Efficacy and Safety of Auriculopressure for Primary Care Patients with Chronic Non-Specific Spinal Pain: A Multicentre Randomised Controlled Trial

Adaptive Auricular Point Acupressure for Sleep Disturbance in Women with Breast Cancer: A Randomized Controlled Trial

Objectives

The study aimed to evaluate the preliminary effect and efficacy of auricular point acupressure (APA) on the quality of sleep in women with breast cancer who were undergoing chemotherapy. Sample & Setting. We conducted a randomized controlled trial on 68 patients with breast cancer who reported poor sleep quality based on the Pittsburgh Sleep Quality Index (PSQI) scores (>7). Methods & Variables. Participants were randomly assigned to an APA treatment group or a control group. Patients in the APA group had magnetic pellets attached to selected auricular points and were instructed to apply pressure to these points 4×/day for three consecutive weeks. We objectively measured sleep quality using the Actiwatch Spectrum and the PSQI at the baseline and postintervention. Statistical analyses of changes in sleep data were performed using the t-test, a rank-sum test, and analyses of covariance.

Results

In patients treated with APA, the PSQI total score and sleep onset latency had significantly decreased, while the total sleep time and sleep efficiency had significantly increased. Although the total PSQI score differed between groups at the baseline, ANCOVA results showed that the APA group had a significantly lower total PSQI score.

Conclusion

APA could be an inexpensive and effective approach to improving sleep quality and reducing sleep disturbance in patients with breast cancer. Further research needs a larger sample size to verify our findings.

Risks and Safety of Extended Auricular Therapy: A Review of Reviews and Case Reports of Adverse Events

OBJECTIVE

Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT.

METHODS

Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy," "auricular acupuncture" or "auricular acupressure," "safety," "adverse events," "chondritis," and "perichondritis," with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT.

RESULTS

Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included.

CONCLUSIONS

The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.

Effects of Auricular Point Acupressure on Pain Relief: A Systematic Review

OBJECTIVES

This systematic review aimed to summarize and provide an update on clinical studies investigating the effects of auricular point acupressure (APA) on pain relief, in addition to the APA methods of delivery and operation.

DESIGN

A systematic review.

DATA SOURCES

A systematic review on literatures published on five English (PubMed, Web of Science, Embase, EBSCO, and Cochrane databases) and four major Chinese databases (China National Knowledge Infrastructure, Wan Fang Data, Chinese Scientific Journals Database [VIP], and SinoMed) was conducted.

METHOD

We screened nine electronic databases from the time of their respective establishment until December 20, 2019. Randomized controlled trials and studies that defined an APA intervention measure and evaluated pain intensity were considered. We individually categorized and analyzed 46 studies considering the following: (1) acute or chronic pain and (2) whether the outcomes positively or negatively support the effectiveness of APA on pain intensity. We also summarized the methods of delivery used (including the acupoint selection, stimulator selection, method of taping seeds on the ears, frequency of replacing seeds, suitability of acupressure intensity, acupressure frequency, and pressing time) and APA operator.

RESULTS

Regardless of pain intensity, APA effectively treated most acute pain when combined with other interventions. Although it was used alone to treat low back pain and dysmenorrhea, other chronic diseases typically underwent a combination of APA with other interventions. The 43 positive studies revealed that acute pain required shorter APA intervention periods than chronic pain. Corresponding acupoints and nervous system acupoints were chosen. Vaccaria seeds, the single-ear method (including the alternate-ear method), and daily seed replacement were commonly adopted. Deqi was considered an effective signal for appropriate acupressure intensity. Additionally, the patients could effectively apply acupressure.

CONCLUSION

This systematic review revealed important trends in APA treatments, which could be essential in determining treatment efficacy.

Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle: A multicenter randomized clinical trial

INTRODUCTION

Ear acupuncture carried out in primary care by trained midwives, with no specialist training in acupuncture, may be effective in alleviating pregnancy-related lower back and/or posterior pelvic girdle pain (LBPGP). The objective of this study was to assess the effect of ear acupuncture associated with standard obstetric care, in the primary-care setting, on LBPGP experienced by pregnant women.

MATERIAL AND METHODS

This four-group, multicenter, randomized controlled trial was conducted at 18 public primary care centers in three regions in Spain, with the participation of 220 pregnant women at 24-36 weeks of gestation, aged 18 years or more, diagnosed with pregnancy-related LBPGP and who had not previously received ear acupuncture. The trial was conducted from March 2014 to December 2016. Participants were randomly assigned (1:1:1:1) to receive standard obstetric care plus two sessions (over 2 weeks) of verum ear acupuncture, or nonspecific ear acupuncture, or placebo ear acupuncture, or standard obstetric care alone. The primary outcome was change in pain intensity, assessed using a visual analog scale (0-100 mm) from baseline to the end of treatment (T2). Secondary outcomes included change or presence of pain at 3 months (T3) and at 1 year (T4) postpartum, and changes in responses to the Roland-Morris disability questionnaire (RMDQ) and Short Form-12 Health Survey (SF-12) at the end of treatment.

RESULTS

A total of 55 women were randomized to each group, and 205 completed the study. With respect to baseline values, the reduction in pain intensity among the verum ear acupuncture group vs standard obstetric care was significantly greater, both at T2 (65.8%, 95%CI 56.2-75.3 vs 25.1%, 95%CI 15.3-34.9) and at T3 (93.8%, 95%CI 88.7-99.0 vs 67.9%, 95%CI 55.3-80.5). Moreover, significant changes were found in the verum ear acupuncture group vs standard obstetric care at T2, in reduced RMDQ scores (70.9%, 95%CI 61.8-80.1 vs 21.2%, 95%CI 8.6-33.7) and in increased SF-12 scores on the physical scale (40.5%, 95%CI 31.5-49.4 vs 8.1%, 95%CI 0.8-15.5).

