Investigating the effects of three needling parameters (manipulation, retention time, insertion site) on needling sensation and pain profiles and regional pressure pain threshold : a study of eight deep needling interventions

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Background: Since 1999, research studies on the effect of acupuncture on regional pressure pain threshold (PPT) have been carried out at the College of Traditional Chinese Medicine, University of Technology, Sydney. The current study extended the previous research by investigating three needling parameters (needle retention time, needle manipulation and site of needle insertion) on the strength and quality of needling sensation (deqi) and on the strength of needling pain. Aims: To investigate the effect of three needling parameters (needle manipulation, needle retention time and site of needle insertion) on: (a) the strength and quality of needling sensation reported, (b) the strength of pain at the needling site and (c) regional PPT measured at ten regional sites. Methods: The design used in this study was a dual blind (subject and assessor) within subject experimental design with randomised repeated measures. Twenty-four healthy subjects (12 males and 12 females) completed eight interventions scheduled at least one week apart. In each intervention manual acupuncture to LI4 or to a designated nonacupoint (NAP) was applied on the hand. Real or simulated manipulation was applied every three minutes and the needle was retained for either one or 21 minutes. PPT measurements were completed before, during and following the 21-minute intervention period using an algometer at ten regional sites across the body. Intensities of needling sensation and pain were measured using a 100mm visual analogue scale (VAS) every three minutes and sensation qualities were reported post-intervention. Results: Independent of the site of measurement (where the mean % PPT of all ten sites were combined for each intervention), the post-intervention mean % PPT were significantly elevated for all eight interventions. LI4m⁺²¹ produced the highest increase (9.1%) and LI4m⁻²¹ the lowest (3.7%). In terms of comparisons by site, the post-intervention mean % PPT were significantly elevated at all ten sites for the following interventions LI4m⁺²¹, NAPm⁻²¹ and NAPm⁺¹; at nine sites for NAPm⁺²¹, LI4m⁻¹ and NAPm⁻¹, at seven sites for LI4m⁺¹ and at only one site for LI4m⁻²¹. No significant difference was found regarding the subjects’ mean anxiety and tension levels and the acupuncturist’s behaviour among the interventions. Immediately post-insertion, mean needle sensation and pain scores were similar for all eight interventions. At all other measurement intervals, irrespective of insertion site (LI4 or NAP), only the two interventions with needle manipulation every three minutes and with needle retention for 21 minutes maintained statistically significantly elevated needle sensation and pain scores. Conclusions: The study did not find any clear relationship between the three needling parameters on regional PPT. However, it has shown that needle insertion is followed by an elevation in PPT above baseline levels that persists after needle removal. Presence or absence of needle manipulation and the duration of needle retention were important variables in terms of the intensity of needle sensation and pain. Similar needle sensation qualities and intensities were elicited at both the acupoint and the nonacupoint. This study also found that, irrespective of needling location, deep needling for 21 minutes with ongoing manipulation elicited and maintained elevated levels of needling pain and needling sensation. The study failed to provide findings that support the common Traditional Chinese Medicine (TCM) assumptions or assertions that deqi is necessary or essential for eliciting a physiological effect.
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