Ask an expert - about acupuncture - does it hurt?

12 questions

Q:  Because it seems that nothings really helped me relieve my sciatica pain caused by a very small disc herniation (L5- S1) I had already 2 acupuncture session. After the  first, i was feeling good but during the second on when the doctor inserted a needle down the buttocks I felt an enormous pain. I asked him if he just hit the nerve but he is said it's "the energy flowing". Is it normal to be that painful when the energy is flowing?

A:  'Normal' is not quite how we would describe what has happened to you, but certainly a reaction like this is within the range of possibilities. There are a great many unknowns, however, which means that we can't be precise. For example, when you say 'doctor' we're not sure whether you mean a conventional medical doctor, a Chinese practitioner who uses the title (as many do) or a traditional acupuncturist amongst our members (who do not use the title doctor unless they are also conventional doctors).

The reason we say this is that there are different styles of acupuncture. Conventional medics use a much more direct style of needling with thicker gauge needles, deeper insertions and often aim for what are called trigger points. When these are needled the sensation can be quite powerful. Many practitioners trained in China use a much more vigorous needle technique than European trained practitioners. The needle is often manipulated quite powerfully to generate a dull aching sensation called 'deqi' which for many Chinese practitioners is an absolute requirement for good treatment. Many western trained practitioners also do the same, but there is a wide range, with many using a relatively light technique. On occasion, however, the needle can cause a channel to become very 'live', and this can produce a sensation which may be painful.

What we can't judge from your account is how long the sensation lasted. If it was short-lived it is much more likely to have been an energetic reaction. This can last for a few hours, but after the initial burst of activity it tends to subside over time. If there is a very sudden and painful reaction which goes away quite quickly, then you cannot rule out the possibility that the practitioner has actually hit a nerve, of which there are many in that area.

The bottom line, though, is that it hurt, and most practitioner can adjust what they do to reduce the chances of it happening again. This can be achieved by needling less depeply, less vigorously, or even somewhere else altogether - the interconnections make this possible. There is no need to worry about talking to the practitioner about it. If they are reputable, they will listen. If they do not respond well to your questions, there are hundreds of practitioners out there!


A:  There are no set rules about the gaps between treatment, but the majority of UK practitioners will see someone weekly to begin with and then, depending on the condition, space the treatment out further. In some cases where someone has an acute condition the treatment may be twice weekly or even more. This would be the normal pattern in China, for example, where a course of treatment offered in an outpatients' department might involve daily treatment for ten days. However, in the UK this is often not possible because of clinic timetables and also, to be truthful, because working out payment schedules for multiple treatments in a short period of time is not to every BAcC member's taste.
The wisdom of weekly treatment is that this allows the practitioner to get a really good idea of how well the treatment has taken. Our old teachers used to use images like dropping a stone in a pond and waiting for the ripples to cease, or more appositely, clearing mud from the bottom of a pond and waiting for the water to clear again to see how well one had succeeded, but the message is intrinsically the same - treat too early and it may not be easy to make sense of what is happening.
By the same token most members do not like to leave long gaps between treatments when a course of treatment starts. It is important to be able to assess what changes have taken place, and after two or three weeks most patients, apart from the diary keepers, find it difficult to recall how they felt. Small changes which to a practitioner may have significance are not recalled. There is also a question of momentum; weekly treatment for the first four or five sessions often has greater accumulated power than the same number of treatments spread over several weeks.
If you have any queries about the specific gaps between your own treatments we are confident that your practitioner will be very happy to explain what is going on.  

There can be some substantial variations in the length of appointment times depending on the style of acupuncture practised by your acupuncturist and also the complexity of the case history which you bring to the treatment. One of the founding associations of the BAcC consisted of graduates of a college where the initial session was often two hours long and each treatment session up to an hour long. At the other end of the scale there are highly experienced practitioners who can often glean what they need to within half an hour and continue with half hour sessions.

Generally speaking we tell people to expect to spend somewhere between and hour and a hour and a half for the initial session and between half an hour to an hour for subsequent sessions. 
The obvious point to make, though, is that the quality of the treatment and the success of the outcomes are what matter, and these are not measured in minutes. 

