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Method Article

Press-needle Therapy, A Traditional Chinese Medical Therapy for Relieving Pain in Patients Under Mechanical Ventilation

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DOI:

10.3791/69684

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January 16th, 2026

 ,  ,  ,  ,  ,  ,  , 
1Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, 2School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine

In This Article

Summary

This article elaborates on how to use press needles in a standardized manner to relieve pain in patients undergoing mechanical ventilation.

Abstract

Mechanical ventilation requires intubation and catheterization, which can cause significant damage to the human body, easily exacerbate the patient's pain, and lead to patient-ventilator asynchrony. Therefore, it is necessary to explore a safe, reliable, and more efficient analgesic and sedative measure to reduce the patient's pain stimulation and ensure the orderly implementation of various treatment procedures. In the past, drugs were commonly used for analgesia and sedation in clinical practice. Although the effect was acceptable, long-term and large-scale use might lead to numerous complications or adverse reactions, thus reducing the quality of prognosis. Press-needle therapy, also known as intradermal needle therapy, is a type of acupuncture therapy. It mainly involves embedding needles at acupoints to promote blood circulation and achieve the goal of pain relief. This paper will elaborate on how to use press-needles in a standardized manner to relieve pain in patients undergoing mechanical ventilation.

Introduction

Critically ill patients, especially those undergoing intubation and mechanical ventilation (MV), often experience pain1. Pain is a common and distressing symptom among patients admitted to the intensive care unit (ICU). Pain can also arise from various causes. Comatose patients may experience pain associated with invasive procedures, mechanical ventilation, and the physical conditions in the ICU2. Regarding mechanical ventilation, it is well-known that patients may feel pain or discomfort during the treatment process, thus requiring sufficient analgesics and sedatives3,4. Pain can increase the activity of the neuroendocrine system and the sympathetic tone of tachycardia, which in turn increases myocardial oxygen demand, suppresses the immune system, and enhances the patient's coagulation, catabolism, limited mobility, pulmonary problems, and developmental delay. Current pain management methods include pharmacological (medication) and some non-pharmacological approaches. Sedative and analgesic drugs are commonly used in critically ill patients under mechanical ventilation to relieve pain, anxiety, and agitation, and to enable patients to tolerate invasive procedures in the intensive care unit (ICU)5. Opioids are the most commonly used analgesics, while benzodiazepines, propofol, or dexmedetomidine are usually used to prevent or reduce anxiety and agitation6. However, excessive use of these drugs is associated with worsened clinical outcomes, such as prolonged mechanical ventilation, extended hospital stay, increased risk of altered mental status, and even higher mortality7. Therefore, in critically ill patients, reducing the unnecessary dosage of sedative and analgesic drugs and their side effects while providing the required analgesic effect has always been a key goal.

Press-needle therapy, also known as "needle-embedding therapy" (see Figure 1 for an image of press-needles), belongs to intradermal needle therapy. It uses unique small needles to provide weak but long-term stimulation to certain acupoints on the human body, with the meaning of "long-term retention for tranquility". Press-needle therapy combines the theories of the cutaneous region, acupoints, and motor acupuncture, representing an innovative application. Press-needle therapy can activate the nerve endings in the dermis and transmit signals to the nervous system, thereby relieving muscle tension and promoting local blood circulation, helping to alleviate symptoms and exert therapeutic effects8. When the press-needle remains under the skin, its continuous stimulating effect can cause local mast cells to degranulate and release, triggering a hypersensitivity reaction. Meanwhile, after epidermal Langerhans cells recognize foreign substances, they will participate in the immune response and activate the body's immune regulation mechanism. Press-needle is a shallow-stimulation technique. It gently inserts the needle into specific subcutaneous acupoints and fixes it to extend the needle- retention time, thus accumulating curative effects. Press-needle therapy is closely related to the theory of the "Twelve Cutaneous Regions", that is, it provides continuous and stable stimulation to the cutaneous regions through long-term pressing9,10,11. Compared with ordinary acupuncture, it has the advantages of simple operation, long-term stimulation, and good patient compliance12.

