Written by Karen Pilkington, Edzard Ernst and the CAM-Cancer Consortium.
Updated December 16, 2015

Acupuncture for fatigue

Is it safe?

Adverse events

In about 8-10% of all patients, acupuncture causes mild, transient adverse effects such as pain, haematoma or bleeding at the site of needling.22,23 In addition, in rare cases complications due to tissue trauma, pneumothorax, cardiac tamponade or infection are on record.24 Risk of cross-infection of blood borne disease, particularly hepatitis B, is minimised by the use of sterile disposable needles, and immunisation of acupuncturists. Rare cases of fatalities after acupuncture treatment have been reported although causality was not confirmed in many of these reports.25

Contraindications

Professional bodies for acupuncture vary somewhat in defining contraindications, particularly in relation to pregnancy.1, 26 Bleeding abnormalities and anticoagulant treatment, oedema, epilepsy, pregnancy and needle phobia are among those conditions that have been suggested as relative, or in some cases absolute, contra-indications. Some points are considered ‘forbidden’ or not to be used for acupuncture needling.

Interactions

None known, except for electro-acupuncture where the electrical current might interfere with pacemakers and is used with caution in epilepsy.26

Warnings

Strict asepsis and use of sterile disposable needles are mandatory to avoid infections. Some patients faint during acupuncture and should thus be treated lying down.

Citation

Karen Pilkington, Edzard Ernst, CAM-Cancer Consortium. Acupuncture for fatigue [online document]. http://cam-cancer.org/The-Summaries/Mind-body-interventions/Acupuncture-for-fatigue. December 16, 2015.

Document history

Summary fully revised and updated in December 2015 by Karen Pilkington.
Summary first published in March 2013, authored by Edzard Ernst.

References

  1. BAcC (British Acupuncture Council) website. Ten Top Things to Know. Available at www.acupuncture.org.uk. Accessed 17th April 2015.
  2. Filshie, J., Cummings, M. Western medical acupuncture. In: Ernst, E., White, A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp 31-59.
  3. White A; Editorial Board of Acupuncture in Medicine. Western medical acupuncture: a definition. Acupunct Med. 2009 27(1):33-5.
  4. White A, Ernst E. Introduction. In: Ernst, E., White, A. (Eds). Acupuncture: A Scientific Appraisal. 1999. Butterworth-Heinemann, Oxford. pp1-10.
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  6. Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008 29(4):245-56.
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  9. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol. 2005 16(4):655-63.
  10. Vickers A, Straus DJ, Fearon B et al. Acupuncture for postchemotherapy fatigue: a phase II study. J Clin Oncol 2004; 22: 1731-5.
  11. Mao JJ, Styles T, Cheville A et al. Acupuncture for nonpalliative radiation therapy-related fatigue: feasibility study. J Soc Integr Oncol 2009;7: 52-8.
  12. Johnston MF, Hays RD, Subramanian SK et al. Patient education integrated with acupuncture for relief of cancer-related fatigue randomized controlled feasibility study. BMC Complement Altern Med 2011; 25 Jun: 49.
  13. Grant, S. J., C. A. Smith, N. de Silva and C. Su. Defining the Quality of Acupuncture: The Case of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther 2015 14(3): 258-270.
  14. He, X. R., Q. Wang and P. P. Li. Acupuncture and moxibustion for cancer-related fatigue: a systematic review and meta-analysis. Asian Pac J Cancer Prev 2013 14(5): 3067-3074.
  15. Ling, W. M., L. Y. Lui, W. K. So and K. Chan. Effects of acupuncture and acupressure on cancer-related fatigue: a systematic review. Oncol Nurs Forum 2014 41(6): 581-592.
  16. Posadzki, P., T. W. Moon, T. Y. Choi, T. Y. Park, M. S. Lee and E. Ernst. Acupuncture for cancer-related fatigue: a systematic review of randomized clinical trials. Support Care Cancer 2013 21(7): 2067-2073.
  17. Zeng, Y., T. Luo, J. Finnegan-John and A. S. Cheng. Meta-Analysis of Randomized Controlled Trials of Acupuncture for Cancer-Related Fatigue. Integr Cancer Ther 2013 13(3): 193-200.
  18. Deng G, Vickers A, Simon Yeung K et al. Acupuncture: integration into cancer care. J Soc Integr Oncol 2006; Spring 4: 86-92.
  19. Sood A, Barton DL, Bauer BA et al. A critical review of complementary therapies for cancer-related fatigue. Integr Cancer Ther 2007; 6: 8-13.
  20. Mao, J. J., J. T. Farrar, D. Bruner, J. Zee, M. Bowman, C. Seluzicki, A. DeMichele and S. X. Xie. Electroacupuncture for fatigue, sleep, and psychological distress in breast cancer patients with aromatase inhibitor-related arthralgia: a randomized trial. Cancer 2014 120(23): 3744-3751.
  21. Tang, W. R., W. J. Chen, C. T. Yu, Y. C. Chang, C. M. Chen, C. H. Wang and S. H. Yang. Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: an experimental pilot study. Complement Ther Med 2014 22(4): 581-591.
  22. White A, Hayhoe S, Ernst E. Survey of Adverse Events Following Acupuncture Acupunct Med. 1997; 15:67-70.
  23. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed. 2009 Apr;16(2):91-7. doi: 10.1159/000209315. Epub 2009 Apr 9.
  24. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med. 2004; 22(3):122-123.
  25. Ernst E. Deaths after acupuncture: a systematic review. Int J Risk Safety 2010; 22(3):131-136.
  26. BMAS (British Medical Acupuncture Society). Code of Practice & Complaints Procedure. Version 9 December 2009. Accessed 21st July 2015.