Generally acupuncture should not be painful.

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It is normal to feel a mild tingle or dull ache as the acupuncturist inserts or adjusts the needle. This sensation is known as deqi (the bringing or arrival of qi). Acupuncture needles are so fine that many patients don't feel them being inserted. While the needles are in place most patients start to feel very relaxed. 

There have been a number of scientific papers published on the safety of acupuncture. These have concluded that acupuncture is safe so long as it is delivered by a properly trained individual. Therefore, it is recommend that you ensure your acupuncturist belongs to a professional organisation such as the CTCMPAO (Ontario).

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As acupuncture involves the insertion of needles there will sometimes be a small bruise where the needle was inserted. Occasionally, people can feel dizzy or tired after a treatment, but this passes quickly.

To help your acupuncturist ensure that there are no unwanted side effects, please let them know any medications that you are taking, such as anti-coagulants. Also let them know if feel hot or the room is stuffy, or you are hungry/thirsty.

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Research papers on the safety of acupuncture:
MacPherson H, Thomas K, Walters S, et al. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ Clinical research 2001;323(7311):486-87.
White, A. (2006). The safety of acupuncture – evidence from the UK. Acupuncture in Medicine, 24(Suppl), 53–57. https://doi.org/10.1136/aim.24.Suppl.53

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Witt CM, Pach D, Brinkhaus B, et al. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forschende Komplementärmedizin 2009;16(2):91-97. doi: 10.1159/000209315

It is generally recommend that people wear loose comfortable clothing. This will help patients to feel relaxed during the treatment and allows easier access to many of the acupuncture points. However wearing loose clothing isn't always possible and that is OK too. Acupuncturists provide sheets and/or blankets at each treatment and many patients prefer to lay underneath these. Patients modesty and comfort is paramount.​

Acupuncture points are believed to stimulate the central nervous system. This, in turn, releases chemicals into the muscles, spinal cord, and brain. These biochemical changes may stimulate the body's natural healing abilities and promote physical and emotional well-being.

TCM theory uses the concept of qi. For example, when somebody is in pain, this is considered to be a blockage in flow of qi. An acupuncturist will select points along the channel(s)/meridian(s) that are affected in order to encourage the qi to flow more freely/in the correct direction. 

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The overall aim is to direct the flow of qi to trigger your body’s healing response and to restore physical, emotional and mental equilibrium. Treatments are designed to affect your whole being as well as your symptoms so, as the condition being treated improves, you may notice other health problems resolve and an increased feeling of wellbeing.

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From a modern science perspective, one of the first potential mechanisms and probably the most famously known mechanism is the release of endorphins. However, it is unlikely that the effects of acupuncture can be attributed to a single mechanism. There are a number of possibilities which include [1]:

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1. peripheral effects (release of adenosine and nitric oxide by axonal and dorsal root reflexes)

2. spinal effects (modulation of sympathetic tone and motor reflexes)

3. modulation of endogenous descending paying inhibitory and facilitatory systems

4. changing the functional connectivity of the brain. Activation deactivation of

   • limbic structures involved in stress/ illness responses

   • the hypothalamus pituitary adrenal axis

   • the prefrontal and frontal cortices

5. restoration of the default mode state

6. modulation of parasympathetic activity

7. activation of the reward and mirror systems

8. modulation of activation of the immune system

9. expectation, attention, conditioning an extinction of conditioned responses

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A landmark study recently published in Nature showed a mechanism that is related to a specific acupuncture but not another. This study demonstrated that vagal-adrenal anti-inflammatory axis in mice was driven by the stimulation of the point ST36 but not ST25 [2]. The importance of this study is that it suggests a specific effect of an acupuncture point. In other words, the mechanisms of acupuncture are not simply general effects which occur regardless of where the needles are inserted.​​

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1. Lund I, Lundeberg T. Mechanisms of acupuncture. Acupuncture and Related Therapies 2016;4(4):26-30. doi: https://doi.org/10.1016/j.arthe.2016.12.001

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2. Liu S, Wang Z, Su Y, et al. A neuroanatomical basis for electroacupuncture to drive the vagal-adrenal axis. Nature 2021;Oct;598(7882)(1476-4687 (Electronic)):641-45. doi: doi: 10.1038/s41586-021-04001-4