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Ask an expert - about acupuncture - does it hurt?

11 questions

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  

Q:   My doctor offered me acupuncture, I had a terrible reaction to just a few seconds of it, and had to stop, I tried reiki and the same happened, could you explain why this is ? I am a great believer in alternative remedies.


A: There is no doubt that there are a few people who are extremely sensitive to treatment aimed at the energetics of the body. Most practitioners have a least two or three patients for whom acupuncture may not be the best choice of treatment and who use acupressure or moxibustion as the treatment of choice.
However, without knowing exactly what style of acupuncture your doctor uses, the underlying theory of western medical acupuncture often involves trigger points and the use of some fairly direct treatments which some people find a little painful. It is possible that a practitioner using acupuncture on the basis of Chinese medical theory may be a little gentler. There would certainly be no harm in speaking to a BAcC member local to you and asking their advice face to face for them to assess whether this would be a problem with what they do.
We can't really comment on the reiki other than to that once again it may be the individual whose own 'powers' are a little stronger than average. There appears to be no doubt that some people have a natural healing ability, and reactions to what they do may not be totally down to the technique of reiki which, as we understand it, is considered by many to be very gentle.
If acupuncture is too painful, for whatever reason, acupressure, moxibustion and tui na, a form of massage which uses the same energetic theory, are likely to be helpful for the very reason that they might well take advantage of your sensitivity to energetic treatment in a positive way. 

Q. Last week I had acupuncture to treat neck and shoulder injuries caused by a fall in December and I could not believe how painful, both during and for 24 hours after the treatment it was. Is this normal? I recieved the treatment in an NHS hospital by a senior physiotherapist. My next appointment is tomorrow and I am dreading it.


A. One of the principal reasons for differences in technique between professional acupuncturists and medical professionals using acupuncture lies in the underlying theory on which the practice is based. The traditional acupuncturist is primarily concerned with the energies of the body, the term 'qi' which the Chinese use to describe all aspects of physical existence, and treatment can often be very subtle and gentle. The medical acupuncturist, however, is more often working on the basis of muscular and neurophysiological approaches. This can often involve the use of what are called 'trigger points', knots in the muscle tissue, and needling these can often be quite painful. The more physically based treatment often calls for a broader gauge of needle than BAcC members generally use, and it's something of a simple truth that the thicker the needle, the more likely it is to cause discomfort.



A great many physiotherapists have added some of the Chinese medical approaches to their repertoire and are equally subtle in their approach, so we would not want to generalise too much on the basis of a single report. It may be as simple as the fact that this person's technique is not that good, or equally that you are one of a small group of people who are extremely sensitive to acupuncture treatment and have to weigh the benefits of treatment against the discomfort of the needles.


All healthcare professionals can only work with the patient's consent, though, and if there is any aspect of a treatment which you do not like you are within your rights to withhold consent. Any practitioner that continues to use a modality after consent has been withdrawn immediately puts themselves on the wrong side of their professional code of conduct.

This is less common a problem than it used to be, as acupuncture has become more commonplace and accepted, and people have seen how fine needles are. However, a small minority of people do still find the idea of needles scary.


Practitioners are trained to deal with cases like this. For many people it's the sight of needles which can be the problem, although that's not always true – for some people it's what they can't see which really upsets them. Your practitioner will do their best to find out exactly what it is about the needles that you find difficult and work to reduce its effect. This might mean choosing points in areas where you feel 'safer' or it may mean very shallow needle insertion. If it really is impossible to bear the thought of needles a great many practitioners use acupressure techniques, or a practise a technique called moxibustion which uses a warming herb on the skin, or even a form of massage called tui na.


The most important thing to remember is that as the patient you can be in charge of the situation as much as you want. If you ask your practitioner to proceed very slowly or cautiously, then that is what they will do.


Very few people are so scared of needles that they try them and never come back or never try them at all. Most can't believe why they were worried in the first place.

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