Does acupuncture hurt?
It is important to understand that acupuncture needles are nothing like the needles used to administer injections or collect blood (called hypodermic needles). Hypodermic needles have thick, rigid shafts with an angled tip that is designed to slice through skin and muscle (see size comparison to the right). In contrast, acupuncture needles are very thin – about the diameter of a cat’s whisker. Because they are so thin, acupuncture needles are very flexible. In addition, they have a highly polished surface and a rounded tip that is designed to pass painlessly through the skin and body tissues without causing damage or bleeding.
Many patients do not experience any sensation when the needle penetrates the skin, but some people feel a prick similar to a mosquito bite or a mild stinging sensation. When the needle reaches the correct depth, some patients feel a dull ache, a tingling sensation, or a sense of distention under the skin. This sensation dissipates quickly, and most patients experience a sense of deep relaxation and calmness for the remainder of the treatment. Many patients actually fall asleep while the acupuncture needles are in place.
Is acupuncture safe?
Is acupuncture safe?
Like any medical procedure, acupuncture is not entirely without risk. Fortunately, injuries are extremely rare among patients treated by trained practitioners. In the United States, acupuncturists use factory-sterilized, single-use, disposable needles. The needles are individually packaged according to strict government guidelines and are discarded immediately after use, so there is no risk of disease transmission.
In a Japanese survey of 55,291 acupuncture treatments given over five years by 73 acupuncturists, 99.8% of them were performed with no significant minor adverse effects and zero major adverse incidents (Hitoshi Yamashita, Bac, Hiroshi Tsukayama, BA, Yasuo Tanno, MD, PhD. Kazushi Nishijo, PhD, JAMA). Two combined studies in the UK of 66,229 acupuncture treatments yielded only 134 minor adverse events. (British Medical Journal 2001 Sep 1). The total of 121,520 treatments with acupuncture therapy were given with no major adverse incidents (for comparison, a single such event would have indicated a 0.0008% incidence).
Common, minor adverse events
A survey by Ernst et al. of over 400 patients receiving over 3500 acupuncture treatments found that the most common adverse effects from acupuncture were:
- Minor bleeding after removal of the needles, seen in roughly 3% of patients. Holding a cotton ball for about one minute over the site of puncture is usually sufficient to stop the bleeding.
- Bruising, seen in about 2% of patients. Bruising usually go away after a few days. This side effect is more common among patients taking blood thinning medications such as Coumadin, warfarin, Plavix, or anti-inflammatory drugs.
- Dizziness, seen in about 1% of patients. Some patients have a conscious or unconscious fear of needles, which can produce dizziness and other symptoms of anxiety. Patients are usually treated lying down in order to reduce likelihood of fainting. Being careful to eat a light meal or snack prior to treatment significantly reduces the likelihood of this type of problem
The survey concluded: “Acupuncture has adverse effects, like any therapeutic approach. If it is used according to established safety rules and carefully at appropriate anatomic regions, it is a safe treatment method.”
Risks from omitting orthodox medical care
Receiving any form of alternative medical care without also receiving orthodox Western medical care can be inherently risky, since undiagnosed disease may go untreated and could worsen. For this reason I prefer to consider acupuncture a complementary therapy rather than an alternative therapy, and always encourage my patients to remain under the care of their physicians.
Safety compared with other treatments
Commenting on the relative safety of acupuncture compared with other treatments, the NIH consensus panel stated that “adverse side effects of acupuncture are extremely low and often lower than conventional treatments.” They also stated: “the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same condition. For example, musculoskeletal conditions, such as fibromyalgia, myofascial pain, and tennis elbow… are conditions for which acupuncture may be beneficial. These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments.”
How many treatments will I need?
The short answer to this question is that an “average” initial course of treatment consists of eight to ten sessions, with most people noticing a clear benefit within three to four sessions. Usually during the initial course of treatment sessions are scheduled on a weekly basis, although in severe cases more frequent treatments are necessary.
Many chronic problems (for example back pain of several years’ duration, lifelong seasonal allergies, or persistent insomnia) require multiple courses of treatment before it is possible to transition to maintenance care. In contrast, acute problems (for example a recent ankle sprain or a bout with influenza) typically require fewer treatments, in many cases two or three are adequate.
It is important to remember — you didn’t get this way overnight and you are not going to heal overnight either. Acupuncture is like eating well or working out — you can’t do it just once and expect it to have a significant and lasting impact on your health. I am results-oriented and my goal is to get you to the point that you can stop treatment or transition to maintenance care as quickly as possible. On the other hand, without exception my patients who have had the best results and who have gone on to truly “graduate” from their pain and health problems are those who have patiently committed to consistent treatment.
