I get this question from people often, especially from new patients on their first visit. I usually give my typical smiley smirk and say, “I’m going to be putting needles into your body. Of course it is going to hurt.” I realize that this is not funny in the classical sense, especially to the patient, but that small bit of absurdity in the midst of the new patient jitters often provides some levity. I follow up with, “Really, though, it’s not that bad.” I then go on to explain in more detail. It is a common enough question, so I thought I would share this information with you now.
There seems to be a popular misconception, especially in America, and perpetuated by mass media, that acupuncture is painless. Well, it is, but it isn’t. It all has to do with the definition of pain and, more specifically, with the Chinese definition of pain as it relates to acupuncture. Acupuncture is from China, after all, and the original phrase stating that acupuncture should not be painful is from China. In China, painful acupuncture would be having a continuous sharp or a continuous burning sensation that does not go away on its own after about one minute. If this happens, it should be brought to the attention of the acupuncturist so that the needle can be adjusted, and then the pain will go away. This does happen on rare occasion, and is just a normal part of the process. So, if it happens to you, do not be alarmed or discouraged, just let your practitioner know when it occurs.
That being said, acupuncture is definitely not sensationless. In fact, some of the normal sensations involved with acupuncture would be thought of as pain sensations by those in American culture. However, those sensations are actually referred to as qi reactions (deqi in Chinese) and are not considered pain by the Chinese definition.
What sensations are involved with acupuncture, then? I will explain, but keep in mind that this is all based on the acupuncture that I do which is based largely on the Chinese TCM model. There are other types of acupuncture with different needling methods, some of which involve no insertion at all.
First, let’s talk about the needles. They are single-use, sterile, disposable, stainless steel needles. I tend to use 32 gauge needles for most applications. That means the needles are 0.25 mm thick, which is very thin. Acupuncture needles are different than the hypodermic needles which are used when we get shots or blood tests. Because they are so thin, around 5 to 10 acupuncture needles can fit inside the tip of a hypodermic needle, depending on the gauges used. Hypodermic needles are hollow and sharp; they cut through the skin and puncture structures (veins, arteries, nerves, etc.) beneath the skin. Acupuncture needles are solid and the tips are relatively dull; they push through the skin and, instead of puncturing structures, will nudge structures out of the way with careful needling. So, do not expect insertion of an acupuncture needle to feel like getting a shot or blood test.
Insertion of the needle is a 2 step process. First, the needle is quickly inserted shallowly so that it gets through the skin. This is done either free-hand, which I do, or with a guide tube, which is also common. It is this initial part of insertion that feels like a pinch. Some people do not even feel the pinch, but the pinch-like sensation usually happens. In sensitive and thin skinned areas, the pinch feeling tends to be more prevalent. In less sensitive and meatier areas of the body, the pinch is less noticeable.
After the initial part of the insertion, the needle then gets inserted deeper into the body to the depth and at the angle that is appropriate for its location and for its purpose. While this happens, a variety of sensations are possible. Some people even feel nothing at all, which I always find surprising because I am very sensitive and feel absolutely everything when being needled. Sometimes only the movement of the needle itself can be felt. However, a common sensation is an ache, pressure, or distended feeling around the needle, as if the needle is much thicker.
This ache is one of the more notable qi reactions. It can come on gradually and be mild, or it can come on suddenly and be very strong for an instant, fading gradually after that. In particular, when it is sudden and strong, Americans categorize it as pain. They typically do not like the sensation. In China, however, it would be typical for a patient to be disappointed if they did not feel that sensation. In fact, once elicited, a Chinese doctor might continue stimulating the needle to prolong and propagate that sensation to the point of having the patient yell at times. Again, the patients expect this as part of a good treatment. It is a different story here. Heavy needling like that would make the majority of American patients question whether or not they should come back for another treatment. Therefore, a much lighter type of needling tends to be done here, and even though I follow the Chinese model, my needling is lighter and more suitable for our culture.
In addition to the ache, there are other common sensations that may be felt. Coolness, warmth, itchiness, and tingly sensations are all possible, too. Also, any of the sensations may be: 1) local, just where the needle is; 2) referred, meaning the needle is one place, but it is felt someplace else; or, 3) radiating, meaning the sensation can travel in any direction away from the needle (most commonly in the direction of the acupuncture channel on which it is located).
Not everyone feels these types of sensations with every needle. Also, what a patient feels during one treatment may not be the same thing felt during the next treatment even if the needles are in the same points. Furthermore, even though these sensations are qi reactions and are an indicator that the acupuncture is doing what it is supposed to be doing, it is actually more important for the practitioner to feel the qi through the needle after insertion. It is because of this that the needle may be manipulated by twisting or pushing and pulling in order to call the qi to the needle and to deliver the proper treatment intent for that point. So, even if a patient feels nothing from a particular needle at a point, as long as I feel what I need to feel, I continue on to needle the next point.
After I feel the qi reaction, in many cases (particularly for functional complaints rather than musculoskeletal or structural complaints) there is no need to leave the needles in place in the patient. They can be removed at that point. However, I tend to leave the needles in, generally anywhere from 10 to 30 minutes depending on many factors. I do this because it is part of the Chinese TCM model, is what I learned in school, and is what is expected by patients getting acupuncture. There is a reason for this.
It is thought that the qi in the body cycles though the various acupuncture channels as connected from beginning to end in about 15 minutes, give or take depending on many factors. Therefore, if an acupuncture needle is positioned properly, but a qi reaction is not felt by the practitioner, the qi will still naturally arrive at the needle at some point during the treatment if the needle is retained.
Many practitioners, especially new ones, are not skilled at connecting the qi to the needle. It is not something that is easily taught. It is a sort of intangible skill that must be experienced in order to fully understand and to replicate. Therefore, needle retention can allow for a more effective treatment. Because of my long-time martial arts, t’ai chi, and qigong backgrounds before I studied acupuncture, I was already familiar with qi, how it felt, and how to manipulate it. This knowledge and experience easily flowed over into my acupuncture practice.
Usually, there is little or no sensation when removing a needle. The patient will often feel either nothing or just the movement of the needle. Sometimes there is discomfort, but it is more or less instantaneous. Also, I occasionally and intentionally elicit another qi reaction as I am removing a needle.
More often than not, there is no blood. In the few instances where there is blood, it is often not more than a small drop and is blotted clean with a cotton swab. Even rarer, a bruise and / or small swelling can occur. If there is a swelling, it can be immediately rubbed out to the point that it will not return, but the bruise will run the normal course of a bruise for you.
It is possible that with certain types of needling, particularly with deep and / or strong needling for structural complaints, the patient will experience some muscle aching for a day or two at the most, very similar to the type of muscle ache one would get from working out too much. This is normal, will go away, and does not take away from the effects of the treatment.
These are the notions that I like to get across to my patients before needling them so that they know what to expect. I try to be thorough, but I keep it basic. I think I have included everything here, but if you have any questions, please let me know.