From the perspective of traditional Chinese medicine theory, press-needle therapy relieves pain by regulating and smoothing qi and blood, dredging meridians, and nourishing tendons, mainly through the theory of cutaneous region-collateral vessels-defensive qi-sinew channels. Modern research suggests that there is a certain material basis for communication between the cutaneous regions and meridians13,14,15. Therefore, shallow needling of the cutaneous regions with press-needles can affect the meridians and internal organs through this material basis, achieving the effects of dredging meridians, regulating qi and blood, and relieving pain. Press-needles stimulate the subcutaneous collateral vessels, regulate the stagnation and disorder of qi in the collateral vessels, restore the qi and blood infusion between the meridians and internal organs connected to the collateral vessels, communicate the inside and outside, balance yin and yang, and make the nutritive and defensive qi smooth and the meridians unobstructed, thus relieving pain16.

From the perspective of modern medical theory, the stimulation of press-needles is transmitted to the central nervous system, affecting endocrine function and the release of endogenous analgesic substances. After the press-needle is inserted into the subcutaneous tissue, the content of free iron, nickel and other ions at the needle-embedding site changes, generating an electric current that triggers nerve impulses. These impulses are transmitted to the central nervous system through afferent nerves, activating central endocrine organs to release small-molecule neurotransmitters such as 5-hydroxytryptamine, norepinephrine, serotonin, and orexin, as well as large-molecule peptides such as opioid peptides and anti-opioid peptides. These substances inhibit the further transmission of nociceptive information by the spinal dorsal horn and affect the descending projection of pain signals, exerting an analgesic effect17,18. Acupuncture can inhibit the autophagy of nerve cells, reduce the production of pro-inflammatory factors such as tumor necrosis factor-α and interleukin-6, and enhance the activity of the anti-inflammatory factor interleukin-1019. Endogenous opioid peptides produced by acupuncture through influencing endocrine function can also affect the release of pro-inflammatory factors and inflammatory reaction substances, playing a therapeutic role in inflammatory diseases20. In addition, acupuncture can also affect the expression of vascular regulatory factors, apoptotic factors, autophagy factors, etc., improving pathological pain21. This study aims to elaborate on how to correctly use press-needles to relieve the pain of patients under mechanical ventilation based on the theory of traditional Chinese medicine acupoints. This intradermal needle therapy is mainly applicable to patients with mild to moderate sedation who have undergone orotracheal intubation and are expected to receive mechanical ventilation for more than 24 h. Patients with skin infections, coagulation disorders, pregnant women, and those with a fear of acupuncture are explicitly excluded. For detailed inclusion and exclusion criteria, please refer to the 'Protocol' section.

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Protocol

This study is a retrospective cohort study, and the enrollment period of the subjects was from January 2024 to January 2025. This protocol has obtained approval from the Clinical Trial Ethics Committee of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine (Ethics Record Number: KY202420). It is necessary to ensure that the environment is clean and free of pollution, well-lit, and quiet. Obtain informed consent from patients to allow the use and publication of the data presented in this article.

1. Patient selection

  1. Inclusion criteria
    1. Include all patients who have undergone orotracheal intubation and are connected to a ventilator for assisted ventilation.
    2. Include patients whose mechanical ventilation time is expected to exceed 24 h.
    3. Include patients who have signed the informed consent form for the study.
    4. Include patients with complete case information.
  2. Exclusion criteria
    1. Exclude patients with skin infections.
    2. Exclude patients with a fear of acupuncture.
    3. Exclude pregnant patients.
    4. Exclude patients with coagulation disorders.
    5. Exclude patients who withdraw from the study due to certain reasons or are transferred to another hospital during the treatment.
    6. Exclude patients whose sedation targets are adjusted before and after the treatment.
      NOTE: All patients need to undergo the Richmond Agitation-Sedation Scale (RASS) assessment twice a day22. The sedation protocol remains unchanged before and after the treatment. In this trial, patients with a RASS score between -2 and +1 are defined as lightly sedated patients, and those with a score between -3 and -5 are defined as moderately or deeply sedated patients.

