"I'm Afraid of the Needles" (December 16, 2014)

This has got to be the most common objection to receiving acupuncture treatment that I hear from people. (Well, actually, “my insurance won’t cover it” is probably the most common. I feel for you guys, I really do. Insurance premiums are just absurd, and we want to be able to use it. But between deductibles, copayments and visit limits, even with insurance coverage you’ll end up paying most everything anyway. That’s why I don’t charge much to start with.)  

Getting stuck with needles for health reasons isn’t a foreign concept to us Westerners. But being stuck with a whole bunch of them and having them left in for almost HALF AN HOUR? No thank you. That’s just weird.

The thing is -- and I hope this doesn't sound to terribly un-American -- Asians are generally healthier than Westerners. They live longer and have far lower incidences of many health issues. This despite widespread malnutrition and the fact that they still smoke like chimneys. Now there are many differences between the ways that our civilizations live that come into play here, but one of them has to be their use of Chinese medicine for so much of their health care. How could it NOT be a factor? So weird or not, Chinese medicine (or East Asian medicine, as I'm starting to hear it called) shouldn’t be overlooked. Most people are good with that, and don't have a real problem with using herbal medicine. It’s those needles.

Now, there are people who have a genuine problem with needles. I once heard a story about a paramilitary training seminar full of seriously tough guys (policemen, soldiers of fortune, mall cops) that lost several of its attendees when they had to learn to give themselves injections. And I’ve worked on more than one person for months who never really became accustomed to being needled. I think that such people are more physically sensitive to needles to begin with, and that when you combine that with the genuine pain that Western injections cause AND exposure to that pain initially at such young and impressionable ages, it’s amazing that any of them tried acupuncture to begin with. (They benefit from the treatment despite their aversion to the needles, by the way.)

But my feeling that most of our aversion to needles is psychological in origin is because this phobia is practically nonexistent among Asians. In my time at the school clinic in Southern California where our patients (and my fellow students) were well over half Asian, I remember only one Asian lady who was spooked by needles and she was consequently the source for much private mirth among my Asian colleagues. Rather than genuine pain issues, for most people it’s just a creepy feeling that they have about the whole unfamiliar business. Here is what those people need to know.

  •  Acupuncture needles are really, really thin. Even thinner than they have been traditionally, since now we use single-use needles – we throw them out after one use and they don’t have to be preserved due to their costliness or be able to stand up to sterilization. Most of the ones I use personally are 2/10th of a millimeter in thickness, slightly on the thin side even for an acupuncture needle. That is about 0.008 of an inch. You can get 20+ acupuncture needles into the bore of a typical hypodermic needle. We’re talking THIN here, people. They are often referred to as “hair thin”, and if we are talking about a thick hair, well, that’s not far off.  

Again, we don’t reuse or sterilize needles. Although I am a great recycler, I do not remember the needles from my own early treatment (where the needles were placed between treatments -- and between patients -- into steel wool soaked in a bleach solution, to both sharpen and sterilize them) with any great nostalgia. To my mind, disposable needles are the greatest invention since the electric light.

  • Besides being really thin, they’re solid -- “filiform” or “threadlike” versus hypodermic/hollow bore. One of the reasons that hypodermics hurt so much is that a hollow needle does a lot more tissue damage than a solid point. An acupuncture needle pushes tissue out of the way as much as it pierces.
  • Most of the time (especially early on in treatment) people don’t feel the needles going in at all, or else they feel no more than a little pressure or sometimes a pinch.  
  • Except in a few fleshy areas, the needles usually are inserted no more than a quarter or half inch into the body, but talking about needle depth kind of gives the wrong impression -- most pain nerves are in the skin, so once you are past the skin you usually don't feel the deeper insertion at all. Most acupuncturists (myself included) use little plastic guide tubes for the needle that not only help in accurate positioning but allow us to “tap” the needle through the skin initially – the speed involved with that also cuts down on any discomfort, which is usually gone almost immediately anyway. Actual pain is genuinely uncommon and is not tolerated in an acupuncture treatment – the offending needle is immediately removed and severely punished.

As well as the associations we have with needles generally (thanks for nothing, "Hellraiser" and "Final Destination 5"), it’s the unfamiliarity of acupuncture treatment that makes it an iffy subject for so many people. Someone asked me many years ago about acupuncture for chronic sinus infections. For a friend. This friend had had two sinus surgeries already, and was scheduled for a third one. S/he was thinking about trying acupuncture instead, but was afraid of the needles. I blurted out, “Your friend isn’t afraid of being knocked unconscious and having holes drilled in her skull, but she’s afraid of a few needles?”. Not a very adept handling of a genuine concern.

But the point remains, and here it is, a little more tactfully this time. We tend to be cautious about the unfamiliar in general. Unfortunately that leads us to often overestimate the risks in something unfamiliar, and underestimate the ones that are familiar. So look at this -- 1/4 of all hospital patients are harmed by a medical error, and medical errors are the 6th leading cause of death in the U.S. Whereas the risk of a serious adverse effect from acupuncture (that’s one that would require hospitalization) is about 0.024%, or about one in 4,000. (That’s a European figure – I couldn’t find an American one.) So -- bring on the needles, I say. 


--dr. diane holmes
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