Q:  I've had chronic lower back pain for three months now. I had my second session of acupuncture yesterday from my physiotherapist and the pain was unbearable. The first session had been painful when the needles were twisted but was bearable and it wore off. This time I had a different physio. Some needles went in fine and the twisting caused a little discomfort. However,  one needle when it was twisted caused me to scream out in pain and as he twisted I was actually shouting stop stop. Can you explain why this is? Also afterwards I felt I'll, very cold and had pins and needles in both legs. I am now reluctant to go to third session.

A: We always tread rather carefully in answering questions like this. Generally speaking, acupuncture needles should be relatively imperceptible; most people experience only a mild dull aching sensation, or a slight tingling feeling like a very weak electric shock. In some styles of practice, especially that used by many Chinese practitioners, there is a more vigorous manipulation of the needle to produce a much more significant dull ache, but many people barely feel anything, especially since the advent of guide tubes for insertion of needles which dull the sensations in the area.
So, in essence, the only pain which occurs beyond this can be a direct insertion into or very close to a nerve, or tangling the needle in muscle fibre. In either case, we always tell our members to remove the needle immediately, and indeed, if a patient tells you to stop, then you stop - to continue would certainly invite censure by the BAcC and possibly be construed as an assault.
We suspect that what has happened here is that someone has used a fairly large gauge of needle, which many musculo-skeletal acupuncture treatments use, and that it has been inserted quite vigorously into a muscle or nerve. The effects which you have experienced afterwards we would categorise as 'needle shock', a form of shock which creates the kinds of sensations which you have and which is like the delayed shock someone experiences after an accident.
There is a more subtle point here, as well, which rests on our belief that using acupuncture as an adjunct to orthodox medical or physiotherapy treatment is fine, as long as the practitioner is aware of the possible reactions which we would anticipate from using the same specific points in our tradition. It may be a different theory of treatment, but the needles still go in the same places. There is a point, for example, near the elbow which is used for treating tennis elbow but which can also, in our system, cause a sharp and immediate fall in blood pressure. If someone with a tendency to postural hypotension had this treatment they might faint. We have long argued that just as we have studied western medicine well enough to know when to refer someone to conventional care, conventional heathcare professionals have a duty of care to be aware of the cautions which inform our work in traditional Chinese medicine.
This is all very well, but what do you do? We think that you would still probably benefit from acupuncture treatment, because chronic back pain has been shown by reliable research to be benefit from acupuncture, but you should raise with the practitioner both the fact that you have had such unpleasant reactions to treatment, and the fact that you would reserve to right in future to tell him or her to stop as soon as you say so. It is important that you feel that you control the situation. If the practitioner does not agree, find someone else! If they do agree, and still carry on as before, report them to their regulator.
Hopefully, though, the treatment will have the desired effect and help to relieve your back pain. 

Q:   I've had five sessions with an acupuncturist for neck pain, which worked. Better with less needles than more. I have complete confidence in the acupuncturist, although the needles hurt going in.

A:  There are sometimes reactions to treatment, especially in the treatment of neck and back pains, which are quite severe. This is not an uncommon reaction, and it is not unique to acupuncture; we often get feedback from patients who have osteopathy and chiropractic that they feel the pains and discomfort intensify for a couple of days before the symptoms they came with start to subside. We routinely (well, this 'expert' anyway) warn patients with neck and back pains that there may be a reaction for 48 hours, after which matters should start to improve.
In your case we wonder whether the fact that you were feeling run down and have now come down with a virus just sensitised the whole system a little more, which has meant that the reactions to treatment have been a little more intense and the pain itself has now increased a little. We often find that the manner in which a cold or virus is understood in Chinese medicine could easily make musculo-skeletal pains a little worse.
We are not in the business of trying to persuade people who feel reluctant to go back for further treatment. We often find out that there were other concerns and the reaction to treatment was simply a tipping point. However, if it is simply the reaction and the intensity of the needles, this is something which a responsible practitioner should and will take into account. The best course of action, rather than cancelling now, is perhaps to talk to the practitioner himself or herself to explain what happened and ask their opinion based on case notes which we, of course, do not have. If you don't feel reassured by what they say then by all means cancel. We believe, however, that will be very concerned to hear of your experience and very keen to make sure that your condition continues to improve comfortably, especially since you appear to have been making good progress.    

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