Jeff Rippey

Generally the only pre-appointment advice I give to patients is to wear loose clothing and have a light meal or small snack prior to coming in. I don't usually have specific instructions for things to avoid.

Good question, I'm not sure I can answer it though. Unfortunately, US acupuncturists have tried to market the procedure as 'painless' and that's not, strictly speaking, true.

First off, we like to think that body structures, particularly those under the skin, are static. They aren't. Depending on temperature, time of year, hydration levels and so on things like vessels and small nerve branches can shift around. Since we're not using x-ray vision when placing needles, it can be hard to know precisely where things are. Most acupuncturists are well trained in gross anatomy, but if a patient is mildly dehydrated and things have shifted slightly as a result, it's difficult to predict what might be in the way. This can lead to a point that wasn't painful previously being painful at the current treatment.

Secondly, I often see acupuncturists using the thinnest possible needles under the mistaken assumption that thinner will cause less pain. It seems paradoxical, but this isn't true. Part of the pain (or lack of pain) in needle insertion is related to how fast the needle gets through the first fractions of a millimeter of skin. Thinner needles are more bendy and will spend more energy on flexing rather than getting through those first few fractions of a millimeter, which makes thinner needles much more likely to be less comfortable relative to a thicker needle (we're talking very small differences here. My standard needle is 0.25mm in diameter. Many acupuncturists I know will use 0.18mm or 0.16mm needles. Generally speaking, I've found these thinner needles to be very uncomfortable relative to a thicker 0.22mm or 0.25mm).

The last reason you may be experiencing undue discomfort is: you might not be seeing a board certified and state licensed acupuncturist. Right now in the US many states will allow chiropractors, physical therapists, and sometimes athletic trainers to perform a procedure that uses acupuncture needles. I like to refer to these folks as providing "acupuncture like" services. Most of the time their training consists of 100 hours or less with zero hours of supervised practice. These folks are often allowed to advertise their services as "acupuncture" which causes a great deal of public confusion. A board certified, state licensed acupuncturist has a minimum of 1,900 hours of training in acupuncture and Chinese medicine with somewhere between 500 and 750 hours of supervised practice. Most of us have much more than this. There is often a big difference between seeing someone who offers "acupuncture like" services under the scope of some other licensure and someone who actually trained and is board certified in acupuncture and Chinese medicine.

Is acupuncture "painless"? No, it isn't and we shouldn't be marketing acupuncture this way. It's very normal to have a very short lived sharp pinching sensation during initial needle insertion. This should fade in a second or two - if it doesn't, you should let your provider know and have the needle removed or repositioned.

There is a list of sensations that are considered normal or even desirable during needle insertion and retention. These include: a dull aching or dull throbbing, a short lived pins and needles sensation that propagates up or down from the needle site, or a mild distending sensation around the needle (somewhat like someone is blowing a balloon up under the skin).

If any of these sensations are too intense or distracting, tell your provider so the needle(s) can either be removed or repositioned. Do not just lay there in discomfort and don't let any provider, acupuncturist or not, guilt or shame you in to not addressing any needles that might be painful or too intense.

How long does it take for acupuncture to work for "x" condition is a question I get a lot. The problem is, it's impossible to answer. This is the case for 3 main reasons:

1. There are a lot of providers in the US who are offering "acupuncture-like" services under the scope of some other licensure (like chiropractors, physical therapists and, increasingly, even athletic trainers). The problem is, unless they happen to be dual credentialed and licensed, none of them have actually attended or graduated from a school of Chinese medicine - most of the time they have 100 hours or less of training (compared to 2,000 to 4,000 hours of the typical graduate of a US based Chinese medicine program). They usually offer what we refer to as "cookbook acupuncture" which rarely works - in the unusual case where "cookbook acupuncture" does work, it can take quite a few treatments to get the job done. Since I don't know what provider you're seeing or what education and credentialing they have, it's hard to set your expectations.

2. The diagnostic model in Chinese medicine is individualized. Even though people might experience the same symptoms, they often don't experience those symptoms for the same reason. Chinese medicine recognizes this and the diagnostic model accounts for these individual differences. Just like conventional medicine, in Chinese medicine some diagnoses are easier to treat than others. Without actually seeing a patient and diagnosing them, it's hard to provide anything other than the most general guidance in terms of how many treatments it might take to get to symptom decrease or symptom resolution.

3. Acupuncture and Chinese medicine are not a monolithic system. In other words there isn't one single acupuncture approach. There are a variety of acupuncture systems in use around the world and different practitioners sometimes specialize in different systems. Some of these systems are a better fit for certain kinds of issues than others. So, without knowing what system(s) of acupuncture you have available to you, it's hard to set your expectations in terms of how long it might take to relieve your symptoms.

All that being said, assuming you're seeing an actual NCCAOM board certified and state licensed acupuncturist (L.Ac. or R.Ac.), it might take something on the order of 5-7 treatments to get your stress under control. Since stress is one of those issues that often has a significant lifestyle component, a patients ability to make changes outside of the treatment schedule can have a large impact on the total number of treatments necessary. Also, with stress in particular, it's entirely probable that you'll notice a difference in a treatment or two.

