The potential presence or absence of analgesic or anaesthetic substances in leech saliva has been debated for many years [11, 12]. Leech bites are not as painful as other types of comparable wounds, suggesting that an antagonistic painkilling agent is delivered during the biting process. Most patients compare the initial leech sucking process to the experience of insect bites or stinging nettle pain, if any sensation is felt at all. Any unpleasant sensations felt, during leech application, usually wear off soon after biting starts. Leech saliva ingredients appear to block certain steps of the regular pain evolving cascade by counteracting cytokines with anti-inflammatory agents in the saliva, thus triggering the analgesic action [6]. Various saliva substances show protease-inhibiting effects; counteracting the inflammatory effects of cytokines as potent sensitizers or activators of pain sensations. These substances also cleave and inactivate pain-inducing tissue cytokines. In similar fashion, eglin c inhibits neutrophil activity, inhibiting inflammation, and leech-derived tryptase inhibitor appears to suppress mast cell-mediated inflammatory reactions. As Hildebrandt and Lemke [6] note ‘leeches’ must ‘suppress the normal reactions of the host to such injuries (swelling, pain, inflammation) to remain undetected during the feeding process’ (p. 995). This principle is also used by ticks, and other insects, when they bite. In leech application, any pain protective action is short-lived, with most people experiencing unpleasant itching sensations, slight swelling and signs of inflammation (skin reddening) at the bite site for some days. It is during this period, that the therapeutic effects of pain relief are expected to start.