Acupuncture has been used as a form of traditional Chinese medicine for thousands of years and has a reputation for being very safe. So even I was somewhat surprised when a recent case in our emergency department prompted me to dig into the medical literature, where I found an authoritative report showing that one of every 5,000 acupuncture treatments (performed for various medical conditions) resulted in a collapsed lung (pneumothorax).

Here’s what happened to the patient I treated: Joe was a college basketball star who had just gotten his first job. During college, he had some upper back pain but never saw a doctor about it. When the pain started up again at work, he began taking ibuprofen. But the pain worsened, so he eventually saw his doctor. X-rays showed no significant problem, and Joe got a potent narcotic prescription pain reliever for muscle pain.

The new tablets helped Joe’s pain but made him drowsy and nauseated. When his coworker mentioned that acupuncture had greatly improved her back pain, Joe decided to give it a try. He was treated by his coworker’s acupuncturist, and after a few treatments, in which long, slender needles were placed just under the top layer of skin, Joe was nearly pain free. But the morning after his last treatment, Joe’s back pain returned—only now, it was even sharper. For the first time, Joe’s pain grew worse when he took a deep breath. He popped a pain pill and pushed himself to go to work.

Over the next 72 hours, Joe got more and more short of breath, and the pain was not improving. When it got so bad that he could not walk up a flight of stairs without gasping for air, he headed for the emergency department. When I met Joe, his vital signs and oxygen saturation (the amount of oxygen in the bloodstream) were normal, but when I examined him, I could not hear with my stethoscope any breathing sounds in his left chest. A chest X-ray confirmed my impression—Joe had suffered an 80% collapse of his left lung.

Even with the collapsed lung, Joe was able to maintain his normal oxygen saturation level because his right lung was just fine, and he was otherwise in great physical shape. But the collapsed lung was causing his shortness of breath. He was admitted to the hospital, where we inserted a chest tube to reinflate his lung, and he then completed his recovery at home within 48 hours. A full workup, including a review of his first X-rays, found no definite cause for the pneumothorax. But given the timetable of events, we strongly suspected that an acupuncture needle used on Joe had gone awry and punctured his lung—one of the most serious complications of acupuncture.

Lesson learned: If considering acupuncture, seek out an experienced certified practitioner. To find one near you, consult the National Certification Commission for Acupuncture and Oriental Medicine,