Faulty Needles & Clinical Relevance
You maybe aware of the current discussion about needle quality and based upon some of the high resolution needle tip pictures , wondered how far we have advanced forward from stone needles, in this area of technology.
The discussion has picked up after publication of research in the current edition of Acupuncture in Medicine, titled “Examination of surface conditions and other physical properties of commonly used stainless steel acupuncture needles” by Xie YM, Xu S, Zhang CS, et al. (Acupunct Med Published Online First: doi:10.1136/acupmed- 2013-010472). You can see the abstract here and because it is open access you can see full paper here.
In this paper, needles from 2 of the ‘most commercially available’ companies were investigated at RMIT University, Melbourne, Australia. One a Japanese company identified as “S” and the other a Chinese company identified as “H,” (note that approximately 90% of all needles are manufactured in China) were photographed at *5000 magnification. To the naked eye needle tips look one and the same. However experienced clinicians ‘known’ that not all needles are the same/feel the same, simply because of their consistency with ease of insertion or ability for repeated fanning.
The two pictures show graphically blunt ends and shards metal loosely attached to needle tips for most of the “H” needles but very few of the “S” needles . In the paper they even show pre and post needling pictures to demonstrate how some of the shards have been removed and were presumably left in the tissue being needled.
Which leads me to the clinical aspects of needling.
Given the “H” needle company is stated to represent the largest manufacturer of needles, from a country that supplies 90% of all needles into the world market, do we have an international crisis on our hands. Clearly not . With adverse events reported consistently around 6-8% of needle interventions (acupuncture and dry needling), and only approximately 2-3% of these relating to bleeding or bruising, it would seem that human tissue is able to accommodate lesions from most of these less-than-perfect needle tips. Personally, I moved a long time ago from Hwato to Seirin, simply because of the ease of insertion across a range of skin textures. Please note I am not privy to what the designations “S” and “H” stand for.
What about skin reactions and deposits of metal fragments in the skin? Needles are made of stainless steel and contain a mix of 65% Iron, 21% Chromium and 10% Nickel and 3% Carbon approximately. Yes there are reports of needle contact irritations, but they are rare and I would guess correspond to those people that find themselves reactive to stainless steel jewelry. I have only seen one in nearly 20 years of needling and she was quite happy with the gained pain relief in comparison to the small raised red pinhead of skin that remained for a couple of weeks.
It is possible that due to fragments on the needle, these could be left insitu when the needle is removed. Stainless steel composition contains some components of commercial inks, so a form of a tattoo is possible. There has been some concern, see The Conversation To Dye For and ABC’s Background Briefing, about the possible carcinogenic links with tattoo inks. However the research is not conclusive and given the number of ‘commercial’ tattoos in comparison to ‘acupuncture’ tattoos, it would seem to be a very minor issue.
If the needle tips were so bad, wouldn’t it be reasonable to expect greater pain? Again reported adverse events related to aggravation of pain are around 2-3%. In my experience the aggravation of pain doesn’t relate to the needle itself (although a Seirin needle is perceptibly much easier to insert), rather the location and technique of insertion. These can usually be overcome by good technique and minute relocation of the needle when required.
My take on the situation - while the pictures are pretty grim and it would be great that all needle manufacturers looked to test and improve upon needle tip quality, it isn't having a negative effect on our clients. I think personal decisions on needle selection will continue to be determined by ease of insertion/reinsertion, tube or no tube and general feel of the needle.
I would be very interested to hear your experience in regards to needle quality and client acceptance of your needling. You can add your comments on the blog post of the same title, accessed from the AAP Education main page.
All the best,
Doug Cary FACP
Specialist Musculoskeletal Physiotherapist (awarded by Australian College of Physiotherapy, 2009)
PhD Candidate Curtin University
Clinical Director AAP Education
ph/fx: 08 90715055
Receive a FREE Information Report
Choose The Top 5 Manual Therapy Apps or Infection Control & Needling (V2)
Along with the report you'll also get a complimentary subscription to "Clinical Kit" our regular eZine (email newsletter) and Free Bronze Membership. You'll get ideas, information, insight and inspiration on a regular basis, plus access to our Resource Library, helping you unravel those clinical conundrums appearing every day.
You are free to use material from the Blog in whole or in part, as long as you include complete attribution, including live website link. Please also notify me where the material will appear. The attribution should read: "By Doug Cary FACP of AAP Education. Please visit our website at www.aapeducation.com.au for additional clinical articles and resources on post graduate education for health professionals" (Please make sure the link is live if placed in an eZine or in a web site.)
Dry Needling Program | Outcome Measures and Screening Tools | Integrated Neck Solutions | MSK & RT Ultrasound | Accredited Courses | Wet Lab Anatomy Workshop | The Shoulder | Mulligan Courses | 100% GUARANTEE | BLOG