Auricular Point Acupressure Smartphone Application to Manage Chronic Musculoskeletal Pain: A Longitudinal, One-Group, Open Pilot Trial

Jennifer Kawi, Chao Hsing Yeh, Mengchi Li, Keenan Caswell Bs, Maurice Mazraani Md, Nada Lukkahatai PhD Rn, Sylvanus Mensah Rn, Janiece Taylor, Chakra Budhathoki, Paul Christo, Jennifer Kawi, Chao Hsing Yeh, Mengchi Li, Keenan Caswell Bs, Maurice Mazraani Md, Nada Lukkahatai PhD Rn, Sylvanus Mensah Rn, Janiece Taylor, Chakra Budhathoki, Paul Christo

Abstract

Background: Chronic musculoskeletal pain (CMP) is the most common self-reported chronic pain condition. Current treatment for CMP is limited.

Methods: This was a two-phase study. In Phase 1, three auricular point acupressure (APA)-naïve participants were recruited to explore their experiences of APA and a smartphone app was developed based on their feedback. In Phase 2, a prospective longitudinal study was used to examine the effectiveness of the smartphone app to self-manage CMP.

Results: Phase 1 resulted in the successful development of the APA smartphone app. In Phase 2, after four weeks of APA, participants reported reduced pain intensity (30%), pain interference (35%), and disability (40%), as well as improved physical function (47%). The mean score for the participants' perception of treatment efficacy was 4.94 (SD = 2.08, scale of 0-7) indicating that approximately 70% of participants rated global improvements with noticeable changes. The majority (88%, n = 22) of the participants were satisfied with the treatment: 32% [8] were very satisfied and 56% [n = 14] were somewhat satisfied. The average frequency of pressing APA seeds per day was 2.93 times (SD = 2.27, range 0-10) and 1.60 minutes per time (SD = 2.64, range 0-10); the participants were able to adhere to the suggested pressing time per day, although they only pressed the ear points about 53% of the suggested time.

Conclusion: It is feasible for individuals to learn APA from the smartphone app and successfully self-administer APA to manage their pain. Participants found the app useful and were satisfied with the information provided through the app.

Keywords: auricular point acupressure; musculoskeletal pain; self-management; smartphone application.

Conflict of interest statement

Authors' Note: Keenan Caswell is now affiliated with School of Medicine, Uniformed Services University, Maryland, US. Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

© The Author(s) 2021.

Figures

Figure 1.
Figure 1.
Auricular Point Acupressure Smartphone App for Musculoskeletal Pain.
Figure 2.
Figure 2.
Participant Recruitment Flowchart.

