Does dry needling with electrical stimulation (ESTIM) cause a transient low‑grade burning sensation at the treatment site?

Dry Needling with Electrical Stimulation and Burning Sensation

Yes, dry needling with electrical stimulation (ESTIM) can cause a temporary low-grade burning sensation at the treatment site, which is an expected response when voltage is set appropriately at or just above the pain threshold. 1

Expected Sensory Responses During Treatment

Normal Electrical Stimulation Parameters

• Electrical stimulation should be delivered at constant current with voltage set just above the pain threshold, which inherently produces a perceptible sensation that patients may describe as tingling, buzzing, or burning 1
• Standard protocols use 2-10 Hz square-wave pulses of 1 millisecond duration for 10-30 minutes, which creates sustained sensory input 1, 2
• The sensation intensity should remain tolerable but perceptible throughout the treatment duration 1

Mechanism of the Burning Sensation

• The electrical current creates continuous nociceptive and proprioceptive input through the needle into underlying tissues, which differs from the intermittent mechanical stimulation of manual needling alone 2, 3
• This sustained electrical stimulation produces localized immune and circulatory responses that can manifest as warmth or mild burning 4
• The sensation is part of the therapeutic mechanism, as electroacupuncture produces superior neuropeptide release compared to manual needling alone 2

Clinical Significance and Safety Considerations

When the Sensation is Normal

• A mild, tolerable burning or tingling sensation during active electrical stimulation is expected and indicates appropriate voltage settings 1
• The sensation should resolve immediately or within minutes after removing the electrical stimulation 5
• Patients should be able to tolerate the full 10-30 minute treatment duration without requesting early termination 1

Warning Signs Requiring Immediate Intervention

• Intense, intolerable burning suggests voltage is set too high and must be reduced immediately 1
• Persistent burning lasting beyond the treatment session may indicate tissue injury 6
• Skin changes including redness, blistering, or charring indicate electrical burns requiring immediate cessation and wound care 6
• Avoid excessive stimulus intensity, as overstimulation can produce symptom flare-ups rather than therapeutic benefit 1

Evidence Quality and Practical Application

The STRICTA guidelines (Standards for Reporting Interventions in Clinical Trials of Acupuncture) from PLoS Medicine establish that voltage settings "just above pain threshold" are standard practice, inherently producing perceptible sensations 1. However, third-degree burns have been documented with electrical stimulation devices, emphasizing the importance of proper technique and monitoring 6.

For myofascial pain treatment, dry needling with electrical stimulation shows equivalent outcomes to dry needling alone at 6 and 12 weeks, though the electrical stimulation group demonstrated faster initial improvement at 3 weeks 5. This suggests the burning sensation, while expected, does not necessarily translate to superior long-term outcomes for all conditions.