In my private practice clients generally expect to be treated gently and specifically. Clients come to our clinic to be made comfortable not made to feel more pain. 

Current evidence supports treatment below the pain threshold (Nijs et al, 2009).

But why should treatment be below pain threshold?

A quick explanation…

Pain causes more pain; the nervous system will reconfigure in response to a persistent pain input and create more pain! (Nijs et al, 2009).

This process has been referred to as ‘wind up’  and occurs as the response of some spinal cord transmission cells becomes more vigorous (Woolf, 1996).

Further nociceptive input (on top of that arising due to injury) converging at dorsal horn may also cause increased activation of second glutamate receptors, the NMDA receptors. These previously ‘dormant’ receptors may become activated semi-permanently and contribute to the central sensitization process. Activation of NMDA receptors results in a much greater pain response to stimulation then the basic ‘AMPA’ receptor which is the first one which responds to the release of glutamate from the primary afferent nociceptive nerve (White et al, 2008).

An interesting study by Paulson & Shay (2013) confirms that Acupuncture activates the sympathetic nervous system during and after treatment. 

Their single blinded randomised descriptive study showed that those who received acupuncture to the forearm muscles (on one side) after a bout of fatiguing wrist extension exercises measured a bilateral decrease in skin resistance and distal skin temperature. There was a significant difference in outcome measures when compared to sham acupuncture or no treatment. The fact that the changes were measured bilaterally suggests central control changes, probably at the level of the hypothalamus.

The acupuncture group also measured an increase in perfusion (blood flow) but on the side of treatment only, which the authors suggest is likely to be due to a local circulatory versus central/systemic control change.