title: Systematic review of adverse events following acupuncture: the Japanese literature.
abstract: BACKGROUND
  Many Japanese cases of adverse events after acupuncture are not listed in medical databases such as Medline. Therefore, they are not easily accessible to researchers outside Japan.
  
  
  OBJECTIVE
  To complement existing reviews of adverse events after acupuncture in the West and to provide more detailed discussion and analysis.
  
  
  METHODS
  Literature search using 'Igaku Chuo Zasshi (Japana Centra Revuo Medicina) CD-ROM version' covering the period of 1987-1999.
  
  
  METHODS
  Case reports of adverse events, which were suspected to be due to acupuncture treatment, were included. Experimental studies, surveys, and news articles were excluded.
  
  
  METHODS
  Two independent reviewers extracted data from located articles in a pre-defined structured way, and assessed likelihood of causality in each individual case.
  
  
  RESULTS
  89 articles which reported 124 cases were located. The most frequent adverse events were: pneumothorax (25 cases), spinal cord injury (18 cases), acute hepatitis B (11 cases), and localized argyria (10 cases). There were two fatalities from infections. Forty-eight events were caused by needle breakage including 26 cases of intentionally embedded needle and 16 cases of accidental breakage. There were also 10 cases of injury from self-treatment.
  
  
  CONCLUSIONS
  Although it has already been demonstrated that severe adverse events seem to be uncommon in standard practice, many serious cases of negligence have been found in the present review, suggesting that training system for acupuncturists (including medical doctors) should be improved and that unsupervised self-treatment should be discouraged.
authors.affiliation: Tsukuba College of Technology Clinic, 4-12-7 Kasuga, Tsukuba, 305-0821, Japan. yamashita@ktsukuba-tech.ac.jp
authors.forename: H
authors.initials: H
authors.lastname: Yamashita
authors.forename: H
authors.initials: H
authors.lastname: Tsukayama
authors.forename: A R
authors.initials: AR
authors.lastname: White
authors.forename: Y
authors.initials: Y
authors.lastname: Tanno
authors.forename: C
authors.initials: C
authors.lastname: Sugishita
authors.forename: E
authors.initials: E
authors.lastname: Ernst
mesh_terms: D015670:Acupuncture Therapy / Q000009:adverse effects*; D001129:Argyria / Q000209:etiology; D004868:Equipment Failure; D006801:Humans; D007564:Japan; D009339:Needles; D013119:Spinal Cord Injuries / Q000209:etiology