Yes, generally speaking acupuncture is a good treatment option for osteoarthritis - particularly if we're talking about pain management.

For the best results, please make sure you're seeing a board certified and state licensed acupuncturist. At a minimum they should have an L.Ac. or R.Ac. credential. If you're outside of CA, you can use the "Find a Practitioner" lookup at NCCAOM.org to get a list of providers local to you.

Acupuncture, in most cases, has a dose dependency. The easiest way to think about this is to compare 1 acupuncture treatment session to 1 dose of a medication. Most of the time, only 1 dose of medication doesn't get a patient lasting effects (sometimes it does). Acupuncture is similar to this - most of the time a single acupuncture session doesn't get a patient lasting effects (though, sometimes it does).

How long a single treatment might last for any given condition is highly variable. There aren't any hard and fast rules, for some folks one treatment might last months and for others a single treatment might last hours.

Most studies show that acupuncture's effects after 8-10 treatments can be quite long lived - upwards of a year in pain management.

All of which is a very complicated (and long) way of saying - for any given individual it's hard to say exactly how long the effects of a single treatment might last. Sometimes it's hard to say exactly how long the effects of a course of therapy might last. Your best bet is to commit to 3-5 treatments and see if your anxiety is getting better. If so, start spacing the treatments out until the anxiety starts to return. Then receive acupuncture at that interval for a few months and see how you feel.

The last variable here is the type of provider you see. Please make sure you're seeing a board certified and state licensed acupuncturist - they will have either an L.Ac. or R.Ac. credential. If you're outside CA, you can use the "Find a Practitioner" lookup at NCCAOM.org to get a list of local providers.

A lot is going to depend on why your knees are swollen. Generally, yes, acupuncture can be a good treatment option for this kind of issue. That being said, a good place to start is with your primary care physician to have some imaging done and rule out any, more serious, issues.

If your doctor can't come up with a reason why the fluid is present or they rule out more serious problems, then acupuncture can probably help.

I do a lot of work with this type of issue and get excellent results with a technique called moxibustion. There are a variety of moxibustion techniques, but they all involve the burning of an herb (Artemesia vulgaris) with the application of heat to the swollen area.

For the best results, please make sure you're seeing a provider who is board certified and state licensed. At a minimum they should have an L.Ac. or R.Ac. credential. If you're outside CA, you can use the "Find a Practitioner" link at NCCAOM.org to get a list of local providers.

Yes, acupuncture can often be successful with excessive sweating.

For something like this, you need to make sure you see a provider who is actually trained in Chinese medicine and licensed as an acupuncturist in your state. If you're not in CA, you can start with the "Find a Practitioner" link at NCCAOM.org to get a list of folks local to you.

Claiming acupuncture is "better than" anything can be tough to back up. There are times when acupuncture is your best bet, there are times when some other method is you best bet and there are times when acupuncture plus something like chiropractic is your best bet.

I treat a lot of headache and migraine, and I often get results for people when chiropractic has failed. Is that because acupuncture is better or is that because I'm getting the folks for whom chiropractic wasn't the answer?

Here's what I'd suggest. If these headaches are a "new" phenomenon for you or they've increased in frequency and/or intensity, you should start with your primary care physician and possibly neurological consult. There are some things we need to rule out first.

Assuming you have gone this route and nothing unusual was detected, use the "Find a Practitioner" lookup at NCCAOM.org and get a list of board certified acupuncture providers local to you. Call around to a few and see if you can find someone who works primarily with pain or headache/migraine. Plan to go to at least 3 treatment sessions. By the 3rd or 4th session you should be noticing a change in frequency and/or severity of your headaches. If you aren't it might be time to think about either adding chiropractic to the acupuncture or switching to chiropractic.

Acupuncture can often help patients get resolution for excess sweating.

This is a case where you need to make sure you're seeing someone who attended a school of Chinese medicine and is licensed as an acupuncturist in your state. If you're not in CA, you can use the "Find a Practitioner" lookup at NCCAOM.org to get a list of local providers.

Generally, yes. There is a sub-specialty in the acupuncture world known as cosmetic acupuncture. These folks are well trained in facial anatomy and usually get very good results with lines and wrinkles.

I'm not trained in nor do I practice cosmetic acupuncture. Your best bet would be to go to the "Find a Practitioner" link at NCCAOM.org, get a list of local providers, and start looking at web-sites or calling to see if anyone in your area is trained in this specialty.

There is a sub-speciality in acupuncture known as "cosmetic acupuncture". These folks receive special training on facial anatomy and generally get very good results with wrinkles and fine lines, so, yes, acupuncture can probably help with your issue.

I'm not trained in nor do I practice cosmetic acupuncture. Your best bet would be to go to the "Find a Practitioner" link at NCCAOM.org, get a list of local providers and check out their web-sites or call them to see if they work with cosmetic acupuncture.

