AERD 2022: the Year in Review

First I have to apologize for neglecting the AERD this year. 2022 was all about POCA Tech’s Self Study Report for ACAHM, along with various forms of administrative cleaning, and there wasn’t room for much else. But I thought it might be interesting to do an overview of what got reported this past year anyway. And once I finally got back into the data, I was so glad I did!

We got 27 reports over the past 12 months (give or take, I did include one report from late December 2021 in this overview because it fit in so well). Obviously that's not a lot and certainly doesn’t represent all the adverse acupuncture events and errors that undoubtedly happened this year. HOWEVER, I think what we have is a representative sample! And that representative sample is beautifully educational, in fact from the perspective of someone who’s responsible for teaching acupuncture safety to students, it’s everything I could ask for.

AERD, I love you, I’m so sorry I ignored you all year! I promise to put more energy into our relationship in 2023. And thank you so much to everyone who took the time to make a report in 2022. Each report represents someone making an effort to create more safety for acupuncture patients and practitioners, and all of those efforts are meaningful and add up to more than the sum of their parts. In 2023 my goal is to write up summaries quarterly.

In no particular order, here are the themes of 2022 in our AERD:

Greatest Hits

Most of the reports in our AERD are pretty pedestrian, which is great! That in itself is good information for us to have. In this category we had:

four reports of needle shock and its variations, the most memorable involving a patient who vomited during treatment (fortunately there was a trash can nearby);

one report of bruising (bruising represents 15.24% of all AERD reports)

three reports of soreness or redness at the needling site, the most notable involving pain at the site of TW 3 that lasted for three days;

two reports of headache or headache-like symptoms occurring during or after treatment;

one report of what sounds like a panic attack (rapid heartbeat and shortness of breath that did not require any follow up once the needles were taken out);

and three reports of forgotten or stray needles, one of which resulted in a patient needle stick.

There were two reports of what sounded like a nicked nerve, one of which involved a patient experiencing hand numbness twenty four hours after the treatment. I’ve been meaning to write a whole post about nicked nerves for two years now -- bumping that to the top of the list for 2023.

Symptoms Worse

I find this category of reports inherently fascinating because there are so many interesting reasons that this can happen. We had four reports in 2022.

A patient being treated for pain became uncomfortable in the chair as their pain flared up, and when the practitioner didn’t notice them soon enough they took their own needles out. In community acupuncture, we expect that patients sometimes take their own needles out. We don’t love this phenomenon and we don’t encourage it (see above: stray needles) but we recognize that it can be a subset of other safety issues, like trauma triggers or, as in this incident, worsening of symptoms.

A patient reported that immediately after treatment, their hip pain was exacerbated and it was hard to walk for about a week afterwards. They got another treatment from a different acupuncturist the next day and that helped. In this case the first practitioner was a student acupuncturist and I’m guessing that the second practitioner was not, so the patient’s perception of students might have been a factor.

It sounds like a patient who was being treated for arm pain felt worse after having LI 11 needled. The report is brief and describes “nerve pain in arm” so it isn’t clear whether this might have been another nicked nerve or a local point making pre existing pain more intense instead of less intense. Either way, it’s interesting.

And my favorite in this category: After a Balance Method treatment for neck pain and headache following motor vehicle accident with neck injury and head trauma 2 years ago, the patient experienced a recurrence of visual disturbances they had after the head trauma and felt it could have been related to the acupuncture treatment. I agree, it could have!

Yep,Things Got Weird

There’s a category of events that doesn’t fit neatly into the Clean Needle Technique Handbook’s official list of things that can go sideways with acupuncture, and so they’re unlikely to ever be reported anywhere other than here -- but I feel like these particular reports are so important in terms of preparing our students for the real world of practice. Acupuncture is inherently weird and humans, all by themselves, are even weirder so nobody should be surprised by all of the “WTF?” moments that appear at that intersection. Acupuncturists need to learn how, in the words of a POCA Tech alum, “to expect the unexpected”. (See also: Why We Do This)

We had five reports in this category:

Prickling pain in abdomen after needling abdominal points. This sounded too diffuse and short-lived to be a nicked nerve and also, I’ve never actually heard of a nicked nerve at an abdominal site. But maybe that’s what this was?

