Acupuncture Needle Sensation: The Emerging Evidence

Abstract

There is a long held belief that de qi is important to achieve positive therapeutic outcomes in acupuncture.1 2 Recently, a panel of experts considered adequacy of acupuncture dose from a neurophysiological perspective and suggested that a patient's sensory experience during needling ( de qi ) was important because it may be related to treatment outcome.3 Previously, we have debated whether the intensity of acupuncture needle sensation ( de qi ) is positively correlated with analgesic outcome and whether acupuncture needle sensation can indicate adequacy of needle technique.4 In this issue of the journal White et al 5 conducted a secondary analysis of data gathered in a randomised controlled clinical trial (RCT) and found no relationship between the strength of de qi and pain reduction for osteoarthritis of the knee and hip ( see page 120 ). Their suggestion that less emphasis should be placed on eliciting painful de qi during acupuncture is certain to raise debate, although it was not clear from the report whether this recommendation extended to non-painful de qi . In the past decade investigators have emphasised the need to generate needle de qi sensations during real but not sham interventions in RCTs. Some trials find better pain relief for real acupuncture with de qi ,6,–,9 whereas others do not.10 11 The secondary analysis by White et al is important because explicit analysis of needle sensation and pain relief is lacking in previous trials. However, there were some confounders that might have biased findings toward a negative outcome. A gross indicator of de qi sensation was used and this may have lacked internal sensitivity. De qi sensation was measured using the total score of the Park needle sensation questionnaire administered once at the end of a 4-week course of treatment. Each patient was …