CONCLUSIONS

After 2 weeks of treatment, ear acupuncture applied by midwives and associated with standard obstetric care significantly reduces lumbar and pelvic pain in pregnant women, improves quality of life and reduces functional disability.

Auriculotherapy in primary health care: A large-scale educational experience in Brazil

Auriculotherapy consists of physical stimuli applied to the outer ear and is commonly associated with traditional Chinese medicine (TCM). The authors present and discuss the development of a course that offers a semi-on-site auriculotherapy course for Brazilian primary health care (PHC) professionals. The course was funded by the Brazilian Ministry of Health and developed at the Federal University of Santa Catarina in 2015 by a team of experts in auriculotherapy. It consisted of 75 h of distance learning (five sequential modules) and 5 h of on-site learning. The modules included the following items: (1) introduction to integrative practices; (2) ear reflexology; (3) introduction to TCM; (4) biomedical view of auriculotherapy; and (5) auriculotherapy in PHC. The teaching material included a workbook for each module, 14 video lectures and an interactive ear (online resource) to study location and application to the main auricular points. The on-site lectures follow a structured script of ear palpation techniques, auricular seed insertion practice and clinical case discussions, under the supervision of trained instructors. The course was offered in 2016 and 2017 and on-site lectures took place in 25 cities, covering all Brazilian regions, in coordination with municipal or state boards of health. A total of 4273 health professionals concluded the training and their evaluation of the course was highly positive. The Brazilian experience of large-scale training shows the potential to disseminate auriculotherapy in the context of PHC, given that its practice is fast, easy to learn, safe, effective for different health problems and well accepted by the patients.

Effects of auriculotherapy on labour pain: a randomized clinical trial

OBJECTIVE

Assessing the effects of auriculotherapy in pain control and its outcomes on the duration of labour.

METHOD

This is a randomized, controlled, double-blind trial with preliminary data. Thirty pregnant women with gestational age ≥ 37 weeks, cervical dilatation ≥ 4 cm and two or more contractions in 10 minutes were selected and randomly divided into three groups: auriculotherapy, placebo and control. Auriculotherapy was applied using crystal beads on four strategic points.

RESULTS

No statistical significance was found between the groups with regard to pain; however, the women from the auriculotherapy group had lower intensity and less perception of pain at 30, 60 and 120 minutes of treatment. The average duration of labour was shorter in the auriculotherapy group (248.7 versus placebo 414.8 versus control 296.3 minutes); caesarean section rates were higher in the placebo group (50%) and the same in the other groups (10%).

CONCLUSION

Mothers who received auriculotherapy presented a tendency for greater pain control and shorter labour duration; however, caesarean section rates in this group were similar to the control group. This trial precedes a larger study in progress. Registration of Brazilian Clinical Trials: RBR-47hhbj.

OBJETIVO

Avaliar os efeitos da auriculoterapia no controle da dor e seus desfechos na duração do trabalho de parto.

MÉTODO

Trata-se de um ensaio controlado, randomizado e duplo-cego, com dados preliminares. Foram selecionadas 30 parturientes com idade gestacional ≥ 37 semanas, dilatação cervical ≥ 4 cm e duas ou mais contrações em 10 minutos, divididas aleatoriamente em três grupos: auriculoterapia, placebo ou controle. A auriculoterapia foi aplicada com microesferas de cristais em quatro pontos estratégicos.

RESULTADOS

Não houve significância estatística entre os grupos com relação à dor; no entanto, as mulheres do grupo de auriculoterapia, apresentaram menor intensidade e menor percepção da dor aos 30, 60 e 120 minutos do tratamento. A média de duração do trabalho de parto foi menor no grupo de auriculoterapia (248,7 versus placebo 414,8 versus controle 296,3 minutos); a taxa de cesárea foi maior no grupo placebo (50%) e igual nos outros (10%).

CONCLUSÃO

As parturientes que receberam auriculoterapia apresentaram tendência a um maior controle da dor e menor duração do trabalho de parto, porém a taxa de cesárea neste grupo foi semelhante à do grupo controle. Este ensaio precede um estudo maior, em andamento. Registro Brasileiro de Ensaio Clínico: RBR-47hhbj.

Adverse events of auricular therapy: a systematic review

The aim of this study was to systematically evaluate the literature on adverse events associated with auricular therapy (AT). Case reports, case series, surveys, and all types of clinical trials reporting adverse events of AT were included. Relevant articles were mainly retrieved from 13 electronic databases and seven Chinese journals on complementary medicine. AT-related adverse events were reported in 32 randomized controlled trials, five uncontrolled clinical trials, four case reports, and two controlled clinical trials. For auricular acupuncture, the most frequently reported adverse events were tenderness or pain at insertion, dizziness, local discomfort, minor bleeding and nausea, and so forth. For auricular acupressure, local skin irritation and discomfort, mild tenderness or pain, and dizziness were commonly reported. Skin irritation, local discomfort, and pain were detected in auricular electroacupuncture, and minor infection was identified in auricular bloodletting therapy. Most of these events were transient, mild, and tolerable, and no serious adverse events were identified. Our findings provide preliminary evidence that AT is a relatively safe approach. Considering the patient's safety, prospective or retrospective surveys are needed in future research to gather practitioner-reported and patient-reported adverse events on AT, and the quality of adverse events reporting in future AT trials should be improved.