Yes, itch at the needle site is a very common event to experience after receiving acupuncture. The body starts to mount a mild immune response to the needle and histamine is part of that response. The itching usually resolves in an hour or two and, if it's too distracting, something like benadryl or hydrocortisone cream (both available over the counter) will help.

If you're talking about a more systemic or body wide itch post treatment, it's possible you might be allergic to the needle itself. Acupuncture needles are typically stainless steel which includes nickel and, while it isn't common, I have seen people react to the nickel in the needles.

Yes, this is a risk when receiving acupuncture. Risks like nerve damage and punctured organs are exactly why I always tell people to make sure their provider is a nationally board certified and state licensed acupuncturist.

These are people who attended and graduated from accredited programs of acupuncture and Chinese medicine. Licensed acupuncturists (L.Ac. or R.Ac.) are generally well trained in terms of the anatomy and structure in and around acupuncture points and patients are much less likely to experience an adverse event when seeing an L.Ac./R.Ac. than when using a provider like a physical therapist (PT) or chiropractor (DC) who is offering an "acupuncture like" service under the scope of their existing license.

I get questions like this a lot and there area couple of caveats to my answer:

1. I don't know if you're seeing or planning to see an actual board certified acupuncturist or a provider who is offering "acupuncture-like" services under the scope of their existing license. There is a big difference between someone trained and board certified specifically in acupuncture and Chinese medicine and someone who has taken a few seminars and is now offering the service. Generally speaking, providers offering acupuncture under the scope of some other licensure are practicing "cookbook acupuncture" which rarely works well for any condition.

2. Chinese medicine uses an individualized diagnostic system. In other words, the reason you have anxiety (or any condition) may not be the same reason someone else is experiencing anxiety (or any condition). Without actually seeing and diagnosing you, it's hard to say how many treatments might be required.

That being said, there are some general guidelines. Assuming your anxiety is more towards mild or moderate, a full course of therapy might be something on the order of 6-8 treatment sessions. Patients are normally noticing a difference in their symptoms by the 3rd or 4th session.

If your anxiety is severe, you may be looking at 10-12 total treatments and may not notice symptoms reducing until the 4th or 5th session. Also in severe cases, you may get faster results by combining acupuncture with therapy and/or prescription medication.

When it comes to anxiety, acupuncture is interacting with the nervous system in a couple of ways: First, acupuncture promotes the parasympathetic nervous system. This is the "rest and digest" side of the autonomic system and acts in opposition to the sympathetic or "fight or flight" side. By activating the "rest and digest" system, acupuncture helps to calm things down. Second, acupuncture has also been shown to stimulate the GABA system in the brain. This is the same neurotransmitter system that is impacted by drugs like Xanax or Valium. The GABA system is inhibitory - meaning it also acts to calm a person.

Yes, acupuncture can usually help anxiety and panic attack. if it's severe, it might take more treatment sessions and you may want to consider adding therapy or prescription medications to help you manage.

How long it takes acupuncture to work for anxiety/depression depends a lot on why you have anxiety/depression. The Chinese model differs from the conventional model in several key ways, one of which is in the differentiation of disease cause. Chinese medicine is individualized which means that even though you may be experiencing similar symptoms to other people, the reason you're experiencing those symptoms may be different.

Without seeing you and going through the diagnostic process, it's very difficult to provide any kind of time frame for symptom resolution. Generally speaking, a course of acupuncture treatment might be something in the range of 8-10 treatments. Usually patients start noticing a difference in their symptoms around the 3rd or 4th treatment session.

If your depression is mild to moderate, yes, acupuncture can be an excellent treatment. If you're more towards the severe end of the spectrum, you'll want to combine acupuncture with either conventional prescription medications or therapy.

Where needles might be placed for any condition is hard to say. There are a couple reasons for this:

1. There are multiple different systems of acupuncture, each of which has a slightly different approach to treatment. Depending on what kind of acupuncturist you see, you might end up with a wide variety of potential needle placement(s).

2. A lot will depend on why exactly you are experiencing anxiety. The Chinese diagnostic and treatment model is individualized. The best way to explain this is through an example - three people could walk in to my office tomorrow complaining of anxiety and, in the Chinese diagnostic model, they might all have anxiety for different reasons. These different root causes will require three different treatment approaches. Even though they're all subjectively experiencing anxiety, they all receive different treatments and the needle placement could be entirely different for each person.

In a roundabout way, yes. We have some excellent studies that show acupuncture regulating blood sugar and insulin levels, hormones used to signal hunger and fullness as well as the release of digestive enzymes. We also know that acupuncture promotes the parasympathetic "rest and digest" portion of the autonomic nervous system. We also know that acupuncture tends to promote homeostatic mechanisms in the body and acts to normalize lots of different functions.

Is acupuncture going to directly increase/decrease metabolic rate? There's no evidence that I'm aware of which would indicate this is the case.