THE SPECTRUM OF ACUPUNCTURE RESPONSE
It is difficult to predict up front how quickly your body will respond to acupuncture. About 10% of people are what we call “acupuncture strong responders”. This means that they will notice dramatic and lasting benefit from just a few sessions. On the other end of the spectrum is about 10% of people who we consider “acupuncture non-responders”. These people will not benefit from acupuncture, no matter how many treatments they receive. The remaining 80% of people fall somewhere between these two extremes.
If you are going to respond to the therapy, you can expect to see some positive changes within 3-4 sessions. This does not mean that your symptoms are gone within this period of time, only that your pain or symptoms are less severe, you are sleeping more restfully, your mood is brighter, you are having more “good days” than you did before, etc. This is an encouraging result which suggests that will continuing care you will experience more and more relief.
PHASES OF TREATMENT
Children or young people in good health with acute problems (for example a cold or minor ankle sprain) often only require 2-3 treatments. Older individuals and those with chronic health problems typically require a longer course of treatment. In these cases, treatment is divided into three phases:
- Acute care – During this phase, treatments are scheduled weekly (or 2-3 times per week in severe cases). The goal during this phase is to relieve symptoms and to start the process of addressing the underlying cause of pain or health problems.
- Convalescent care – During this phase, treatments are usually scheduled every two weeks. The goal during this phase is to maintain symptomatic relief while focusing on resolving underlying disharmonies and preventing future problems.
- Maintenance care – During this phase, treatments are scheduled once a month or four times per year (usually at the change of seasons). The goal during this phase of care is to maintain the progress we have made and to support your vitality and overall wellbeing.
FACTORS THAT GO INTO DETERMINING HOW MANY TREATMENTS YOU WILL REQUIRE
The length of time you spend in each phase depends on a number of factors, including:
1. Whether your problem is acute or chronic
2. How long you have had the problem
3. Whether you can avoid the conditions that caused your problem
4. Your age
5. Your general state of health
6. How readily your body responds to acupuncture (see above)
7. Whether or not you follow the instructions you are given regarding diet and lifestyle
Progress will be faster if you faithfully follow your treatment plan by keeping your appointments, taking your herbal medication every day (if applicable), and following any advice that you are given about dietary or lifestyle changes. Click here to learn about The Three Free Therapies — things that you can do at home to minimize the number of treatments you will require.
What conditions does acupuncture help with?
Click here for an introduction to acupuncture from the National Center for Complementary and Alternative Medicine.
In 2002, the World Health Organization published a comprehensive review and analysis of controlled clinical trials on acupuncture. The authors of the review analyzed over 300 studies of acupuncture, and categorized the various conditions that were studied into four groups: (1) diseases, symptoms, or conditions for which acupuncture has been proved – through controlled clinical trials – to be an effective treatment; (2) diseases, symptoms, or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed; (3) diseases, symptoms, or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult; and (4) diseases, symptoms, or conditions for which acupuncture may be tried, provided the practitioner has special modern medical knowledge and adequate monitoring equipment.
Diseases, symptoms, or conditions for which acupuncture has been proved – through controlled clinical trials – to be an effective treatment:
- Adverse reactions to radiation or chemotherapy
- Allergic rhinitis (including hay fever)
- Biliary colic (pain from gallstone attack)
- Dysentery (disease which causes inflammation of the large intestine, leading to diarrhea, abdominal pain, vomiting, and fever)
- Dysmenorrhea (painful periods)
- Epigastric pain (including peptic ulcer, acute and chronic gastritis, and gastrospasm)
- Facial pain (including craniomandibular disorders)
- Hypertension (elevated blood pressure)
- Hypotension (decreased blood pressure)
- Induction of labor
- Knee pain
- Leukopenia (reduced number of white blood cells)
- Low back pain
- Malposition of fetus (breech)
- Morning sickness (nausea in pregnancy)
- Nausea and vomiting
- Neck pain
- Dental pain (including temporomandibular joint dysfunction)
- Periarthritis of the shoulder
- Postoperative pain
- Renal colic (pain from kidney stones)
- Rheumatoid arthritis
- Tennis elbow
Diseases, symptoms, or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
- Abdominal pain
- Alcohol dependence and detoxification
- Bell’s palsy (one-sided facial paralysis resulting from damage to the 7th cranial nerve)
- Bronchial asthma
- Cancer pain
