pain during and after treatment

I had my first acupuncture appointment two days and I am having a symptom that I hope someone could shed some light on.

I recently saw a licensed acupuncturist in my urologist’s office. Since it was my first time and I was nervous about the procedure, she only put in four needles. The first three went in fine with minimal pain. Unfortunately, when she put in the fourth needle, I felt quite a bit of pain. It was placed on the underside of my wrist, in between or near the center tendons. It hurt much worse when I tried to move my arm. I told her this and moved her fingers over my arm "spreading it through the meridian." The pain lessened but throbbed a couple more times while I was lying on the table. When the nurse removed the needles, I asked her if that was normal. She said yes. It has been two days since my appointment, and I’m still feeling a dull ache on the underside of my forearm to the elbow. I also feel more pain the more I use my arm and hand. I called her today and she said that the ache I felt during the session was normal. In fact, it can mean she put the needle in the ‘right’ spot. However, she said it was uncommon to still be feeling it and it is probably sore muscles. I am concerned it could be nerve pain, so I asked her if that could be the case. She said that since the needle was so small and thin there is no way it hit a nerve. Plus, she doesn’t think my symptoms show that. She also said people in a high stressed state (i.e. anxious) could be more sensitive to the treatment.

Does my symptom sound like sore muscle or could it be nerve pain? I read that nerve pain can feel like a deep ache. I also read that even if a needle was too close or touched a nerve, that it wouldn’t cause permanent damage. Is that true? When might the pain go away? I’m afraid to go back now. My doctor seems like a very knowledge and caring person, so I find it quite disheartening to be having negative side effects from her treatment.

Thanks so much for reading this and I appreciate any responses.

Sincerely, GRH (greenredhead)


Comments

Chad Dupuis's picture

I've responded to similar

I've responded to similar posts previously (some posted at the end of my response here) but yours warrants some further commentary.  Generally everything your practitioner said is technically correct - yes sometimes the needles can hurt and for the most part this dissipates with a few days and may only happen a time or two.  Instead of talking it away, however, your practitioner could simply use different needles and/or different techniques to avoid this.  Generally the technique is to blame.  The point she used, PC 6, -can- cause nerve damage if needled inappropriately and it is somewhat disturbing that she wouldn't be aware of this.  My guess is that she is, but was simply trying to appease you in your concern.  

One of the many things which separates fully trained licensed acupuncturists from MD's, DC's, etc. that practice acupuncture is the extent of our training which culminates in better technique, better point location and generally a better understanding of the underlying anatomy.  

Some practitioners use more aggressive/deeper needling techniques or do not properly account for differences in anatomy (i.e. size of wrist, etc.) well.  There was actually a study a while back done on needling of PC 6 in particular (I tried but couldn't find it right now...).  The study found that 20% of Chinese practitioners studied (it was a small study - 20 or so practitioners if I remember correctly) caused nerve damage to the point with more aggressive techniques.  It was unclear whether or not this lead to any permanent damage.  My understanding is that permanent nerve damage is extremely unlikely without the most invasive and improper of techniques being applied.  A similar study looking at a few points in the neck illustrates some of the possible dangers of not being trained well (see "Clinical anatomy study on the acupuncture safety of tiantu (CV 22) and qishe (ST 11)").  

So the short of this is if your practitioner really did say - "since the needle was so small and thin there is no way it hit a nerve" - this is 100% incorrect.  Chances are very, very small with proper technique, but it can happen with improper/aggressive technique.

 

I would venture to say that you will be fine after a few days and that this will more than likely never happen again.  I would say, however, that a practitioner that lets a patient dictate how many needles to use because of fear is generally a little uncomfortable with their technique to begin with.  Proper technique would mean you would feel very little from the needles, even if you are stressed or apprehensive the first time (which, by the way, many people are).  In fact, proper point selection and technique should make the treatment a very enjoyable, relaxing experience.  If this is not the case for you I would simply find another practitioner.

My general recommendation would be to voice your concern, go back for another treatment or two, and if this response continues and, more importantly, you are not improving with your main complaint - find someone else.

Related Responses - "Pain with Needles", "Back Pain Worse After Treatment"

rcandeias's picture

I suffered from similar pain

I suffered from similar pain I was treated with lots of needles on my neck back leg foot and finally my shoulder and just on the side of my bicep the last two were not painfull going in but after he placed the needles he put some kind of heater over the arm needles and left me there for about 20 minutes, after a few minutes of being under the heater it was feeling far too hot and I tried to move the arm but I couldn't feeling pain from where the needles were when I attempted moving, so I didn't and endured the burning feeling from the heating...finally he came back into the room and removed needles was a relief....

