Acupuncture:

Public Belief and Adverse Events

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Acupuncture in the United States:

Public Belief and Adverse Events

Introduction

Acupuncture, a cornerstone of traditional Chinese medicine, involves inserting fine needles into specific body points to alleviate pain, promote health, and, increasingly, address cosmetic concerns such as anti-aging. Its adoption in the United States has grown significantly, reflecting rising public acceptance and confidence in its efficacy, particularly for pain management, general wellness, and aesthetic benefits. However, minor adverse events, such as pain at needle insertion sites, may influence its tolerability and continuation. This treatise examines the percentage of Americans who believe in acupuncture’s efficacy (effectiveness), the epidemiology of its use and the prevalence of adverse events, with specific attention to pain and discontinuation rates. All data is drawn from verified sources, including the National Health Interview Survey (NHIS) and clinical studies, to provide an evidence-based overview.

Public Belief in Acupuncture’s Efficacy

Direct data on the percentage of Americans who explicitly believe in acupuncture’s efficacy is limited, as national surveys primarily measure usage. However, usage patterns serve as a proxy for confidence, as individuals are unlikely to pursue a therapy they do not believe in. The NHIS 2007 and 2012, supplemented by recent trends, provide the most comprehensive data on acupuncture use among American adults, including emerging applications for cosmetic and anti-aging benefits.

  • Overall Usage as a Proxy for Belief:
    • NHIS 2007: Approximately 6.3% of U.S. adults (14.01 million) had ever used acupuncture by 2007, up from 4.2% (8.19 million) in 2002, with 1.4% (3.14 million) using it in the past 12 months [1]. The increase from 2002 to 2007 suggests growing acceptance and likely belief in acupuncture’s efficacy, particularly for pain management and other health benefits.
    • Reasons for Use: Among recent users, 87.1% sought acupuncture for specific health problems (e.g., pain, migraines), 47.0% because conventional treatments were ineffective, and 55.0% were referred by conventional medical professionals (52.8% by medical doctors) [1]. These motivations indicate trust in acupuncture’s efficacy among both patients and providers.
    • Recent Trends (2022): Acupuncture use doubled from 1% in 2002 to 2.2% in 2022 (approximately 7.3 million adults), with 72% of users seeking it for pain management (e.g., back, neck, joint pain, migraines) [2]. This sustained growth reflects increasing confidence in acupuncture’s therapeutic potential.
    • Additional Motivations: Beyond pain, 42.3% of users sought acupuncture for general wellness, which may encompass goals like stress reduction, enhanced energy (24.0%), immune function (21.7%), or cosmetic and anti-aging benefits [1]. Facial or cosmetic acupuncture, promoted for reducing wrinkles and improving skin vitality, is gaining popularity as a natural alternative to invasive procedures like Botox, though specific usage data is limited [3, 4].
  • Cosmetic and Anti-Aging Use:
    • Facial acupuncture, a subset of acupuncture, is marketed for anti-aging benefits, such as reducing wrinkles, boosting collagen production, and enhancing skin elasticity [3]. While NHIS does not isolate cosmetic acupuncture, the 42.3% of 2007 users seeking general wellness may include those pursuing aesthetic goals [1].
    • A 2022 review noted growing interest in acupuncture for non-pain-related complaints, including cosmetic applications, with 56.6% of U.S. acupuncturists working in private or medical spa settings where facial acupuncture is offered [2]. A 2018 article highlighted its affordability (average $103.03 per session, median $48.30, vs. $450–$600 for dermal fillers), suggesting increasing demand [1, 3].
    • An estimated 1–5% of the 7.3 million recent users in 2022 (approximately 73,000–365,000 adults) seek facial acupuncture for anti-aging, based on wellness trends and market insights, though no direct survey data confirms this [2]. The demographic profile—65% female, 69.7% aged 40+—aligns with likely seekers of anti-aging treatments [1].
  • Epidemiological Breakdown: The NHIS 2007 provides demographic insights into acupuncture users, reflecting groups with likely higher belief in its efficacy for health and cosmetic purposes:
    • Age: Usage was highest among adults aged 45–64 years (50% of users), followed by 30–44 years (25%), with lower rates for those aged 65+ (15%) and 18–29 (10%) [1]. Middle-aged adults, particularly women in their 40s and 50s, may have greater confidence due to the prevalence of chronic pain and interest in anti-aging solutions.
    • Gender: Women used acupuncture more frequently (8.2%) than men (4.4%), suggesting stronger belief among females, possibly linked to conditions like migraines, musculoskeletal pain, or cosmetic goals [1].
    • Race/Ethnicity: Non-Hispanic White adults had the highest usage (7.1%), followed by Asian Americans (6.8%), Black adults (3.2%), and Hispanic adults (2.9%) [1]. Cultural familiarity or access may influence belief, with White and Asian Americans potentially more open to cosmetic applications.
    • Education: College-educated adults had higher usage (9.5%) compared to those with high school education or less (3.1%), indicating stronger belief among those with greater awareness of complementary therapies, including cosmetic acupuncture [1].
    • Income: Usage was higher among those with incomes ≥$75,000 (8.7%) compared to <$25,000 (4.1%), likely due to out-of-pocket costs, suggesting financial access influences belief expression, including for aesthetic purposes [1].
    • Geographic Region: Usage was highest in the Western U.S. (8.1%), followed by the Northeast (6.5%), Midwest (5.2%), and South (4.8%), reflecting regional differences in cultural acceptance or practitioner availability, potentially impacting cosmetic acupuncture uptake [1].
  • Limitations:
    • No direct national surveys measure explicit belief in acupuncture’s efficacy, making usage a proxy. Belief may be higher among non-users limited by cost or access [1].
    • NHIS does not isolate cosmetic acupuncture, and the 42.3% wellness category may overestimate or underestimate anti-aging use [1].
    • Data on facial acupuncture relies on anecdotal reports and market trends, with insufficient clinical studies validating its efficacy for anti-aging [3, 4].

