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Acu in Practice: Excess Pain vs. Deficient Pain

Welcome to acu in practice! This week’s focus is on the most commonly known benefit – pain relief. As humans who experience pain, we know that there are different sensations that are felt when we are in pain. These can be stabbing, sharp, dull, aching, burning, numb, heavy, tingling…the list goes on. It only makes sense that with our patients, who have very similar nervous systems, they also feel different types of pain.

One of the advantages of integrating Traditional Chinese Medicine (TCM) and acupuncture into pain management protocols, is that TCM recognizes that different types of pain warrant different, or more specific, treatments. Today, the focus will be on Excess vs. Deficient pain.


Excess pain is typically acute (sudden or fast onset), localized, stabbing and constant until it is resolved. This type of pain is better with movement/exercise and worse after being sedentary. Good examples include middle-aged patients who are showing signs of stiffness or soreness in the morning, but as they “warm up” or go for a walk, their movement becomes more fluid and they no longer appear stiff or sore. Patients with excess pain typically do not enjoy massage or pressure on the affected areas. *Note: Excess pain can be caused by trauma and in these cases it will not get better with exercise during the early acute phase or if there is true structural damage such as a broken bone.

Deficient pain is typically chronic, moving or migrating, and dull. The pain may come and go. This type of pain is worse with significant physical activity or movement. A good example would be an older horse whose lameness is more severe after exercise. Deficient pain is usually found in older patients as they are becoming deficient in organ function or fundamental substances such as Blood and Qi.


Both types of pain involve Stagnation of Qi and Blood, but for different reasons. And, a patient may have both types of pain present simultaneously. For example, a senior dog may be slow and stiff to rise in the morning, feel and move better after the morning walk, and then experience increased soreness later in the day after a second round of exercise, possibly showing up as dragging the hind feet.


Because the underlying causes of the pain are different, it is most effect to treat them differently.


TCM principles for Excess Pain:

Move Blood and Qi Stagnation, invigorate the channels, eliminate pathogens if present (Wind, Cold, Damp, Heat) and move Liver Qi if stagnation is present or Wood constitution,


TCM principles for Deficient Pain:

Identify and nourish the underlying deficiencies that have predisposed the patient to pain, along with moving the Qi and Blood.


Thus, by paying attention to the details of how and when the pain manifests in the patient, we can choose more specific and effective acupuncture points and herbs for the patient. The end result is greater comfort for the patient based on the individualized treatment plan and a more successful long term outcome.


This post is created by Nell Ostermeier, DVM, CVA and is intended for informational use only, not to replace medical advice.