Jeff Rippey

Into nerves? No. Near nervous tissue/bundles? Sometimes.

Deliberately placing an acupuncture needle into a nerve would cause intense pain and, sometimes, lasting damage. Board certified and state licensed acupuncturists are well trained in the anatomy around acupuncture points (and anatomy in general). Part of the reason for this is so we don't end up getting a needle directly into a nerve.

That said, many acupuncture points are near nerve tissue. Several scientific studies on acupuncture, especially in pain conditions, show the needles are exerting some effect on neurotransmitters and brain processing of pain signals - making it likely that, at least in part, we're interacting with the nervous system in some way. I suspect this interaction is indirect by deformation of tissue near nerve bundles rather than a direct interface with the nerve itself.

The "how many treatments" question is one I get a lot. It's very difficult to answer for several reasons:

1. The Chinese diagnostic system takes in to account individual factors in presentation. Three people could walk in to my clinic with "sciatica" but, from the perspective of Chinese medicine, all three could be experiencing sciatica for different reasons. Those different root causes will have different treatments. Some root causes respond faster to treatment than others and some people respond faster to treatment than others.

2. There are a variety of different systems of acupuncture. Some of these systems are better for dealing with certain kinds of issues relative to other systems. Without knowing what kind of acupuncture your provider practices, it's hard to know whether or not there's a good fit between that system of acupuncture and your issue.

3. As in conventional medicine, some practitioners are just better with certain kinds of issues relative to other practitioners. There's an add-on here specific to acupuncture: depending on where you're located, there could be providers who offer "acupuncture" without having attended school for Chinese medicine or actually being licensed or board certified as an acupuncturist. Without knowing whether or not you're seeing a board certified and state licensed acupuncturist and what that person's track record with pain conditions it is, again, difficult to predict what a course of therapy might look like.

Let's make a few assumptions and try to give some general guidance. Assuming your sciatica isn't severe in terms of either frequency or pain levels (i.e. you're typically under 5-6/10 on a pain scale and there are days or times during the day where you experience no pain) and assuming you're seeing a board certified, state licensed acupuncturist (as opposed to a chiropractor or physical therapist) and assuming that person works primarily with pain conditions, you may be looking at something like 5 or 6 treatments spaced one week apart to bring the issue, more or less, under control. After that you might be looking at a few treatments with a greater spacing (every other week or every third week) and then you're probably looking at either issue resolution or maintenance.

Maintenance is likewise variable. On the low end you could be receiving one treatment every 4-6 weeks. On the high end you could be looking at one treatment per year.

The "how many treatments" question is one I get a lot. It's very difficult to answer for several reasons:

1. The Chinese diagnostic system takes in to account individual factors in presentation. Three people could walk in to my clinic with "sciatica" but, from the perspective of Chinese medicine, all three could be experiencing sciatica for different reasons. Those different root causes will have different treatments. Some root causes respond faster to treatment than others and some people respond faster to treatment than others.

2. There are a variety of different systems of acupuncture. Some of these systems are better for dealing with certain kinds of issues relative to other systems. Without knowing what kind of acupuncture your provider practices, it's hard to know whether or not there's a good fit between that system of acupuncture and your issue.

3. As in conventional medicine, some practitioners are just better with certain kinds of issues relative to other practitioners. There's an add-on here specific to acupuncture: depending on where you're located, there could be providers who offer "acupuncture" without having attended school for Chinese medicine or actually being licensed or board certified as an acupuncturist. Without knowing whether or not you're seeing a board certified and state licensed acupuncturist and what that person's track record with pain conditions it is, again, difficult to predict what a course of therapy might look like.

Let's make a few assumptions and try to give some general guidance. Assuming your sciatica isn't severe in terms of either frequency or pain levels (i.e. you're typically under 5-6/10 on a pain scale and there are days or times during the day where you experience no pain) and assuming you're seeing a board certified, state licensed acupuncturist (as opposed to a chiropractor or physical therapist) and assuming that person works primarily with pain conditions, you may be looking at something like 5 or 6 treatments spaced one week apart to bring the issue, more or less, under control. After that you might be looking at a few treatments with a greater spacing (every other week or every third week) and then you're probably looking at either issue resolution or maintenance.

Maintenance is likewise variable. On the low end you could be receiving one treatment every 4-6 weeks. On the high end you could be looking at one treatment per year.

It depends on why you have sciatica. There are a variety of reasons why a person might experience radiating pain in the low back/hips/legs, some of those reasons are better addressed with acupuncture, some are better addressed with chiropractic, sometimes your best bet is to use both acupuncture and chiropractic, and occasionally neither one is going to help.

if you're experiencing sciatic pain due to pinched nerves in the low back as a result of misaligned vertebrae or discs, then sometimes chiropractic alone and sometimes acupuncture plus chiropractic will help to resolve the issue.

