Hypersenitive to skin puncture

Submitted by altmed on Thu, 05/06/2010 - 11:31am

Hello,

I am treating a 55 yr. old post menopausal female for general health issues. Her only complaint was right lateral knee pain radiating to her outer foot. My initial assessment was high stress levels, pupils chronically constricted, sleep disturbed, build is thin and a fast metabolism. She denies anxiety, depression, OCD or any psychiatric hx. She appears calm and is able to remain in a relaxed posture.

She is hypersentive to initial needle insertion. I have tried a number of techniques and including cosmetic needles. Once the skin is punctured I can needle and obtain deqi, however, her sypathetic system goes into hyperdrive at the beginning of a treatment (sweating etc) and I have to revert to accupressure or trancutaneous.

I have tried H7, P6 and Lu 9 to reduce sypathetic, with no result. I am able to needle Du 20 and auricular points, but no body points; she does stae some relaxation and outwardly appears calm able to relax for 30 mins or more. She is particulary sensitive to and hand or foot points i.e Li 4 and Liv 3. I ensure she has no dietry stimulants also.

Any ideas ?

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Comments

Chad Dupuis's picture
Submitted by Chad Dupuis on Thu, 05/06/2010 - 12:22pm.

What is the overall diagnosis

What is the overall diagnosis for the patient?  From the brief description it sounds like yin deficiency perhaps.  Either way, I'm not sure I see where LV 3 and/or LI 4 fit into either the diagnosis or the treatment.  For knee problems we most often use LV 8 and of course the extra points for the knee.

Sensitivity to needling is nearly always related to technique.  There are, I imagine, a few people with heightened sensitivity and in those cases using GV 19 (sensory cortex of the brain) can be helpful.  Technique wise, however, we use insertion tubes, possibly with seirin's and with even insertion (no manipulation, no "obtaining deqi", etc.) - just get the needle in and leave it alone....  Personally I've never had a patient that couldn't handle needling, some we just have to be a bit more adaptable (outside of just the types of needles being used).  PC 7, if necessary, is a far better choice than HT 7 or PC 6 in this case.

Chad J. Dupuis, L.Ac.
Yin Yang House Acupuncture and Wellness Center

tzvi's picture
Submitted by tzvi on Wed, 05/12/2010 - 10:45am.

55 year old/

according to japanese acup. outer knee pain refers to dai mai and is treated by needeling gb41 + tw4 on the same side +  liv 13 on the other side u can try even both sides at the same time ,there

is another option but for that u need "ion cord " and to conect st2   to  st 44( water point )

good luck

tzvi

sriendeau's picture
Submitted by sriendeau on Wed, 05/12/2010 - 6:30pm.

needle sensitivity

A heightened sensitivity to needles can be a sign of  a couple of things.  One is heat, especially Empty Heat.  Heat combined with dampness on the skin (in the form a slight sweat at the site you are needling) can make the sensitivity even worse.  Another very common factor is an over stimulated nervous system, e.g. a "fight-or-flight" condition which will tend to lead to hyper-reactivity and also to hyper "wei qi responses" such as hives, rashes or swellings with needling.  The key is to signal to the brain that the stimulation is not invasive or does not require a strong Wei Qi response.  Do this by keeping all touch very calm and slow and by minimizing the prodding or number of needles.

 

I have treated many clients with needle sensitivity and can recommend the following. 

  • Make sure you and your hands are truely relaxed.
  • Ask the patient to take a big breath and then insert with exhale.  Breath in deeply  with the patient and exhale as you insert and always use a soft tapping with the tube.
  • Use the thinnest needle possible; this patient will benefit even from a tiny needle.
  • Try stroking the point slowly before needling.
  • Needle the points you think might be the least sensitive first (this might mean you do your back treatment first --beginning with upper back or ST line on leg is especially good).
  • If the point is wet or sweaty: make sure it is dry.  If the patient is not too hot try a cone moxa on the spot first. 
  • The smell of moxa can be extremely relaxing so you might burn a cone or two some where (stay below the waist if the patient has XS or def Heat signs.
  • Try pressballs in or the ear or even on Yintang first.  Try: Master Cerebral, Shenmen, Point Zero; or just gently and slowly tug on the ear for a few seconds.
  • Use other tools on the points if the patient cannot tolerate the needles.  Some choices include:  magnets (10,000 gauss), presstacks, non-insertive needles such as teishins, even essential oil on points or taping ear seeds. 

Remember to keep pt rx simple and to minimize needling in very sensitive areas such as the inner wrist  (just do one side or see above).

Good luck!

Suzahne

altmed's picture
Submitted by altmed on Wed, 06/02/2010 - 11:29am.

Needle Hypersensitivity

Thanks for your comments and suggestions. I had already tried some of you suggestions but following your post i continued and am now able to needle the pt. She is able to tolerate needling without stim, I am using Seirin also which has helped.

Many Thanks

blade's picture
Submitted by blade (not verified) on Wed, 06/02/2010 - 3:14pm.

Laser might be an option?

I never used it, but would laser treatment also be an option in this case?

Judith Poole's picture
Submitted by Judith Poole on Wed, 06/16/2010 - 4:24pm.

Options the patient can attend to

In my experience hypersensitivity is usually related to a chronic stress situation in which triple warmer is over-energized (and spleen often under energized). Several things a patient can do to minimize reactivity include:

  • Exhaling the triple warmer sound (a long drawn out subvocal "Heeeeee")
  • The spleen hug - Right palm over spleen, left on right elbow - balances triple warmer and spleen
  • Smooth behind the ears - starting at the temple (end point of TW meridian) trace to top of ear and then behind ear, through neck, and ending by pulling the (excess) energy off the shoulders

The patient can be instructed to do these practices frequently throughout the day. The likelihood is that triple warmer is chronically over active. This will gradually retrain that energy habit. During the treatment the patient can exhale the triple warmer sound after getting on the table and before you begin the treatment. And you could "smooth behind the ears" on her behalf, or even just hold the TW neurovascular points at the temples to sooth and relax your patient.

Judith Poole, MA