- Cardiac neurosis (chest pain caused by stress)
- Cholecystitis (gallbladder inflammation)
- Cholelithiasis (gall stones)
- Competition stress syndrome
- Craniocerebral injury, closed
- Diabetes mellitus, non-insulin dependent (adult-onset diabetes)
- Ear ache
- Epidemic hemorrhagic fever
- Epistaxis, simple (nose bleed)
- Eye pain
- Female infertility
- Facial spasm
- Female urethral syndrome
- Gastrokinetic disturbance
- Gouty arthritis
- Hepatitis B carrier status
- Herpes zoster (shingles)
- Hyperlipidemia (elevated cholesterol)
- Hypo-ovarianism (deficient hormonal activity of the ovaries)
- Labor pain
- Lactation, deficient (inadequate breast milk production)
- Male sexual dysfunction, non-organic
- Meniere’s disease (vertigo)
- Neuralgia, post-herpatic (persistent pain following shingles)
- Opium, cocaine, and heroin dependence
- Pain due to endoscopic examination
- Pain in thromboangiitis obliterans
- Polycystic ovarian syndrome (a hormonal disorder that is associated with ovarian cysts, irregular ovulation, infertility, male-pattern hair growth, and obesity)
- Postextubation in children
- Premenstrual syndrome
- Prostatitis, chronic (inflammation of the prostate)
- Pruritis (itchy skin rash)
- Radicular and pseudoradicular pain syndrome (pain due to irritation of a spinal nerve)
- Raynaud’s syndrome (cold and discolored fingers or toes due to inadequate circulation)
- Recurrent lower urinary tract infection
- Reflex sympathetic dystrophy (dysfunction of the nervous system that causes severe pain and progressive disability)
- Retention of urine, traumatic
- Sialism, drug-induced (excessive salivation)
- Sjogren syndrome (autoimmune disorder in which the glands that produce tears and saliva are destroyed)
- Sore throat
- Spine pain, acute
- Stiff neck
- Temporomandibular joint dysfunction
- Tietze syndrome (inflammation of the ligaments that connect the sterum and ribs)
- Tobacco dependence
- Tourette’s syndrome (disorder that involves tics and involuntary sounds and compulsive rituals or behaviors)
- Ulcerative colitis, chronic (inflammation and ulcers of the large intestine)
- Urolithiasis (kidney stones)
- Vascular dementia (dementia due to vascular disease)
- Whooping cough (pertussis)
Diseases, symptoms, or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:
- Cholasma (hyperpigmentation of the skin, sometimes associated with pregnancy)
- Choroidopathy, central serous (fluid accumulation under the retina caused by leakage from the blood vessel under the retina)
- Color blindness
- Hypophrenia (low IQ)
- Irritable bowel syndrome
- Neuropathic bladder in spinal cord injury (reduced bladder capacity or incomplete bladder emptying)
- Pulmonary heart disease, chronic
- Small airway obstruction
Diseases, symptoms, or conditions for which acupuncture may be tried, provided the practitioner has special modern medical knowledge and adequate monitoring equipment:
- Angina pectoris (chest pain due to cardiovascular disease)
- Breathlessness in chronic obstructive pulmonary disease
- Convulsions in infants
- Diarrhea in infants and young children
- Encephalitis, viral
- Paralysis, progressive bulbar and pseudobulbar (neurological disorder which causes weakness and spasticity of the muscles of the pharynx, larynx, and tongue)
What type of education does a licensed acupuncturist have?
Graduate-level degree programs in Acupuncture or Traditional Chinese Medicine entail 2800-3400 hours of specialized instruction and extensive supervised clinical practice (3-4 years of full-time study). A practitioner who has passed the NCCAOM acupuncture examination is entitled to add Dipl. Ac. (Diplomate of Acupuncture) after their name and a practitioner who has passed the NCCAOM herbal examination is entitled to add Dipl. CH (Diplomate of Chinese Herbology) after their name. The highest level of board certification is the Dipl. OM (Diplomate of Oriental Medicine) — practitioners with this designation have passed written and practical examinations on acupuncture, Chinese herbal medicine, and Western biomedicine.
Although some other healthcare professionals (such as medical doctors, doctors of osteopathy, and chiropractors) have the legal ability to practice acupuncture, it is important to recognize the vast discrepancy between the acupuncture training required of Licensed Acupuncturists versus other health professionals. In most states, medical doctors and doctors of osteopathy are allowed to practice acupuncture without any training whatsoever in Traditional Chinese Medicine, while chiropractors are required to complete only 100 hours of training (usually completed over the course of several weekends). Unfortunately, the limited training of other healthcare professionals in acupuncture often leads to a “cookbook” approach to treatment. Although this approach may bring about some benefits, acupuncture and Chinese herbal medicine only reaches its fullest degree of effectiveness when it is practiced by an individual with extensive training in the detailed and subtle system of TCM diagnosis and treatment.
For more on this topic, please read this article (written by a physician) — Abbreviated Courses in Acupuncture for Physicians Pose a Serious Problem.