If the pain is due to imbalanced muscle tension in the low back/hips/low limbs or if it's the result of piriformis syndrome, then acupuncture is probably your best bet. Sometimes acupuncture alone is better for problems that arise due to stenosis (narrowing of the spinal canal).

If you're experiencing radiating pain with lower limb weakness, loss of control over the bowels or urination, or saddle anesthesia (numbness in genito-anal area), then neither one is going to help and you need to get an othospinal/neurology consult immediately.

I suggest you start with your primary care physician and get some x-rays of your low back. If it the cause can be determined from the image, you'll have a better idea how you want to proceed with treatment.

Yes, it's safe to receive acupuncture daily. In China, patients will often receive acupuncture daily over several days in order to resolve a condition. We don't often use this model of delivery in the US because of cost.

Usually, yes, acupuncture can be a good choice for relief from lower limb neuropathy. The one outlier here is: if the foot neuropathy is a diabetic complication and the patient's blood sugar is not well controlled, acupuncture isn't going to be much long-term help. If the patient's blood sugar is under control, then yes, acupuncture can provide relief.

There are several mats and rolling devices that have a knobby or bumpy surface which will stimulate the feet in a general way.

When performed by a board certified and state licensed acupuncturist, yes. Broadly speaking, acupuncturists fall in to two camps: those who treat by placing needles in the location experiencing an issue (local needlers) and those who treat by placing needles in other places, but not in the location experiencing an issue (distant needlers). If your problem is neck pain, see if you can find a licensed acupuncturist in your area who practices Tung or Tan or "distant" style acupuncture. These folks will be able to address your pain without having to place needles in your neck. If you're not in CA, you can go to NCCAOM.org and use their "Find a Practitioner" lookup. This will give you a list of local providers. Then you can call around and see who practices a "distant" style.

Yes, acupuncture can be a good choice for management of neck pain due to arthritis. I work quite a bit with this issue and usually get very good results for people.

Make sure you're seeing a licensed acupuncturist in your area and be prepared to attend at least 3 or 4 sessions.

The "how many sessions" question is one we get a lot. The problem is the number of treatments can be highly variable. A lot depends on why you're experiencing the issue, whether or not there are lifestyle factors in play, how committed the patient is to addressing lifestyle factors, and how good the acupuncturist is.

Let's start by assuming you're seeing a board certified and state licensed acupuncturist (as opposed to a chiropractor or physical therapist who might be offering "acupuncture like" services with a fraction the training).

Let's also assume that your neck pain is fairly straight-forward from the perspective of the Chinese diagnostic model.

If your pain is acute (you've been experiencing the issue for 6 months or less), then you may be looking at 5-7 treatments to either bring the pain down or resolve the pain entirely.

If your pain is chronic (you've been experiencing the issue for longer than 6 months), then you may be looking at more like 8-10 treatments.

Sometimes acupuncture can resolve pain and no further treatment is needed. Sometimes acupuncture reduces the pain to tolerable levels and maintenance is required to keep the pain tolerable. Maintenance intervals can be highly variable and depend largely on the individual being treated and the root cause for the problem. On the low end maintenance intervals are on the order of 4-6 weeks. On the high end, we're talking one treatment every 12 months or so.

Either way, in the long run, acupuncture is often much cheaper than conventional pain management strategies. Acupuncture also has the advantage of minimal side-effect and no risk of dependency/addiction.

Acupuncture can be an excellent treatment for anxiety disorder.

We can break acupuncture's effects in anxiety down to two basic things:

1. Acupuncture promotes the parasympathetic side of the autonomic nervous system. This part of the nervous system acts in opposition to the "fight or flight" (sympathetic) side. The benefits here are increased relaxation, promotion of blood flow to the internal organs and reduced blood pressure.

2. Acupuncture also interacts with the GABA system in the brain/central nervous system. This is the same place where anti-anxiety drugs like valium or xanax exert their effect, acupuncture does it without the risk of addiction or withdrawal. The GABA system helps the central nervous system relax which brings a level of relief to anxiety sufferers.

When working with more complex issues like anxiety or depression, it's important to make sure you're seeing a board certified and state licensed acupuncturist. You want someone who attended and graduated from a school of Chinese medicine rather than some other practitioner who may be adding acupuncture under the scope of some other licensure. Generally you're looking for an L.Ac. or R.Ac. credential and, outside of CA, your provider should also have an NCCAOM board certification. If you need help finding a local provider, again assuming you're not in CA, you can go to the "Find a Practitioner" lookup at NCCAOM.org.

To be honest, you may not notice much of a difference after a single treatment. Acupuncture for any condition is usually a front-loaded process - meaning you're looking at a series of treatments to bring your issue under control. For most folks and most conditions I usually tell people to be prepared to attend at least 3-4 sessions before they decide acupuncture isn't working.

The other complicating factor here is the Chinese diagnostic model. In Chinese medicine we recognize that people often experience the same or similar issues for different underlying reasons. Some of those underlying reasons are easier to treat than others which can affect how many treatments a person might need before they start to notice changes.

