports found that serious adverse events associated with<unk>  are rare, but that<unk>  is not without risk. Between 2000 and 2011 the English-language literature from 25 countries and regions reported 294 adverse events. The majority of the reported adverse events were relatively minor, and the incidences were low. For example, a prospective survey of 34,000<unk>  treatments found no serious adverse events and 43 minor ones, a rate of 1.3 per 1000 interventions. Another survey found there were 7.1% minor adverse events, of which 5 were serious, amid 97,733<unk>  patients. The most common adverse effect observed was infection (e.g. mycobacterium), and the majority of infections were bacterial in nature, caused by skin contact at the needling site. Infection has also resulted from skin contact with unsterilized equipment or with dirty towels in an unhygienic clinical setting. Other adverse complications included five reported cases of spinal cord injuries (e.g. migrating broken needles or needling too deeply), four brain injuries, four peripheral nerve injuries, five heart injuries, seven other organ and tissue injuries, bilateral hand edema, epithelioid granuloma, pseudolymphoma, argyria, pustules, pancytopenia, and scarring due to hot-needle technique. Adverse reactions from<unk> , which are unusual and uncommon in typical<unk>  practice, included syncope, galactorrhoea, bilateral nystagmus, pyoderma gangrenosum, hepatotoxicity, eruptive lichen planus, and spontaneous needle migration. A 2013 systematic review found 31 cases of vascular injuries caused by<unk> , three resulting in death. Two died from pericardial tamponade and one was from an aortoduodenal fistula. The same review found vascular injuries were rare, bleeding and pseudoaneurysm were most prevalent. A 2011 systematic review (without restriction in time or language), aiming to summarize all reported case of cardiac tamponade after<unk> , found 26 cases resulting in 14 deaths, with little doubt about causality in most fatal instances. The same review concluded cardiac tamponade was a serious, usually fatal, though theoretically avoidable complication following<unk> , and urged training to minimize risk. A 2012 review found a number of adverse events were reported after<unk>  in the UK's National Health Service (NHS) but most (95%) were not severe, though miscategorization and under-reporting may alter the total figures. From January 2009 to December 2011, 468 safety incidents were recognized within the NHS organizations. The adverse events recorded included retained needles (31%), dizziness (30%), loss of consciousness/unresponsive (19%), falls (4%), bruising or soreness at needle site (2%), pneumothorax (1%) and other adverse side effects (12%).<unk>  practitioners should know, and be prepared to be responsible for, any substantial harm from treatments. Some<unk>  proponents argue that the long history of<unk>  suggests it is safe. However, there is an increasing literature on adverse events (e.g. spinal-cord injury).<unk>  seems to be safe in people getting anticoagulants, assuming needles are used at the correct location and depth. Studies are required to verify these findings. The evidence suggests that<unk>  might be a safe option for people with allergic rhinitis. Chinese, Korean, and Japanese-language A 2010 systematic review of the Chinese-language literature found numerous<unk> -related adverse events, including pneumothorax, fainting, subarachnoid hemorrhage, and infection as the most frequent, and cardiovascular injuries, subarachnoid hemorrhage, pneumothorax, and recurrent cerebral hemorrhage as the most serious, most of which were due to improper technique. Between 1980 and 2009, the Chinese-language literature reported 479 adverse events. Prospective surveys show that mild, transient<unk> -associated adverse events ranged from 6.71% to 15%. In a study with 190,924 patients, the prevalence of serious adverse events was roughly 0.024%. Another study showed a rate of adverse events requiring specific treatment of 2.2%, 4,963 incidences among 229,230 patients. Infections, mainly hepatitis, after<unk>  are reported often in English-language research, though are rarely reported in Chinese-language research, making it plausible that<unk> -associated infections have been underreported in China. Infections were mostly caused by poor sterilization of<unk>  needles. Other adverse events included spinal epidural hematoma (in the cervical, thoracic and lumbar spine), chylothorax, injuries of abdominal organs and tissues, injuries in the neck region, injuries to the eyes, including orbital hemorrhage, traumatic cataract, injury of the oculomotor nerve and retinal puncture, hemorrhage to the cheeks and the hypoglottis, peripheral motor-nerve injuries and subsequent motor dysfunction, local allergic reactions to metal needles, stroke, and cerebral hemorrhage after<unk> . A causal link between<unk>  and the adverse events cardiac arrest, pyknolepsy, shock, fever, cough, thirst,<unk> honia, leg numbness, and sexual dysfunction remains uncertain. The same review concluded that<unk>  can be considered inherently safe when practiced by properly trained practitioners, but the review also stated there is a need to find effective strategies to minimize the health risks. Between 1999 and 2010, the Korean-language literature contained reports of 1104 adverse events. Between the 1980s and 2002, the Japanese-language literature contained reports of 150 adverse events. Children and pregnancy Although<unk>  has been practiced for thousands of years in China, its use in pediatrics in the United States did not become common until the early 2000s. In 2007, the National Health Interview Survey (NHIS) conducted by the National Center For Health Statistics (NCHS) estimated that<unk> proximately 150,000 children had received<unk>  treatment for a variety of conditions. In 2008 a study determined that the use of<unk> -needle treatment on children was "questionable" due to the possibility of adverse side-effects and the pain manifestation differences in children versus adults. The study also includes warnings against practicing<unk>  on infants, as well as on children who are over-fatigued, very weak, or have over-eaten. When used on children,<unk>  is considered safe when administered by well-trained, licensed practitioners using sterile needles; however, a 2011 review found there was limited research to draw definite conclusions about the overall safety of pediatric<unk> . The same review found 279 adverse events, 25 of them serious. The adverse events were mostly mild in nature (e.g. bruising or bleeding). The prevalence of mild adverse events ranged from 10.1% to 13.5%, an estimated 168 incidences among 1,422 patients. On rare occasions adverse events were serious (e.g. cardiac rupture or hemoptysis); many might have been a result of substandard practice. The incidence of serious adverse events was 5 per one million, which included children and adults. When used during pregnancy, the majority of adverse events caused by<unk>  were mild and transient, with few serious adverse events. The most frequent mild adverse event was needling or unspecified pain, followed by bleeding. Although two deaths (one stillbirth and one neonatal death) were reported, there was a
Acupuncture
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Depot injection
Mustard bath
Equianalgesic
Electroanalgesia
Premedication
Kinaesthetics