One of the most common reasons people don’t try acupuncture is because they think it will be painful. We’re all familiar with the needles used for blood tests and injections, but an acupuncture needle is so much smaller than these, and much less painful. Acupuncture needles are so fine they won’t even pop a balloon.
The surface layers of the skin are the toughest and most sensitive, so initial insertion of the needle is where there is the greatest potential for feeling pain. With good technique, it is possible to get the needle through these layers without any sensation at all. Most patients who are new to acupuncture are surprised by how little they feel when the needles are inserted.
After insertion, most acupuncturists will stimulate the point to obtain ‘deqi’. This is where the needle connects with the qi flowing in the channel. This is very important if that’s what you’re trying to do with an acupuncture treatment (as opposed to releasing trigger points in muscles, for example).
Interestingly, research on acupuncture point LI 4 Hegu found that stimulating the point to obtain the deqi sensation turned off a pain pathway in the brain. But inserting a needle superficially without obtaining deqi did not. You can watch a BBC documentary which includes a section on that research (from 41:27) here.
Deqi sensations are not painful, although sometimes they can be quite strong.
The kinds of sensations people feel vary enormously. Different points can feel different (and the same points often feel different on different days). There are 6 classically defined deqi sensations:
* Numbness – ‘ma’ – dull, numb or tingling sensation.
* Sourness – ‘suan’ – sore sensation, like a muscle fatigue ache
* Heavy – ‘zhong’ – like it would be difficult to move the limb
* Distension – ‘zhang’ – full sensation, like the after-effects of a dental local anaesthetic
* Warmth – ‘re’ – warm or burning sensation
* Cool – ‘han’ – cool or cold sensation
It is possible for a skilled acupuncturist to elicit particular types of deqi sensation, choosing different sensations for different effects.
The strength of the deqi sensation depends on several things:
* Accuracy of location – some points are bigger than others, but it’s possible to be nearby and obtain a weaker deqi sensation.
* Characteristics of points and imbalances – some points will be more tender on palpation, and give a stronger deqi sensation. This is usually because there is some kind of imbalance or blockage in the area.
* Strength of manipulation – once deqi is obtained, a stronger sensation can be produced by stimulating the point. Different types of stimulation are used for strengthening deficiency and for clearing stagnation or pathogens.
* Openness of the patient’s energy system – some people have a more active energy system than others. Usually younger people and children are relatively ‘yang’, so their energy is more active and nearer the surface. Also those who have some kind of energetic practice (such as qigong or yoga) tend to be more sensitive to acupuncture.
Feeling sensations in other locations
It is not unusual to feel deqi sensations in places other than where the needle is. Some techniques encourage the sensation to travel along acupuncture channels. This is called Propagated Needle Sensation, and sometimes it happens spontaneously. These sensations are not always felt along the channels (though they often are), and can potentially be anywhere in the body.
Other types of sensation
Rarely (research suggests less than 1% of treatments) you may experience one of the following uncomfortable sensations during acupuncture:
* You may feel sharpness when the needle is inserted that continues for more than a second or so. This is usually because the needle has been inserted into a structure such as a sweat gland or hair follice. It can also be due to a poor quality needle.
* Sometimes a needle will touch a nerve creating an electrical shooting sensation.
In either case, the needle should be redirected or reinserted to avoid causing minor damage to the structure. It is possible for some discomfort to remain after the needle is removed, but this will usually fade within minutes. Occasionally it may persist for a few hours, and rarely for a few days.
While the needles are left in
After obtaining deqi and stimulating the points, needles will often be retained for anything from 5 mins to an hour, though most commonly around 20 mins. During this time you may feel a pleasant tingling, throbbing, warmth or other sensations around the needles or moving around the body. These are all good signs that qi is moving, but people often don’t feel any sensations while the needles are retained, and that is fine too. Almost everyone finds this part of the treatment incredibly relaxing.
Even though most of this article has been about the sensations people feel during the insertion and manipulation of the needles, these sensations will usually only last a second or two. Even where a patient experiences strong deqi sensations, the majority of the acupuncture treatment will be very comfortable and relaxing.
What about after treatment?
After treatment, people sometimes feel a little drowsy or ‘spaced out’, though often people feel really energised and clear, lighter and breathing easier. Improvements may be felt in a wide range of symptoms either immediately or over the course of the following few days.