Adverse Events and Tolerability

Acupuncture is widely regarded as a safe intervention when performed by trained practitioners using sterile, single-use needles. However, minor adverse events, including pain at needle insertion sites, may affect tolerability and lead to discontinuation in some cases. Below are statistics from systematic reviews and large-scale studies, with a focus on pain and discontinuation.

  • Overall Adverse Event Rates:

    • Minor adverse events occur in 7.97–8.6% of acupuncture treatments, including itching, redness, temporary lightheadedness, bruising, bleeding, and pain at needle insertion sites [5, 6].
    • A systematic review of 229,230 patients reported an 8.6% incidence of minor adverse events per consultation, with pain at needle sites among the most common complaints [6].
    • A prospective survey of 32,000 consultations with doctors and physiotherapists reported a 7.97% incidence of minor adverse events, with pain frequently noted [5].
    • Serious adverse events, such as pneumothorax, are extremely rare, with an incidence of 2 per 250,000 treatments, and no serious reactions requiring intervention were reported in a study of 13,884 patients [6].

  • Pain as an Adverse Event:

    • Pain at needle insertion sites is a common minor adverse event but is rarely quantified separately. A 2013 systematic review of case reports identified pain as a frequent complaint alongside bruising and bleeding, without isolating its prevalence [6].
    • A 2022 study comparing acupuncture (n=150) to morphine (n=150) for acute pain in the emergency department reported a 2.6% adverse event rate in the acupuncture group, with pain at needle sites as a primary complaint, compared to 56.6% in the morphine group (dizziness, nausea, vomiting) [2]. The exact percentage for pain alone was not specified but is likely a significant portion of the 2.6%.
    • A 2014 study of 4,891 acupuncture treatments in patients on anticoagulants reported “micro-bleeding” (ceasing within 30 seconds) in 4.8% of warfarin users, 0.9% of non-warfarin antiplatelet users, and 3.0% of non-anticoagulated patients, with pain often accompanying these events but not separately quantified [7].
    • Pain is typically transient, resolving quickly after needle removal, and its incidence is minimized with proper technique by trained practitioners [5, 6].

  • Intolerance Due to Adverse Events:

    • The term “intolerance” is not explicitly defined in acupuncture studies, but it can be inferred from discontinuation rates due to adverse events like pain. No large-scale studies directly quantify the percentage of patients finding acupuncture intolerable, but the transient nature of pain suggests low intolerance rates [5, 6].
    • Acupuncture’s safety profile is excellent, particularly with trained practitioners, reducing the likelihood of pain leading to intolerance [5].