2. Pre-operation assessment

  1. Verification of the patient's basic information: Ensure that it includes gender, age, condition, main symptoms, affected area, local skin condition, coagulation function, clinical symptoms, past medical history, presence of hemorrhagic diseases, pregnancy or menstruation status, and history of allergies.
  2. Assessment of the patient's psychological state: Ensure that it involves understanding the patient's awareness and cooperation level regarding the intradermal needle operation, pain tolerance, etc. For conscious patients, explain the purpose of the operation to gain their cooperation.
  3. Conduct the Critical Care Pain Observation Tool (CPOT) assessment on all patients before the operation23.
  4. Environment: Ensure that the light and temperature are appropriate.
  5. Equipment: Check the expiration dates of the equipment, ensure they are in good working condition and ready for use, and are neatly arranged.

3. Preparation by the medical staff

  1. Dress neatly, wash hands, and wear masks.
  2. Environment: Maintain appropriate temperature and humidity, pay attention to protecting the patient's privacy, and avoid cross-ventilation.
  3. Equipment preparation: Prepare a treatment tray, intradermal needles, tweezers, dressings, sterile cotton swabs, iodine-disinfectant cotton swabs, a bent dish, and a sharps container.

4. Implementation steps

  1. Bring the equipment to the patient's bedside. Re-verify the patient's information. Gain the cooperation of conscious patients.
  2. Prepare the patient: Assist the patient to assume a comfortable position, expose the area for intradermal needle injection, clean the local skin, and draw the curtain to protect the patient's privacy.
  3. Select acupoints (using the patient's own body measurements)
    1. Bring the equipment to the patient's bedside, re-verify the patient's information, and gain the cooperation of conscious patients.
    2. Assist the patient to assume a comfortable position, expose the area for intradermal needle injection, clean the local skin, and draw the curtain to protect the patient's privacy.
    3. Keep hands warm and select acupoints. Adopt the patient's own cun measurement method for positioning, referring to the standard operation specifications of Meridian and Acupoint Science41. Hegu acupoint is located at the midpoint of the radial side of the 2nd metacarpal bone, Renying acupoint is 1.5 cun beside the Adam's apple, and Neiguan acupoint is 2 cun above the wrist crease. For conscious patients, determine the exact position of the acupoints by asking about their sensations (such as soreness, heat, numbness, distension, or pain).
    4. Disinfection: Use 75% medical ethanol disinfectant to spray the acupoints 2-3 times. Take a disposable sterile cotton swab dipped in 75% ethanol, and wipe the area in a spiral manner from the inside out with the acupoint as the center. The diameter of the disinfected area is no less than 3 cm. Wait for the ethanol to evaporate completely before performing acupuncture.

