An Experimental Study on the Self-Report of Acupuncture Needle Sensation during Deep Needling with Bi-Directional Rotation

Abstract

Background Traditionally, acupuncturists manipulate needles to enhance sensations referred to as de qi or 'acupuncture needle sensation'. Acupuncture needle sensations are complex and quantifying the experience has been diffi cult. The aim of this crossover study was to measure self-reported needle sensation during deep and bi-directional rotated needling in 15 healthy volunteers. Methods Each participant received an experimental intervention consisting of superfi cial needling followed by deep needling and then deep needling with bi-directional rotation. The control intervention consisted of superfi cial needling, followed by mock deep needling and then mock bi-directional rotation of the needle. The intensity of overall needle sensation was measured using a visual analogue scale (VAS). The subjective acupuncture sensation scale was used to capture component sensations. Results VAS scores were higher during 'deep' needle penetration when compared to superfi cial needling with mock deep insertion (p=0.0002). VAS scores were also higher during deep needling with bi-directional rotation compared to superfi cial needling with mock bi-directional rotation (p<0.0001). There were higher scores for total component sensation scores and for the sensation of throbbing during the deep needling with bi-directional rotation (p=0.001) when compared to superfi cial needling with mock bi-directional rotation. Tentative evidence that bi-directional needle rotation generated stabbing, tingling, heaviness, soreness and aching was also found. Conclusion Bi-directional rotation of a needle inserted into deep soft tissue produced higher acupuncture needle sensation intensities when compared to superfi cial needle insertion with mock deep penetration and bi-directional rotation. INTRODUCTIONManual manipulation of acupuncture needles is commonly used in clinical practice to increase the intensity of stimulation in order to improve therapeutic effects. Manipulation techniques include deep insertion of needles into deep soft tissue and/ or bi-directional rotation of needles. The relationship between manual needle technique and acupuncture needle sensation is poorly understood. 1There is some evidence that deep needling may be more effective than superfi cial needling for shoulder and low back pain 2 3 although a randomised controlled clinical trial involving 1162 low back pain patients found that deep acupuncture generated only 'marginally' superior pain relief than superficial acupuncture. 4 Manual manipulation of acupuncture needles can evoke 'de qi' in patients. 5 De qi is a term derived from traditional Chinese medicine to describe sensations experienced by the patient as a direct result of needling and to describe 'needle grasp' where the acupuncturist feels resistance to movement of a needle that has been inserted through the patient's skin. 6 More recently, the term 'acupuncture needle sensation' has been used to describe sensations experienced by the patient local to the inserted needle. 7 It is claimed that acupuncture n...

Effectiveness of strengthened stimulation during acupuncture for the treatment of Bell palsy: a randomized controlled trial

“…However, several clinical trials have shown that real acupuncture needling, especially with rotation, can elicit higher intensity sensations than sham or superficial needling. 5,7,21,23,27 Our observed rate of complete recovery in the control group (77.1% of patients) is similar to that in the corticosteroid group (76.7%) in a recent Cochrane review, 28 which suggests that patients in our control group had similar experiences to patients who received sham acupuncture.…”

“…[6][7][8][9][10][11] However, this long-held belief has not been confirmed by sufficient evidence from randomized controlled trials. 5 Consequently, de qi and its related techniques have been neglected in acupuncture practice and research. As such, the therapeutic effects of acupuncture may be seriously compromised.…”

“…3,4 De qi -an internal compound sensation of soreness, tingling, fullness, aching, cool, warmth, heaviness and a radiating sensation at and around acupoints -is elicited by manipulation of the needles (rotated as well as being moved upward and downward). 5 The concept of de qi, originating from the long-term accumulation of clinical experiences, has been explained to some degree by several scientific studies. [6][7][8][9][10][11] However, this long-held belief has not been confirmed by sufficient evidence from randomized controlled trials.…”

Discrimination Accuracy between Real and Sham Needles using the Park Sham Device in the Upper and Lower Limbs

“…22 Participants may have used the sensations generated by the real and sham needles as cues for making their judgements. Benham et al 23 found that deep needle insertion produced a higher intensity of needle sensation compared with superfi cial insertion. In our study, the needle insertion depth for the upper limb acupoints was more superfi cial than the lower limb acupoints.…”

Acupuncture Needle Sensation: The Emerging Evidence

“…This might explain the spread of needle de q' sensations away from the needle. 26 Interestingly, our research found that needle sensation distribution patterns were markedly similar to trigger point referral patterns, leading us to speculate that needle stimulation may be affecting the same structures as those affected when stimulating trigger points 25 …”