I do a bit of work with mild to moderate depression. I've received a variety of feedback from patients after a first session. This feedback ranges from improvement of symptoms for the first day or two after the first session, to no changes for a day or two after the session followed by a slow improvement over the next several days. Sometimes people notice improvement in other symptoms like reduced fatigue or more energy in the mornings or greater ability to tolerate things that would previously have caused anger or increased depression. Sometimes people don't report any changes for the first session or two and by the third or fourth session they're seeing lots of improvement.

Each person represents a unique set of circumstances and treatments are tailored to the individual. Without meeting and diagnosing you, it's hard to predict what you might experience after your first treatment.

A lot is going to depend on how severe your panic attacks are and how frequently you experience them. Acupuncture is usually a front-loaded process which means that we typically see a patient fairly frequently up front and then space the treatments out as symptoms start to improve or resolve.

If we assume a mild to moderate condition, you may be looking at 6-7 treatments spaced one week apart, followed by 3-4 treatments every other week, and then a few treatments on a monthly basis. After that, the frequency depends on how well a patient has responded to the initial course of therapy.

For a more severe situation your provider may want to see you a couple of times per week until you're feeling more relaxed and experiencing less episodes, then they might start to space things out.

Acupuncture is a great choice for stress management. Helping people deal with their fear/anxiety/stress over the coronavirus situation is pretty much all I'm doing right now.

If you're experiencing chest pain and/or tightness and/or shortness of breath, you need to start with your primary care physician or an ER. There are lots of potential causes for this type of discomfort and you need to rule a few things out before considering acupuncture.

If you've already been through the conventional process and the doctors don't have a good answer for you, yes, acupuncture and Chinese medicine can often bring relief in this type of situation.

Please make sure you're seeing a board certified and state licensed acupuncturist. If you're not in CA, you can start with the "Find a Practitioner" look up at NCCAOM.org.

Yes, acupuncture can typically help reduce a fever. In the current circumstances though, it's probably best to go to your doctor's office/urgent care/ER and get checked out - just to be on the safe side.

Usually, yes. Fatigue is a very common complaint, often in combination with other health issues. Acupuncture can typically help to bring your energy levels back towards normal.

In cases where fatigue is the primary complaint, there is often a lifestyle component in play as well. Addressing lifestyle issues at the same time will often get you where you want to be much more quickly.

How long needles are retained is often dependent on what kind of practitioner you're seeing, what your chief complaint is and what Chinese syndrome diagnoses match your presentation.

For something like simple musculoskeletal pain due to trigger point(s) or motor point issues there might be minimal retention. Most of the times these problems can be resolved with a precise insertion and removal.

If you're going to a community style acupuncture session, 15-20 minutes is the norm.

For a private appointment, most folks use a 30'ish minute retention time.

For a typical private appointment session, most folks use something around 30-40 minute retention. In China I've seen retention times closer to 60 minutes for particular patients and particular conditions.

I like to use small dermal tacks on certain patients with certain conditions. These are really tiny needles on an adhesive backing (it looks like a circular bandaid). Most of the time these can be left in place for a few days.

If we're talking regular acupuncture needles, somewhere between 30-60 minutes is probably good enough. You shouldn't be leaving your practitioners' office with any regular sized acupuncture needles still in place. The concern isn't necessarily that the point is overstimulated in some way, it's more about infection risk and tissue damage.

Great question - there are probably a lot of things going on when we talk about acupuncture's pain relieving effects.

1. For a long time we've known that acupuncture stimulates the release of endogenous opiate peptides. These are protein molecules, released in the brain and central nervous system that diminish pain signals coming from the limbs and trunk. We also now have fMRI studies that show acupuncture increases binding sites for endogenous opiates.

2. We also have several studies showing acupuncture regulates a set of neurotransmitters in the brain and spinal cord that are involved in the propagation of sensory signaling.

3. Finally, we have fMRI studies showing acupuncture changes the way the prefrontal cortex of the brain deals with pain signaling.

In addition to these changes, acupuncture increases blood NO concentrations which dilates blood vessels and provides more fluid flow through injured areas, down-regulates the immune system through its impact in interleukins, prostaglandins and cytokines and generally puts the body in to "rest and digest" mode by promoting the parasympathetic side of the autonomic nervous system.

Taken together these effects reduce pain, reduce inflammation and promote healing. Lastly, we have some interesting studies showing acupuncture, especially electroacupuncture, stimulates the production of stem cells.

In short, there are a lot of biological effects that can arise as a result of acupuncture, which is why you want to make sure you're seeing a well-trained, board certified and state licensed acupuncturist. These folks are in the best position to diagnose and choose the proper treatment for your issue. If you're outside CA, you can go to the "Find a Practitioner" link at NCCAOM.org to get a list of local providers.