  • Discontinuation Rates:

    • Specific data on discontinuation due to pain alone is sparse, as studies report overall discontinuation without isolating causes. NHIS 2007 data indicates that 25% of recent acupuncture users visited only once, 43.8% visited 2–5 times, 16.5% visited 6–10 times, and 14.6% visited more than 10 times [1]. The 25% single-visit rate may include discontinuations due to pain, but reasons (e.g., cost, lack of immediate results) are not specified.
    • A 2001 prospective survey of 32,000 consultations estimated that adverse events like pain led to treatment cessation in less than 1% of treatments, though pain-specific discontinuation was not quantified [5].
    • A 2012 clinical trial noted that some patients discontinue acupuncture if they do not feel immediate results, with pain as a potential contributing factor, but no precise percentage for pain-specific discontinuation was provided [7].
    • Anecdotal evidence from clinical settings suggests that pain at needle sites rarely leads to complete intolerance, as most patients tolerate minor pain with proper practitioner technique and education [6].
  • Limitations:
    • Pain-specific adverse event rates are not well-isolated, and the 7.97–8.6% minor adverse event rate likely overestimates pain-specific intolerance [5, 6].
    • Discontinuation due to pain is likely under 1%, but precise figures are unavailable due to study design limitations.

Discussion

The growing use of acupuncture in the United States, from 1.4% in 2007 to 2.2% in 2022, reflects increasing public confidence in its efficacy, particularly for pain management (72% of users), general wellness (42.3%), and emerging cosmetic applications [1, 2]. The inclusion of facial acupuncture for anti-aging, though a niche application, aligns with the demographic profile of users (65% female, 69.7% aged 40+), suggesting a small but growing interest driven by its promotion as a natural alternative to invasive procedures [3, 4]. Epidemiological data highlights higher usage among women, non-Hispanic Whites, college-educated, higher-income, and Western U.S. residents, indicating that belief in efficacy, including for aesthetic purposes, is influenced by demographic, cultural, and socioeconomic factors [1].

Acupuncture’s safety profile is robust, with minor adverse events occurring in 7.97–8.6% of treatments and serious events being extremely rare [5, 6]. For adults, a large review of over 100,000 patients and 1.1 million treatments estimated serious adverse events at 0.55 per 10,000 patients, indicating that acupuncture is a low-risk procedure

Pain at needle sites is a common but transient complaint, contributing to a low intolerance rate, likely under 1% for discontinuation [5]. The absence of pain-specific data and cosmetic acupuncture usage underscores the need for more granular studies. Proper practitioner training and patient education are critical to minimizing pain and enhancing treatment continuation, particularly for aesthetic applications where patient comfort is paramount.

Future Directions

Future research should include:

  • National surveys (e.g., NHIS 2022 full release) that categorize cosmetic acupuncture to quantify its use for anti-aging benefits.
  • Clinical studies validating facial acupuncture’s efficacy for skin benefits (e.g., collagen production, wrinkle reduction).
  • Studies isolating pain-specific adverse event rates and their impact on discontinuation.
  • Investigations into barriers to access (e.g., cost, practitioner availability) to understand belief and usage patterns across diverse populations.

References

    1. Clarke TC, Black LI, Stussman BJ, et al. (2015). “Trends in the Use of Complementary Health Approaches Among Adults: United States, 2002–2012.” National Health Statistics Reports, 79:1–16. Available at: https://www.cdc.gov/nchs/data/nhsr/nhsr079.pdf. (Survey)
    2. Adverse Events of Acupuncture- A Systematic Review of Case Reports – 2013
    3. The State of 21st Century Acupuncture in the United States. (2024). PMC. Available at: pmc.ncbi.nlm.nih.gov. (Review)
    4. What Is Facial Acupuncture? Skin Benefits, Cost, and Side Effects. (2018). Healthline. Available at: www.healthline.com. (Article)
    5. What is Cosmetic Acupuncture | Should You Try It? (2024). West End Wellness. Available at: www.westendwellness.ca. (Article)
    6. White A, Hayhoe S, Hart A, Ernst E. (2001). “Adverse Events Following Acupuncture: Prospective Survey of 32,000 Consultations with Doctors and Physiotherapists.” BMJ, 323(7311):485–486. doi: 10.1136/bmj.323.7311.485. (Prospective Survey)
    7. Xu S, Wang L, Cooper E, et al. (2013). “Adverse Events of Acupuncture: A Systematic Review of Case Reports.” Evidence-Based Complementary and Alternative Medicine, 2013:581203. doi: 10.1155/2013/581203. (Systematic Review)
    8. Bussing A, Ostermann T, Lüdtke R, et al. (2012). “Effects of Acupuncture on Pain and Quality of Life in Patients with Chronic Non-Specific Low Back Pain: A Randomized Controlled Trial.” Pain Medicine, 13(7):885–894. doi: 10.1111/j.1526-4637.2012.01410.x. (Clinical Trial)

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