The scalp needle ant: “Patient reports immediate tingling after having a scalp needle (points to DU20). The tingling is intense and uncomfortable. Still has not resolved after five days. Pt reports it is sometimes painful and feels like an ant is crawling around their scalp. The discomfort has wandered around each side of the scalp as well as the apex.” This could also be a nicked nerve but the symptoms were so vivid and strange that I put it in this category.

Intense muscle cramping during treatment: The patient said, in tears, that they were in pain and could not get anyone to take out their needles; they were shaking when the needles were finally removed. At first glance this sounds like a straightforward and very unfortunate practitioner error EXCEPT that the patient had actually been checked on repeatedly during treatment and apparently did not make eye contact or indicate that anything was wrong. It sounds like it could be a “freeze” response to a trauma trigger and incidents like this are a major reason why POCA Tech puts so much emphasis on Trauma Informed Care and understanding how trauma can show up in the clinic.

Feeling of paralysis during acupuncture: Similarly, on a student clinic shift at POCA Tech when an intern was practicing threading scalp needles (including one on the Motor Line), a patient had the experience of feeling unable to move their head or their eyes, or swallow.

Ears and neck on fire: The patient reported that four or five hours after their treatment, they broke out with a rash on their ears and felt like their whole neck was on fire. Ear points were used in the treatment but not neck points. That’s a new one!

Patient Reports

In 2022 we had two reports that came directly from patients. I feel really good about this.

The first one represents a practitioner error and it would fall under “Greatest Hits” except that a patient reported it, so I think that’s notable. They reported that two needles were left in after acupuncture. They did not require any follow up medical treatment.

And the second report represents, as much as any other in the AERD, why we’re committed to this project. This report is like a bonus prize -- an adverse event PLUS a practitioner error. Based on the location of the incident I don’t think this happened at a clinic we know and it isn’t clear whether it happened in the context of community acupuncture or conventional acupuncture. There are multiple acupuncture clinics in this particular city (it’s in the same region as a very established acupuncture school).

The patient reported that they were treated for tennis elbow/wrist pain. A needle in “the shoulder” felt painful. They experienced severe chest pain and difficulty breathing immediately following treatment. They called the acupuncturist right away and told them about the severe chest pain and difficulty breathing. The acupuncturist advised the patient to “go home and rest with tea”; instead the patient went to the ER... and was hospitalized with a pneumothorax.

Okay. I’m sure there are acupuncturists out there who will doubt that this happened, but I don’t. In part because “go home and rest with tea” is something I probably would have said, probably DID say at some point, God help me, when I was a new practitioner who had no idea how to think about acupuncture safety issues in a constructive way. (I was just lucky that I never said it to a patient experiencing something this dire). Yes, this is a classic red flag situation but “go home and rest with tea” is also (unfortunately) a classic acupuncturist response to anything unexpected. What I take from this report is that the acupuncturist didn’t respond properly in the moment because they probably didn’t believe something like this could happen in their practice.

And for that, I blame the narrative in the acupuncture profession that acupuncture is ALWAYS safe IF the practitioner meets the acupuncture profession’s standards of training. Our collective attitude that the only safety issue with acupuncture is undertrained physical therapists stealing it is a safety problem in its own right. It’s a good thing the patient in this report was thinking clearly about their symptoms because the acupuncturist certainly wasn’t.

Our other most recent AERD report of a pneumothorax at Kid 27 from an experienced acupuncturist who had needled that point many times highlights the random nature of this particular adverse event. Pneumothorax is a potential risk of acupuncture unless you use all distal needles, all the time. It’s just something that can happen. It doesn’t mean that anyone was undertrained or reckless. All our political rhetoric connecting pneumothoraxes to lack of training or carelessness or “encroachment by other professions” is doing a serious disservice to licensed acupuncturists and their patients by framing pneumothoraxes as some kind of moral failure, as opposed to a basic risk that we might actually have to deal with if things go sideways in clinic. As they sometimes do, because that’s just how risks are.

The “go home and rest with tea” report demonstrates why acupuncturists need a safety-positive culture. We need to be able to talk about all safety issues, from bruises to scalp needle ants to pneumothoraxes, as if safety issues were a normal part of practicing acupuncture -- because they are! -- as opposed to a political weapon. Normalizing safety issues greatly increases the chances of practitioners responding appropriately to them when they inevitably occur.

So once again, huge thanks to all the acupuncturists, acupuncture students and patients who shared their stories via the AERD -- your generosity makes acupuncture safer.