References

    1. Dahlhamer J, Lucas J, Zelaya C, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. MMWR Morbid Mortal Wkly Rep. 2018; 67(36):1001–1006.
    1. United States Bone and Joint Initiative. United States Bone and Joint Initiative: The Burden of Musculoskeletal Diseases in the United States (BMUS). . Published 2018.
    1. Denkinger MD, Lukas A, Nikolaus T, Peter R, Franke S. Multisite pain, pain frequency and pain severity are associated with depression in older adults: results from the ActiFE Ulm study. Age Ageing. 2014; 43(4):510–514.
    1. Statista Dossier About Back Pain in the United States. . Published 2019. Accessed October 1, 2020.
    1. By The Numbers: Musculoskeletal Conditions Is Sourced From The Burden of Musculoskeletal Diseases in the United States (BMUS). . Accessed September 11, 2016.
    1. Johannes CB, Le TK, Zhou X, Johnston JA, Dworkin RH. The prevalence of chronic pain in United States adults: results of an internet-based survey. J Pain. 2010; 11(11):1230–1239.
    1. Knauer SR, Freburger JK, Carey TS. Chronic low back pain among older adults: a population-based perspective. J Aging Health. 2010; 22(8):1213–1234.
    1. Institute of Medicine of the National Academies Report. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington, DC: The National Academies Press; 2011.
    1. Skelly AC, Chou R, Dettori JR, et al. Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Comparative Effectiveness Review No. 227. (Prepared by the Pacific Northwest Evidence-based Practice Center Under Contract No. 290-2015-00009-I.) AHRQ Publication No. 20-EHC009. Rockville, MD: Agency for Healthcare Research and Quality; 2020.
    1. Abdel Shaheed C, Maher CG, Williams KA, Day R, McLachlan AJ. Efficacy, tolerability, and dose-dependent effects of opioid analgesics for low back pain: a systematic review and meta-analysis. JAMA Int Med. 2016; 176(7):958–968.
    1. Frieden TR, Houry D. Reducing the risks of relief—the CDC opioid-prescribing guideline. N Engl J Med. 2016; 374(16):1501–1504.
    1. Manchikanti L, Ailinani H, Koyyalagunta D, et al. A systematic review of randomized trials of long-term opioid management for chronic non-cancer pain. Pain Physician. 2011; 14(2):91–121.
    1. Manchikanti L, Abdi S, Atluri S, et al. American Society of Interventional Pain Physicians (ASIPP) guidelines for responsible opioid prescribing in chronic non-cancer pain: Part I–evidence assessment. Pain Physician. 2012; 15(3 Suppl):S1–S65.
    1. American Geriatrics Society 2015. Updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatrics Soc. 2015; 63(11):2227–2246.
    1. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics. Spine J. 2008; 8(1):173–184.
    1. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008; 11(2 Suppl):S105–S120.
    1. Mafi JN, McCarthy EP, Davis RB, Landon BE. Worsening trends in the management and treatment of back pain. JAMA Intern Med. 2013; 173(17):1573–1581.
    1. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015; 156(4):569–576.
    1. Centers for Disease Control and Prevention NCfIPaC. Prescription Opioids. . Published 2017. Accessed June 1, 2020.
    1. Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ (Clinical Research Ed). 2015; 350:g6380.
    1. Petzke F, Klose P, Welsch P, Sommer C, Hauser W. Opioids for chronic low back pain: an updated systematic review and meta-analysis of efficacy, tolerability and safety in randomized placebo-controlled studies of at least 4 weeks of double-blind duration. Eur J Pain (London, England). 2020; 24(3):497–517.
    1. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017; 166(7):514–530.
    1. Kawi J. Predictors of self-management for chronic low back pain. Appl Nurs Res: ANR. 2014; 27(4):206–212.
    1. Sparks T, Kawi J, Menzel NN, Hartley K. Implementation of health information technology in routine care for fibromyalgia: pilot study. Pain Manag Nurs. 2016; 17(1):54–62.
    1. Talusan R, Kawi J, Candela L, Filler J. Implementation and evaluation of an APRN-led opioid monitoring clinic. Feder Practition. 2016; 33(11):22–27.
    1. Chou R, Huffman LH. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007; 147(7):492–504.
