During needle insertion
Pain during insertion is usually due to clumsy technique, or to blunt, hooked or thick needles. It may also occur in highly sensitive patients. In most patients, skilful and rapid penetration of the needle through the skin is painless. The correct technique and optimum degree of force to use must be learned through practice. A few devices may facilitate smooth and fast penetration, such as the use of needle guide tubes (which hold the needle steady over the point while it is tapped into place), and the "flicking-in" technique (a method of inserting the needle by flicking the upper end of its handle with the middle or index finger of one hand while the handle of the needle is loosely held by the index and middle fingers of the other hand, with the tip of the needle lightly touching the acupuncture point). The "acupuncture sensation" of soreness, tingling and heaviness indicating the arrival of qi (deqi) at the point should be distinguished from painful reactions.
Pain occurring when the needle is inserted deep into the tissues may be due to hitting pain receptor nerve fibres, in which case, the needle should be lifted until it is just beneath skin and carefully inserted again in another direction.
Pain occurring when the needle is rotated with too wide an amplitude, or is lifted and thrust, is often due to it becoming entwined with fibrous tissue. To relieve the pain, gently rotate the needle back and forth until the fibre is released.
Pain occurring while the needle is in place is usually caused by it curving when the patient moves, and is relieved by resuming the original position.
This is usually due to unskilled manipulation or excessive stimulation. For mild cases, press the affected area; for severe cases, moxibustion may be applied in addition to pressure.