However after that I suffer from constant dull but strong pain when my arm is in resting positions like now typing here, or when I am in bed trying to sleep, is like the needles are still there and i am trying to move the arm one point on my shoulder another on the side of my arm near my bicep...the pain has now persisted for over a month.

So if this is nerve damage, how can one heal nerve damage or repair it? will it ever be good again, as an arm is something somwhat difficult to immobilize if one needs to work.

 

regards  (ps sorry about my written English)

Yeoman's picture

Pain during and after treatment

I think many patients (myself included!) find PC6 a sensitive point, and sometimes it 'hums' for a few hours post treatment. This, however, is not painful. I would say a treatment that causes pain after 24 hrs has not been particularly well done. I'm confused, from your report, who actually did the acupuncture. At one point you say it was a nurse. I am not familiar with the policies in the US (I'm in the UK) but maybe she was not really a Lic Ac - she might have done one of those short courses many medical people do. I speak as a nurse who trained to be a Lic Ac acupuncturist; I know how easy it is to be seduced into thinking acupuncture is an 'add - on' to orthodox medicine. I tend to agree with Chad. As with any practitioner, if you are not happy with them, don't carry on. However, don't let this put you off acupuncture for good. Find a properly qualified one, ask friends for suggestions, and when you get one - ask them about their qualifications and experience. Good luck, and I hope you feel better soon. 

acubalance's picture

with acupuncture, the main

with acupuncture, the main thing to be aware of is your definition of "pain".  a strong qi sensation can often feel heavy, achey, sore, etc....which is good and therapeutic.  generally, if you hit a nerve, it's a shooting pain that extends past the area and through the limbs, into the fingers, etc.  it's not true that an acupuncture needle CANNOT damage a nerve, however generally the nerve can only be damaged if the needle hits the nerve and the acupuncturist continues to manipulate the needle (twisting it, for example).  the needles are so small that if they hit a nerve, the nerve can easily repair itself, in most cases.

i agree with the comments above, in that you should make sure you're seeing a licensed acupuncturist...and also only the acupuncturist should be removing the needles, not a nurse.

i also hope this doesn't deter you from future acu treatments, but make sure you're with a practitioner you're comfortable with and who listens to you.  acu treatments are generally very relaxing, once you get over the initial nervousness that everyone feels.  go with your gut, if you're not confident in this practitioner, find a better one! :)

greenredhead's picture

response

Chad: Thank you very much for your candid response. I have been avoiding talking more about what happened with the acupuncturist because it seems she doesn’t want to admit any liability. After doing some hard digging on the internet, I found another interesting study using ultrasound to view the insertion of the needle at the PC 6 point. Out of 97 cases, 52 needles came in contact with the median nerve, while 14 penetrated the nerve. After one week follow up, no complications were reported (http://www.liebertonline.com/doi/abs/10.1089/acm.2007.6247). It has been difficult to find a lot of literature on the subject, so thank you again Chad for your response. It made me feel less like I was the only person ever having to deal with something like this.

 Acubalance: To clarify, the licensed acupuncturist put in the needles, and then the nurse took them out. I think my biggest mistake was going to someone who didn’t have enough experience under her belt. She only graduated in 2008. I didn’t realize the importance of carefully selecting an acupuncturist. I thought with training, everyone was the same. I know different now.

 Update on how I’m feeling: The pain around the PC 6 point diminishing quite a bit over several days. However, within two days of my appointment, I began to feel the same deep ache in both wrists and ankles. My wrists feel a bit tired and weak. I get shooting pain in my hands, wrists, elbows, forearms, calves, ankles, and feet. I’m not sure if it’s referred nerve pain or that I’m still reacting from the other needle placements (total of 4 needles were used: wrist, hand, and both feet). I’m hoping it will go away and if not I will be making an appointment with my family physician. Maybe acupuncture just isn’t for me, and I may consider non-insertion techniques or acupressure down the road.

Thanks again for all your helpful responses. It has been a real comfort.   

Chad Dupuis's picture

Thank you for finding that

Thank you for finding that study, I had read that one as well awhile back and couldn't find it.  Very interesting reading.  Also I'm glad to hear that you are feeling better but am concerned that you may not further pursue acupuncture.  I would simply try someone else, perhaps even someone that practices Japanese acupuncture or at the very least ask them if they use seirin needles.  Generally if they use those needles they do lighter needling techniques.  The seirin needles have a light silicon coating on the needle that makes for a very smooth insertion and they are generally small in diameter than the standard Chinese needles most commonly used.