    1. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: an overview of cochrane reviews. Cochrane Database Syst Rev. 2017; 4:CD011279.
    1. Krein SL, Metreger T, Kadri R, et al. Veterans walk to beat back pain: study rationale, design and protocol of a randomized trial of a pedometer-based internet mediated intervention for patients with chronic low back pain. BMC Musculoskelet Disord. 2010; 11:205.
    1. Eleswarapu AS, Divi SN, Dirschl DR, Mok JM, Stout C, Lee MJ. How effective is physical therapy for common low back pain diagnoses? A multivariate analysis of 4597 patients. Spine. 2016; 41(16):1325–1329.
    1. Morone NE, Greco CM, Moore CG, et al. A mind-body program for older adults with chronic low back pain: a randomized clinical trial. JAMA Intern Med. 2016; 176(3):329–337.
    1. Morone NE, Rollman BL, Moore CG, Li Q, Weiner DK. A mind–body program for older adults with chronic low back pain: Results of a pilot study. Pain Med. 2009; 10(8):1395–1407.
    1. Cherkin DC, Sherman KJ, Balderson BH, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. Jama. 2016; 315(12):1240–1249.
    1. Hall AM, Maher CG, Lam P, Ferreira M, Latimer J. Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res. 2011; 63(11):1576–1583.
    1. Weifen W, Muheremu A, Chaohui C, Md LW, Lei S. Effectiveness of Tai Chi practice for non-specific chronic low back pain on retired athletes: a randomized controlled study. J Musculoskelet Pain. 2013; 21(1):37–45.
    1. Nambi GS, Inbasekaran D, Khuman R, Devi S, Shanmugananth, Jagannathan K. Changes in pain intensity and health related quality of life with Iyengar yoga in nonspecific chronic low back pain: a randomized controlled study. Int J Yoga. 2014; 7(1):48–53.
    1. Cramer H, Lauche R, Haller H, Dobos G. A systematic review and meta-analysis of yoga for low back pain. Clin J Pain. 2013; 29(5):450–460.
    1. Henschke N, Ostelo R, van Tulder MW, et al. Behavioural treatment for chronic low‐back pain. Cochrane Database Syst Rev. 2010; 2010(7):CD002014.
    1. Rubinstein SM, de Zoetes A, van Middelkoop M, Assendelft WJJ, de Boer MR, van Tulder MW. Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomised controlled trials. BMJ (Clin Res Ed). 2019; 13(364):1689.
    1. Chou R, Deyo R, Devine B, et al. The Effectiveness and Risks of Long-Term Opioid Treatment of Chronic Pain. Evidence Report/Technology Assessment No. 218. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2012-00014-I.) AHRQ Publication No. 14-E005-EF. . Published 2014. Accessed December 28, 2015.
    1. Deyo RA, Smith DH, Johnson ES, et al. Prescription opioids for back pain and use of medications for erectile dysfunction. Spine. 2013; 38(11):909–915.
    1. Starrels JL, Becker WC, Alford DP, Kapoor A, Williams AR, Turner BJ. Systematic review: treatment agreements and urine drug testing to reduce opioid misuse in patients with chronic pain. Ann Intern Med. 2010; 152(11):712–720.
    1. Bohnert AS, Valenstein M, Bair MJ, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. Jama. 2011; 305(13):1315–1321.
    1. Miller M, Barber CW, Leatherman S, et al. Prescription opioid duration of action and the risk of unintentional overdose among patients receiving opioid therapy. JAMA Intern Med. 2015; 175(4):608–615.
    1. Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR Morbid Mortal Wkly Rep 2011; 60(43):1487–1492.
    1. Fields HL. The doctor’s dilemma: opiate analgesics and chronic pain. Neuron. 2011; 69(4):591–594.
    1. Nogier P. Handbook to Auriculotherapy. 1st ed Moulins-les-Metz: Maisonneuve; 1981.
    1. Nogier R. How did Paul Nogier establish the map of the ear? Med Acupunct. 2014; 26(2):76–83.
    1. Huang LC. Auricular Medicine: A Complete Manual of Auricular Diagnosis and Treatment. 1st ed Orlando, FL: Auricular International Research & Training; 2005.
    1. Oleson T. Auriculotherapy manual: Chinese and western systems of ear acupuncture. 3rd ed London: Churchill Livingstone; 2003.
    1. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. 4th ed Edinburgh: Churchill Livingstone, Elsevier; 2014.
    1. Lu W, Rosenthal DS. Recent advances in oncology acupuncture and safety considerations in practice. Curr Treatment Options Oncol. 2010; 11(3–4):141–146.
