Safety & Risks
Is acupuncture safe?
TL;DR — What the Evidence Shows
Serious problems from acupuncture are rare with trained practitioners. Studies estimate 5 to 8 serious events per million treatments. Minor side effects like bruising or soreness happen in roughly 1 to 10 out of 100 treatments.
No deaths from acupuncture with qualified practitioners appear in published research. However, reporting of problems is voluntary and incomplete. Only about 5 out of 100 expected problems get reported. The true rate is unknown.
Safety depends heavily on your practitioner. Training and clean-needle technique matter a great deal.
How certain is the safety evidence?
| Claim | Certainty | What the evidence says |
|---|---|---|
| Serious AE rate with trained practitioners | Low Certainty | Acupuncture may result in a serious AE rate of approximately 5–8 per million treatments. |
| Serious AE types (infection, pneumothorax, nerve damage) | Moderate Certainty | Specific serious AEs likely result from needling errors or unsterile technique, based on case reports and passive surveillance. |
Underreporting caveat — required reading
The 5–8 per million figure comes from passive surveillance and voluntary reporting systems. Multiple analyses estimate that reported serious adverse events represent approximately 5% of expected cases, based on injury rates in comparable procedures. The true rate is unknown but likely higher. This caveat applies every time the 5–8 per million figure appears on this site.
What you need to know before, during, and after
Discuss with your doctor before starting if you:
- Take blood thinners — warfarin, heparin, or direct anticoagulants (rivaroxaban, apixaban, etc.)
- Have a pacemaker or other implantable cardiac device — some acupuncture techniques use electrical stimulation
- Are pregnant — specific acupuncture points are contraindicated during pregnancy
- Have a compromised immune system or are on immunosuppressive therapy
- Have a bleeding disorder (hemophilia, thrombocytopenia)
Based on cited sources. This is not personalized medical advice — discuss with your healthcare provider.
Stop the session and report if you experience:
- Increasing or unusual pain at needle sites during or after treatment
- Signs of infection at needle sites — redness, warmth, swelling, or discharge in the hours or days following treatment
- Fainting or near-fainting during or immediately after treatment
- Symptoms that seem disproportionate to the procedure
Based on cited sources. This is not personalized medical advice — discuss with your healthcare provider.
Absolute contraindications — do not proceed if:
- Active skin infection at proposed needle sites
- Suspected or confirmed blood-borne infection requiring universal precautions that are not being followed
- Known or suspected tumor at proposed needle site
Based on cited sources. This is not personalized medical advice — discuss with your healthcare provider.
What are the common minor side effects?
Minor side effects are common and generally short-lived. These are not signs of harm.
- Bruising or minor bleeding at needle sites — common, resolves within days
- Soreness or aching at needle sites during or after treatment — common, typically resolves within 24 hours
- Lightheadedness or mild dizziness — more common in first-time patients; less so over subsequent sessions
- Fatigue in the hours following treatment — reported by some patients
- Temporary worsening of symptoms — occurs in a minority of patients; often precedes improvement
How does this compare to alternatives?
Risk context requires care — per-session acupuncture rates should not be directly compared to annual population rates without labeling. These are presented separately.
| Treatment | Serious risk figure | Basis |
|---|---|---|
| Acupuncture (trained practitioner) | ~5–8 serious AEs per million treatments | Per treatment session; passive surveillance; likely underreported |
| NSAIDs (ibuprofen, naproxen) | 5,000–16,500 GI deaths per year (US) | Annual population estimate; Bhala et al. 2013 (Lancet) |
| Opioids (chronic use) | 42,245 overdose deaths in 2016 (US) | Annual US figure; CDC; includes illicit and prescription opioids |
| Chiropractic manipulation | ~1 serious AE per million manipulations (vertebral artery dissection) | Per treatment; estimate range varies widely across studies |
These figures use different denominators and different reporting systems. They are not directly comparable. They are presented to illustrate that all pain treatments carry risk — not to suggest a direct equivalence.
Why practitioner credentials matter for safety
Almost all documented serious adverse events involve needling errors, unsterile technique, or inappropriate patient selection. These are practitioner errors, not inherent to the procedure.
- Licensed Acupuncturists (LAc): 2,000–4,000 hours of training; clean-needle technique required for state licensure in most states.
- Physicians practicing acupuncture: most US states have no additional training requirement beyond the MD/DO degree.
- State regulation varies — Oklahoma has no acupuncture regulation; California uses its own exam rather than the national NCCAOM exam.
Practitioner credentials checklist and red flags.
Key sources
- MacPherson H et al. "The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists." BMJ. 2001;323(7311):486–487. PMID 11532841.
- White A. "A cumulative review of the range and incidence of significant adverse events associated with acupuncture." Acupunct Med. 2004;22(3):122–133. PMID 15551936.
- Bhala N et al. (NSAID GI/CV risks). Lancet. 2013;382(9894):769–779. PMID 23726390.
- CDC. Drug Overdose Surveillance Data. 2016, 1999–2023.
- Methodology & sources.
Page last reviewed: March 7, 2026 · Authored by Claude (Anthropic AI) · Research methodology