A question I have been asked countless times over the course of my career is “Does acupuncture hurt?”.
Really there are so many variables here that come into play!
Let’s explore a few of the things that can influence your acupuncture experience and whether it will hurt or not!
Acupuncture Style Used by Practitioner
There are a multitude of different acupuncture styles that are practiced around the world (I tried to do a quick count of those I knew and stopped when I reached 50).
The training that your acupuncturist has had will largely influence the type of treatment that you recieve. This can influence how many needles are used, where needles are placed, the amount of needle manipulation (movement) after a needle is placed, how long a needle is retained- you could go to ten different acupuncturists trained in different styles and have a vastly different experience each time.
I am trained in a number of different acupuncture styles, all of them tend towards having fewer needles (sometimes only one!), with shallower insertion, and minimal manipulation.
Personally I am very sensitive to needle sensation so I tend to be drawn more to gentle styles that I find more comfortable. When treating someone new for the first time I will typically go for a treatment style that has fewer needles, and is going to be less painful.
Styles that I have been trained in and use regularly:
Neoclassical Acupuncture: Palpation based style that uses minimal needles (as few as one)
Tung: System that often needles multiple points close together the amplify the effect of the needles (can use more needles depending on the issues that are happening- sometimes up to 20)
I Ching: Great for time based issues (think seasonal issues, or something that happens regularly around the same time of the day). Usually uses eight specific needles, minimal manipulation.
Unified Acupuncture Theory (UAT): A beautiful system that works wonderfully with supporting emotional issues. Usually uses 4 specific points, with minimal manipulation.
Classical Acupuncture: An amazing linage drawn from Jeffrey Yuen, lots of different ways of applying acupuncture technique within this style. Some of them more intense with lots of needling but minimal retention, some with fewer needles, but longer retention. This style is amazing for long chronic issues, as well as for stuck emotions, or inablity to process big events that may have been traumatic. With this style it is very dependant on the symptoms as to what style of manipulation will be used.
Traditional Chinese Medicine: This is the style most commonly taught at universities in Australia. TCM style usually has deeper insertion, with more manipulation, and depending on practitioner can sometimes be more intense for sensitive patients.
Shonishin: This is a Japanese style of acupuncture used for children, it uses a variety of different tools that are tapped, and stroked/passed over the skin. Great for those who are super sensitive to needles, as well as children!
Kiiko Matsumoto Style (KMS): This is another Japanese style that is also based on palpation, created by a modern master Kiiko Matsumoto. This style provides a great foundation for much of what I do, as well as helping to decide between points if I am unsure- as it allows me to test if an acupuncture point will have an effect before actually needling it. Typically when using this style I will use 3-10 needles, and only a small amount of manipulation.
Even just from the descriptions above you can see that depending on what style I use during a treatment, you may have anywhere from between 1-20 needles in a session with me (or even possible no needles!). As mentioned I will typically use less painful techniques before diving into more intense sessions if possible.
Type of Needle Used
Not all acupuncture needles are the same!
There is a large variety in types of needles, whether they are silicon coated (less painful), or what they are made from, along with the size of the needle – length, gauge (width) all play into this as well. Usually the thinner a needle is the less painful it is.
The needles that I use are typically 0.18mm wide (about as thick as an eyebrow hair), and usually between 15 and 30mm long depending on where I am needling on your body.
A lot of acupuncturists will typically use 0.25mm wide needles.
You can read more about acupuncture needle sizes here.
Acupuncture Points that Can Hurt More
Where an acupuncture point is located will also play a large role in how painful a point is.
As a general rule- the closer a point is to the tips of fingers/toes the more sensitive it will be. This is because we have a greater density of nerve endings in our fingers and toes. If a point has more flesh around it (like on the thigh for example), they will typically have less sensation, as the nerve endings are not as concentrated.
Experience and Training of Practitioner
As with the style of acupuncture a practitioner uses, where someone trained will also play a large part in whether the acupuncture hurts or not.
The most common style taught in Australia at universities or to doctors who practice acupuncture is Traditional Chinese Medicine (TCM) style. This style can be quite heavy handed with lots of needle manipulation until a patient experiences “de qi”, which is usually a deep throbbing sensation around the needle. This style of needling is also quite common with many sports therapists, or dry needling where a muscle twitch response is sort to ensure a change is occuring within the muscle.
When needling it is important to be quick as the needle is inserted into the skin, as the longer the needle tip sits on the skin the more painful it will be. Being confident and not hesitating when needling comes with experience- sometimes newer practitioners may inadvertantly cause more pain because of their hesitation to insert the needle!
Another factor is whether a practitioner uses guide tubes or not- a guide tube is a thin plastic tube that is slightly shorter than the needle, and allows the practitioner to insert the needle quickly with minimal pain. This can be a wonderful way to ensure insertion is quick, and the pressure of the guide tube on a point will often reduce the needle insertion sensation.
I describe the sensation of a needle insertion to patients “like a hair being plucked- you may have a quick sharp sensation that is over before you have time to react”. If there is further manipulation on the needle then it is also possible to get a deep ache or throb around the needle which is the “de qi” sensation- this is usually where the main discomfort comes from.
Pain Tolerance Can be a Big Factor if Acupuncture Hurts
If you have a low pain threshold you are more likely to be sensitive to the needling sensations!
Make sure to let your practitioner know that you are quite sensitive, and they should be able to adjust their technique to make it more comfortable for you! It also means that they are able to choose points which are less likely to be painful for you.
Movement through Treatment
It is not recommended to move the area that has needles in it.
If you move an area that has a needle in it during the treatment it will often cause some discomfort- depending on where the needle is and the amount of movement will determine how much. The sensation is usually a deep aching throb, but sometimes it can be quite sharp as well.
During treatments I will often encourage patients to move an area that is sore, but rarely (if ever) will needles be in the same area.
The majority of treatment styles I use are distal, which means that I am needling an area that is different from where is sore. One of the reasons I love these styles is it allows you to test how the area experiencing pain is while the needles are still in. For example if you have pain in your shoulder, I may put a needle in your ankle/foot- which allows you to still move the shoulder without you needing to worry about the needle moving. Or if you have a sore back, I may put a needle in your ankle or wrist- allowing you to move your lower back to see if the pain has changed before the end of the treatment.
Depth of Insertion of Needle
The depth of insertion is determined by the location of the acupuncture point. Generally the fleshier an acupuncture point is, the deeper the insertion (a point on your thigh will go in significantly deeper than a point on your wrist or finger).
Again the depth can also depend on the style of acupuncture used! Japanese styles typically have more shallow insertion (somtimes not even breaking the skin!), whereas TCM based styles will usually have a much deeper insertion.
I tend to fall somewhere inbetween- I will err more towards shallow insertion, but won’t go as deep as most TCM acupuncture practitioners.
Overall does Acupuncture Hurt?
I would say it depends mainly no the practitioner’s style, and your level of pain tolerance. If you have an experience that is painful talk to your practitioner about it- let them know! If you don’t like the style they are using then seek out someone that does a more gentle style- don’t be afraid to call a practitioner first to find out more about how they work before booking in.
Does acupuncture hurt- it can, but also it doesn’t have to. Find the practitioner that is right for you, and that has more gentle techniques if you are worried.