    1. Gottschling S, Reindl TK, Meyer S, et al. Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology—a randomized multicenter crossover pilot trial. Klinische Padiatrie. 2008; 220(6):365–370.
    1. Yeh CH, Chien LC, Balaban D, et al. A randomized clinical trial of auricular point acupressure for chronic low back pain: a feasibility study. Evid-Based Complement Alternat Med. 2013; 2013:196978.
    1. Yeh CH, Morone NE, Chien LC, et al. Auricular point acupressure to manage chronic low back pain in older adults: a randomized controlled pilot study. Evid Based Complement Alternat Med. 2014; 2014:375173.
    1. Yeh CH, Suen LKP, Chien LC, et al. Day-to-day changes of auricular point acupressure to manage chronic low back pain: a 29-day randomized control study. Pain Med. 2015; 16(10):1857–1869.
    1. Yeh CH, Chien LC, Lin WC, Bovbjerg DH, van Londen G. Pilot randomized controlled trial of auricular point acupressure to manage symptom clusters of pain, fatigue, and disturbed sleep in breast cancer patients. Cancer Nurs. 2016; 39(5):402–410.
    1. Yeh CH, Chien LC, van Londen G, Bovbjerg DH. Auricular point acupressure (APA) to manage a symptom cluster of pain, fatigue, and disturbed sleep in breast cancer patients: a pilot study. J Pain Relief. 2015; 4:199.
    1. Yeh CH, Lukkahatai N, Campbell C, et al. Preliminary effectiveness of auricular point acupressure on chemotherapy-induced neuropathy: part 1 self-reported outcomes. Pain Manag Nurs. 2019; 20(6):614–622.
    1. Yeh CH, Chien LC, Huang LC, Suen KPL. Auricular point acupressure for chronic pain: a feasibility study of a four-week treatment protocol. Holist Nurs Pract. 2014; 28(3):184–194.
    1. Yeh CH, Chien LC, Albers KM, et al. Function of auricular point acupressure in inducing changes in inflammatory cytokines during chronic low back pain: a pilot study. Med Acupunct. 2014; 26(1):31–39.
    1. Lin WC, Yeh CH, Chien LC, Morone NE, Glick RM, Albers KM. The anti-inflammatory actions of auricular point acupressure for chronic low back pain. Evid Based Complement Alternat Med. 2015; 2015:103570.
    1. Yeh CH, Lukkahatai N, Campbell C, et al. Preliminary effectiveness of auricular point acupressure on chemotherapy-induced neuropathy: part 2 laboratory-assessed and objective outcomes. Pain Manag Nurs. 2019; 20(6):623–632.
    1. Yeh CH, Chien LC, Chiang YC, Suen L, Ren D. Analgesic effect of auricular point acupressure as an adjunct treatment for cancer patients with pain. Pain Manag Nur. 2015; 16(3):285–293.
    1. Yeh CH, Caswell K, Pandiri S, et al. Dynamic brain activity change after auricular point acupressure on patients with chemotherapy-induced peripheral neuropathy: a pilot longitudinal functional magnetic resonance imaging study. Glob Adv Health Med. 2020; 9:1–9.
    1. Yeh CH, Van De Castle B. Integrating auricular point acupressure into real-world nursing practice to manage cancer-related pain. Baltimore, MD: Brager Award; 2019.
    1. Yeh CH C, P, Lukahatai N., Morone N.E. Management of Chronic Low Back Pain in Older Adults Using Auricular Point Acupressure (R01): Preliminary Data Analysis on 133 Study Participants. 2020.
    1. Yeh CH VDCB. Integrating auricular point acupressure into real-world nursing practice to manage cancer-related pain: Preliminary report. Brager Award Presentation; Janurary 30, 2020; Baltimore, MD.
    1. You E, Kim D, Harris R, D’Alonzo K. Effects of auricular acupressure on pain management: a systematic review. Pain Manag Nurs. 2019; 20(1):17–24.
    1. Nielsen A, Gereau S, Tick H. Risks and safety of extended auricular therapy: a review of reviews and case reports of adverse events. Pain Med. 2020; 21(6):1276–1293.
    1. Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977; 84 2:191–215.
    1. Grady PA, Gough LL. Self-management: a comprehensive approach to management of chronic conditions. Am J Public Health. 2014; 104(8):e25–e31.
    1. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Ann Behav Med. 2003; 26(1):1–7.
