We report a significant complication of acupuncture in a 50 year old woman who developed a pneumothorax shortly after receiving acupuncture needling to her scapulothoracic region in a lateral oblique direction. As acupuncture is increasingly being used in pain management, physicians need to be aware of its potential adverse effects. We discuss issues relating to appropriate counselling of patients receiving this form of therapy. The inner Bladder line should be needled obliquely towards the spine.