Does acupuncture hurt?

Why the needle does not feel like a shot

A hypodermic needle is a hollow tube with a beveled cutting edge, built to push fluid through the skin; a standard 25-gauge is about 0.5 mm across. A filiform acupuncture needle is a solid wire with a rounded, polished tip that parts the tissue rather than cutting it, and the sizes used in everyday practice run from 0.16 to 0.30 mm. The American Academy of Family Physicians' patient handout puts it simply: the needles are very thin and have no cutting edge, which makes them much less painful than needles used to give shots, and once in place you may not feel them at all. Needles are sterile, single-use, and regulated by the FDA as medical devices, so the needle that goes into you has never been used on anyone else.

What you actually feel: de qi, measured

The sensation that acupuncture is meant to produce is called de qi, pronounced duh-chee, which translates as the arrival of qi. A 2007 study at Massachusetts General Hospital needled three standard points in 42 adults who had never had acupuncture and compared the sensations with a light touch control. The commonest reports were aching at 62 percent of needlings, tingling at 58, soreness at 56, pressure at 51, numbness at 40, dull pain at 31, heaviness at 27, and warmth at 22. The investigators treated sharp pain as something else entirely: when it occurred, briefly and in a minority of needlings, they classed it as accidental stimulation of a nerve or vessel, not de qi, and adjusted the needle until it stopped. A 2013 review of the de qi literature makes the same distinction, and the patient-reported scale used in research lists sharp pain separately from the de qi sensations for that reason.

That is the plain answer to the question. Acupuncture is supposed to produce a sensation, and the sensation is a dull, deep, spreading one. It is not supposed to produce sharp or burning pain, and when it does, the needle is in the wrong place or too deep and is moved.

Where it is more sensitive, and what to say

Skin with more nerve endings and less flesh under it feels the tap more: the hands and fingers, the feet and toes, the face and ears. Points there are needled more shallowly and with finer needles, and many practitioners insert them last. The fleshy points on the legs, arms, back, and abdomen are usually felt as pressure only. Two things make a real difference. Say so if anything feels sharp, hot, or electric, or if a sensation is building rather than settling, because every one of those is a cue to adjust or remove the needle, and a good practitioner wants to hear it. And breathe out as the needle goes in; tensing the muscle around a point is what turns pressure into an ache.

How safe it is, in numbers

Two prospective surveys published together in the BMJ in 2001 are still the benchmark. One followed 31,822 consultations with physician and physiotherapist acupuncturists and recorded no serious adverse events; the most common minor events were a small bleed at the needle site in about 3 percent of consultations, pain on needling in about 1 percent, and a temporary flare of symptoms in about 1 percent, most of which were followed by improvement. The other, the York study, followed 34,407 treatments by traditional acupuncturists, again with no serious events; practitioners recorded mild bruising in 1.7 percent, pain at the needling site in 1.2 percent, and bleeding in 0.4 percent, and 12 percent of patients reported feeling relaxed. The National Center for Complementary and Integrative Health notes that the complications which have been reported come from non-sterile needles or improper technique, which is why single-use needles and a trained practitioner matter more than the question of pain.

Common questions