    1. Yeh CH, Huang LC, Suen KPL. The application of a comprehensive and systematic auricular diagnosis for musculoskeletal system disorder: a treatment protocol for chronic low back pain. Med Acupunct. 2014; 26(3):148–153.
    1. Suen LKP, Yeh CH, Yeung SKW. Using auriculotherapy for osteoarthritic knee among elders: a double-blinded randomised feasibility study. BMC Complement Alternat Med. 2016; 16:257–257.
    1. Yeh CH, Lin WC, Suen LKP, et al. Auricular point acupressure to manage arthralgia related to aromatase inhibitors in breast cancer survivors. Oncol Nurs Forum. 2017; 44(4):476–487.
    1. Yeh CH, Huang LC. Comprehensive and systematic auricular diagnosis protocol. Med Acupunct. 2013; 25(6):423–436.
    1. Suen KPL, Yeh CH. Auricular diagnosis in chronic illnesses. Med Acupunct. 2014; 26(2):125–129.
    1. MacPherson H, Altman DG, Hammerschlag R, et al. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. PLoS Med. 2010; 7(6):e1000261.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med, Singapore. 1994; 23(2):129–138.
    1. Dworkin RH, Turk DC, McDermott MP, et al. Interpreting the clinical importance of group differences in chronic pain clinical trials: IMMPACT recommendations. Pain. 2009; 146(3):238–244.
    1. Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000; 25(24):3115–3124.
    1. Roland M, Morris R. A study of the natural history of back pain. Part I: Development of a reliable and sensitive measure of disability in low-back pain. Spine. 1983; 8(2):141–144.
    1. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995; 7(4):524–532.
    1. Waddell G, Newton M, Henderson I, Somerville D, Main CJ. A fear-avoidance beliefs questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain. 1993; 52(2):157–168.
    1. Craig BM, Reeve BB, Brown PM, et al. US valuation of health outcomes measured using the PROMIS-29. Value Health. 2014; 17(8):846–853.
    1. Hays RD, Spritzer KL, Schalet BD, Cella D. PROMIS((R))-29 v2.0 profile physical and mental health summary scores. Qual Life Res. 2018; 27(7):1885–1891.
    1. Hays RD, Revicki DA, Feeny D, Fayers P, Spritzer KL, Cella D. Using Linear Equating to Map PROMIS((R)) Global Health Items and the PROMIS-29 V2.0 Profile Measure to the Health Utilities Index Mark 3. PharmacoEconomics. 2016; 34(10):1015–1022.
    1. Hurst H, Bolton J. Assessing the clinical significance of change scores recorded on subjective outcome measures. J Manipulat Physiol Ther. 2004; 27(1):26–35.
    1. Yeh CH, Chien LC, Chiang YC, Huang LC. Auricular point acupressure for chronic low back pain: a feasibility study for 1-week treatment. Evid Based Complement Alternat. 2012; ▪: 383257.
    1. Lin WC, Burke LE, Schlenk EA, Yeh CH. Use of an ecological momentary assessment application to assess the effects of auricular point acupressure for chronic low back pain. Comput Informat Nurs. 2019; 37(5):276–282.
    1. Miles MB, Huberman AM. Qualitative Data Analysis: An Expanded Sourcebook. 2nd ed Thousand Oaks, CA: SAGE Publications; 1994.
    1. Shail MS. Using micro-learning on mobile applications to increase knowledge retention and work performance: a review of literature. Cureus. 2019; 11(8):e5307–e5307.
    1. Bedrov A, Bulaj G. Improving self-esteem with motivational quotes: opportunities for digital health technologies for people with chronic disorders. Front Psychol. 2018; 9:2126–2126.
    1. Fader J. The Science Behind Why Motivational Quotes Motivate You. . Published 2020. Accessed May 18, 2020.
    1. Las Vegas Recovery Center. 28 Inspirational Chronic Pain Quotes That Can Help You Cope When You’re in Pain. . Published 2017. Accessed May 18, 2020.
    1. Pew Research Center. Mobile Fact Sheet 2020. Published 2020. Accessed April 14, 2020.
    1. Devan H, Farmery D, Peebles L, Grainger R. Evaluation of self-management support functions in apps for people with persistent pain: systematic review. JMIR mHealth and uHealth. 2019; 7(2):e13080.
    1. Mirkovic J, Jessen S, Kristjansdottir OB, Krogseth T, Koricho AT, Ruland CM. Developing technology to mobilize personal strengths in people with chronic illness: positive Codesign approach. JMIR Format Res. 2018; 2(1):e10774.

Source: PubMed

Sponzoři a spolupracovníci

Zdravotní podmínky

Drogové intervence

3
Předplatit