5. Intradermal needle operation

  1. Check the intradermal needles: Ensure they are within the expiration date, open the package, check for integrity, and make sure the intradermal needles are in a sterile state without damage or deformation.
  2. Acupuncture at Hegu: Fix the skin with the thumb and index finger of the non-dominant hand. Use the dominant hand to pick up the intradermal needle with tweezers, keeping the needle tip sterile. Align the needle tip with the Hegu acupoint and insert the needle at an angle of 30° or 45°54,55. After touching the skin, reduce the angle between the intradermal needle and the skin and further insert the needle into the acupoint. Use tweezers to pick up the attachment strip and paste it along the direction of the needle body, ensuring no warping at the edges of the attachment strip and no loosening of the needle body. Press and fix the attachment strip with the non-dominant hand (Figure 2).
  3. Requirements: During the operation, avoid shaking or sudden movement to prevent increasing the patient's pain or causing damage. After acupuncture, the skin at the needling site should be slightly pale without bleeding or exudation, and the needle body should be perpendicular to the skin surface without inclination.
  4. Acupuncture at Renying: Follow the procedure outlined in Step 5.2 (Figure 3). The requirements for the appearance of the needling site are the same as Step 5.3.
  5. Acupuncture at Neiguan: Follow the procedure outlined in Step 5.2 (Figure 4). The requirements for the appearance of the needling site are the same as Step 5.3.
  6. Ask about the patient's sensations: For lightly sedated patients (RASS score from -2 to +1), gently press the inserted needles three times and ask if they feel soreness, numbness, distension, or pain. If the patient has sensations, leave the needles in place. If not, adjust the needle-insertion direction until the patient has sensations and then leave the needles. For moderately or deeply sedated patients, evaluate the analgesic effect through the CPOT score (observing facial expressions and limb activities)24,25.
  7. Needle removal: Remove the needles after 2 days, let the patient rest for 1 day, and then apply the intradermal needles to the same acupoints again. One treatment course lasts for 2 weeks, and there are a total of 2 treatment courses.
  8. Needle retention care: During the needle-retention period, keep the room temperature at 22-24 °C and the humidity at 50%-60%. The patient should avoid strenuous activities at the needling site to prevent the needle body from falling off or shifting. Press the needles about every 3 h, 3 times a day, for about 1 min each time. The pressing force should be based on the patient's tolerance (taking the slight soreness and distension reported by lightly sedated patients as the standard), and avoid excessive pressing, causing skin damage.
  9. Needle removal operation: Fix the skin with the thumb and index finger of the non-dominant hand. Use the dominant hand to pick up the needle strip with tweezers and remove the needle vertically from the skin. After removal, press the needle hole with a sterile cotton swab for 30 s until there is no bleeding. Disinfect the local area with an alcohol cotton swab. After needle removal, there should be no redness, swelling, or bleeding at the needle hole, and the skin integrity should be good.
  10. Efficacy evaluation: Conduct the CPOT assessment on the patient again after needle removal.

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Results

A total of 60 eligible patients participated in and completed this study. During the process, 3 patients had their tracheal tubes removed prematurely, 4 patients were discharged voluntarily, and 4 patients had their sedation protocols adjusted due to changes in their conditions. The CPOT score of the patients was used as the main evaluation indicator in this trial, and the paired t-test was used for the comparison of the patients' self-control before and after the treatment.

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Discussion

General analgesia and sedation are necessary for critically ill patients undergoing mechanical ventilation. However, the excessive use of sedative and analgesic drugs may lead to varying degrees of side effects, such as reduced respiratory drive26. These side effects are associated with worsened clinical outcomes, including prolonged mechanical ventilation, extended hospital stays, increased risk of delirium, and even higher mortality rates27,28...

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Disclosures

The authors have nothing to disclose.

Materials

List of materials used in this article
NameCompanyCatalog NumberComments
Medical EthanolSinopharm Chemical Reagent Co., Ltd.GB/T 678-2021Category: Disinfectants
Specification/Model: 75% (v/v), Analytical Grade
Stainless Steel Hemostatic ForcepsShanghai Surgical Instrument FactoryYY/T 0294.1-2015Category: Instruments
Specification/Model:  12cm, Straight Tip
Medical Intradermal NeedleSuzhou Medical Supplies Co., Ltd.YY 0105-2016Category: Needles
Specification/Model:  0.25mm×2mm
Medical Sterilized Cotton SwabsJiangsu Yangtze Medical Products Co., Ltd.YY/T 0969-2013Category:: Sterile Supplies
Specification/Model:  Individually Packaged, 8cm in Length

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Pain ReliefIntradermal NeedleAcupuncture TherapyPatient Ventilator AsynchronyAnalgesic MeasuresSedative MeasuresBlood CirculationTraditional Chinese Medicine
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