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Ask an expert - about acupuncture - does it hurt?

14 questions

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.    

Q: Does acupuncture hurt? A friend of mine has just had acupuncture and described it as 30 minutes of the worst pain of her life.


A:  Acupuncture rarely 'hurts'. The most that people experience is a dull ache around the base of the inserted needle, or a slight tingling feeling when the needle is inserted. Points at the extremities, like toe or finger ends, can sometimes be a little sharp, but the sensation is usually brief.
If someone experiences real pain it suggests one of three things: the needle has been inserted into a nerve and has been left causing discomfort; the practitioner is incompetent; or the patient is extremely sensitive. If it is the latter acupuncture treatment is not for them. There are a few prospective patients who find the experience genuinely uncomfortable, and we advise them to try acupressure or shiatsu. If the needle has caught a  nerve it is unlikely to be a repeatable experience. If the practitioner is incompetent, that might be the cause, although in modern times the use of guide tubes with needles means that it is very difficult to put a needle into without the requisite sensitivity.
In fact, acupuncture is one of the most relaxing treatments you can get.
We are sorry that your friend has had such an unhappy experience of acupuncture but are confident that this is unlikely to be the case should you decide to have treatment yourself. 


Q:   Does acupuncture for plantar fasciitis hurt. I have been told that it will, as the idea is to put needles close to the bone to create a flamatory response. Is this all true.

A:  Acupuncture performed using the techniques of Chinese medicine is not usually painful. There are a couple of recognised responses - a localised tingling sensation or a dull ache, called 'deqi' - about which most practitioners will forewarn the patient. Occasionally there can be a slightly sharper sensation, especially with acupuncture points where there is relatively little covering of flesh, i.e. near the nails, etc.
However, the theory of Chinese medicine involves the movement of energy, or 'qi' as it is called, and while a few practitioners in the BAcC employ quite vigorous techniques, the majority are trying to achieve subtle changes and use very gentle needle insertion. Treating a condition like plantar fasciitis would involve a mixture of local treatment and distal treatment to encourage energy flow through the affected area and to stabilise the balance of the whole system to ensure that once treated it stayed treated.
Western medical acupuncture, which we believe is what you are describing, has a different understanding of what the acupuncture is doing, expressed usually in terms of neurophysiological effects or inflammatory responses. If you believe that the healing which takes place can be enhanced or even kick-started by an inflammatory response, then it makes sense to needle quite deeply to encourage the best responses. This may not be everybody's cup of tea, but then, plantar fasciitis is an extremely uncomfortable condition and the trade-off, a few minutes of increased discomfort against a longer term relief, is often worth it. 


Q: I had acupuncture at my physio appointment yesterday it hurt like hell and had to ask him to remove the needles as it felt like i had been hit hard on my knee only two needles were used is this normal to feel this kind of pain


A: The sensations usually experienced from acupuncture treatment are not what one would class as 'pain'. Many people feel a slight dull ache around the needle, a little like a bruised feeling, which tends to stop with the treatment, and some people feel a small tingling or electrical sensation. Occasionally a point will cause a sharper sensation, but this is usually very short lived.
It is not fair for us to comment on the style of treatment of an individual, but our general experience is that physios who use acupuncture tend to use slightly heavier gauges of needle, i.e. thicker, and use points on the basis of a different underlying theory which often requires a slightly heavier technique. For some people this is too intense, and can actually be unpleasant. We can't also rule out the possibility that the practitioner has inserted the needles incorrectly or too deeply, but this would normally leave a residual pain after the needles had been removed.
As a general rule, though, acupuncture should not be painful  

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