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| Journal of the New Zealand Medical Association,
13-August-2010, Vol 123 No 1320
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Brian Kennedy, Lutz Beckert
Mrs P, a 54-year-old woman, presented with chest pain and
increasing shortness of breath. She suffers chronic left-sided musculoskeletal
chest pain, for which she sought out acupuncture therapy.
It was during her second acupuncture session that she became
acutely short of breath, following introduction of an acupuncture needle into
the right side of her chest posteriorly. She developed “tightness”
in the right apical area and associated chest pain. She immediately left the
acupuncture clinic, returned home and called an ambulance when her shortness of
breath and pain worsened.
On arrival to hospital she was dyspnoeic and distressed. She
described her chest discomfort as being pleuritic in nature and exaggerated by
movement. She has a 25-pack year smoking history, having stopped smoking about
10 years prior. On clinical examination, absent air entry was noted in the right
hemithorax with hyper-resonance to percussion.
Her chest X-ray confirmed a moderate-sized right
pneumothorax (Figure 1).
Figure 1. Pneumothorax (lung border identified
by arrow)
 Her pneumothorax was aspirated and 450 ml of air removed
from the pleural space. Her symptoms improved following the drainage. However
the following morning Mrs P was noted to be increasingly dyspnoeic after
mobilising to the bathroom.
A repeat chest film demonstrated a recurrence of the right
pneumothorax extending to the right base. She was treated with a 12-gauge chest
drain into the fourth intercostal space anterior axillary line. Her lung
reinflated, the chest drain was removed and she was discharged home the next
morning.
DiscussionAcupuncture is described as the insertion of one or more dry
needles into the skin and subcutaneous tissue into acupuncture points. The term
is derived from the Latin words “acus” meaning needle and
“punctura” meaning penetration. Having originated in China over 2000
years ago, it remains a popular therapy for a variety of conditions today
including chronic pain, nausea and vomiting, headache and hypertension. Its
efficacy has proven difficult to ascertain.
A meta-analysis of randomised controlled trials of
acupuncture for pain that included both sham acupuncture and no treatment arms
found that the superiority of acupuncture over sham acupuncture, if real,
appeared to be too small to be clinically
important.1
Multiple models have been derived attempting to explain the
perceived effects of acupuncture. Its most common use is in pain relief and this
remains the most studied application. A popular theory is that of endorphin
release. According to this theory, acupuncture stimulation is associated with
neurotransmitter effects such as endorphin release at both the spinal and
supraspinal levels.2,3 It has been shown that
opioid antagonists block the analgesic effects of acupuncture, supporting this
theory.
Complications are infrequently observed with acupuncture
treatment; however as with any form of needle use, adverse events can occur.
These include transmission of diseases, needle fragments left in the body, nerve
damage, pneumothorax, pneumoperitoneum, organ puncture, cardiac tamponade and
osteomyelitis. Local complications include bleeding, contact dermatitis,
infection, pain and paraesthesias.4,5
Despite the variety of listed complications and the
occasional case reports, major adverse events are exceedingly rare and are
usually associated with poorly trained unlicensed
acupuncturists.6 A prospective investigation in
Germany of 97,733 patients constituting 760,000 treatment sessions reported that
the two most frequently reported adverse events were needling pain (3.3 percent)
and haematoma (3.2 percent).7 Potentially
serious adverse events included two cases of pneumothorax.
In conclusion, patients seeking acupuncture treatment should
be directed to see only acupuncturists who are experienced and licensed. Despite
the low risk of pneumothorax, all patients should be advised of the risk of
pneumothorax when needles are being introduced into the thoracic region.
Author information: Brian Kennedy,
Respiratory House Officer; Lutz Beckert, Respiratory Physician; Respiratory
Medicine, Christchurch Hospital, Christchurch
Correspondence: Dr Lutz Beckert,
Respiratory Medicine, PO Box 4345, Christchurch Hospital, Christchurch, New
Zealand. Fax: +64 (0)3 3640914; email: Lutz.Beckert@cdhb.govt.nz
References:
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