Efficacy of auricular therapy for pain management: a systematic review and meta-analysis

Chao Hsing Yeh, Yi Chien Chiang, Samuel L Hoffman, Zhan Liang, Mary Lou Klem, Wilson W S Tam, Lung-Chang Chien, Lorna Kwai-Ping Suen, Chao Hsing Yeh, Yi Chien Chiang, Samuel L Hoffman, Zhan Liang, Mary Lou Klem, Wilson W S Tam, Lung-Chang Chien, Lorna Kwai-Ping Suen

Abstract

Objective. The objective of this systematic review and meta-analysis was to assess the efficacy of auricular therapy by including a sham therapy control group. Methods. Relevant, randomized clinical trials (RCTs) were identified by searching medical related databases from, depending on journal, 1900 (at the earliest) to 1994 (at the latest) through May 2013. The outcome measure was a pain intensity score. Results. Twenty-two RCTs were identified and 13 RCTs were included for meta-analysis. In these studies, auricular therapy provided significant pain relief when compared to a sham or control group. The overall standardized mean differences (SMD) was 1.59 (95% CI [-2.36, -0.82]) (13 trials, total subject numbers = 806), indicating that, on average, the mean decrease in pain score for auricular therapy group was 1.59 standard deviations greater than the mean decrease for the sham control. In terms of the efficacy of the different treatment methods, auricular acupressure boasts the largest strength of evidence for pain relief, followed by auricular acupuncture. Electroacupuncture stimulation did not show significant evidence for efficacy, which may be due to the small sample size (i.e., only 19 subjects were included). Conclusion. Further large-scale RCTs are needed to determine the efficacy of auricular therapy for pain.

Figures

Figure 1
Figure 1
Flow chart of screened, excluded, and analyzed articles.
Figure 2
Figure 2
Pain relief of auricular therapy for 13 trials.
Figure 3
Figure 3
Pain relief of auricular therapy using auricular acupuncture.
Figure 4
Figure 4
Pain relief of auricular therapy using electroacupuncture stimulation.
Figure 5
Figure 5
Pain relief of auricular therapy using auricular acupressure.
Figure 6
Figure 6
Immediate pain relief after auricular therapy (within 15 minutes).
Figure 7
Figure 7
Immediate pain relief after auricular therapy (12 to 24 hours after treatment).
Figure 8
Figure 8
Pain relief after auricular therapy (24 to 48 hours after treatment).

References

    1. WHO Scientific Group. The burden of musculoskeletal conditions at the start of the new millennium. World Health Organization Technical Report Series. 2003;919(1–10):1–218.
    1. Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Practice and Research: Clinical Rheumatology. 2010;24(6):769–781.
    1. CDC. Prevalence of disabilities and associated health conditions among adults—United States. MMWR. 2009;58:421–426.
    1. Vorvick L, Ma C, Zieve D. Low back pain—acute. U.S. National Library of Medicine, 2012,
    1. St. Sauver JL, Warner DO, Yawn BP, et al. Why patients visit their doctors: assessing the most prevalent conditions in a defined American population. Mayo Clinic Proceedings. 2013;88(1):56–67.
    1. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine Journal. 2008;8(1):8–20.
    1. Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Archives of Internal Medicine. 2009;169(3):251–258.
    1. Strine TW, Hootman JM. US national prevalence and correlates of low back and neck pain among adults. Arthritis Care and Research. 2007;57(4):656–665.
    1. Du Bois M, Szpalski M, Donceel P. Patients at risk for long-term sick leave because of low back pain. The Spine Journal. 2009;9(5):350–359.
    1. Malanga G, Wolff E. Evidence-informed management of chronic low back pain with nonsteroidal anti-inflammatory drugs, muscle relaxants, and simple analgesics. The Spine Journal. 2008;8(1):173–184.
    1. Benyamin R, Trescot AM, Datta S, et al. Opioid complications and side effects. Pain Physician. 2008;11(2):S105–S120.
    1. Maltoni M. Opioids, pain, and fear. Annals of Oncology. 2008;19:5–7.
    1. Kanodia AK, Legedza ATR, Davis RB, Eisenberg DM, Phillips RS. Perceived benefit of Complementary and Alternative Medicine (CAM) for back pain: a national survey. Journal of the American Board of Family Medicine. 2010;23(3):354–362.
    1. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. 2012;172(19):1444–1453.
    1. Nahin RL, Barnes PM, Stussman BJ, Bloom B. Costs of complementary and alternative medicine (CAM) and frequency of visits to CAM practitioners: United States, 2007. National Health Statistics Reports. 2009;(18):1–14.
    1. Upchurch DM, Rainisch BW. A sociobehavioral wellness model of acupuncture use in the United States, 2007. Journal of Alternative and Complementary Medicine. 2013;20(1):32–39.
    1. Huang LC Auricular Medicine: A Complete Manual of Auricular Diagnosis and Treatment. Orlando Fla, USA: Auricular International Research & Training;
    1. Spagrud LJ, von Baeyer CL, Ali K, et al. Pain, distress, and adult-child interaction during venipuncture in pediatric oncology: an examination of three types of venous access. Journal of Pain and Symptom Management. 2008;36(2):173–184.
    1. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. Kidlington, UK: Churchill Livingstone; 2003.
    1. Alimi D, Rubino C, Pichard-Léandri E, Fermand-Brulé S, Dubreuil-Lemaire M-L, Hill C. Analgesic effect of auricular acupuncture for cancer pain: a randomized, blinded, controlled trial. Journal of Clinical Oncology. 2003;21(22):4120–4126.
    1. Allais G, Romoli M, Rolando S, et al. Ear acupuncture in the treatment of migraine attacks: A randomized trial on the efficacy of appropriate versus inappropriate acupoints. Neurological Sciences. 2011;32:173–175.
    1. Barker R, Kober A, Hoerauf K, et al. Out-of-hospital auricular acupressure in elder patients with hip fracture: a randomized double-blinded trial. Academic Emergency Medicine. 2006;13(1):19–23.
    1. Goertz CMH, Niemtzow R, Burns SM, Fritts MJ, Crawford CC, Jonas WB. Auricular acupuncture in the treatment of acute pain syndromes: a pilot study. Military Medicine. 2006;171(10):1010–1014.
    1. Hunter RF, McDonough SM, Bradbury I, et al. Exercise and auricular acupuncture for chronic low-back pain: a feasibility randomized-controlled trial. The Clinical Journal of Pain. 2012;28(3):259–267.
    1. Kindberg S, Klünder L, Strøm J, Henriksen TB. Ear acupuncture or local anaesthetics as pain relief during postpartum surgical repair: a randomised controlled trial. BJOG. 2009;116(4):569–576.
    1. Lewis SM, Clelland JA, Knowles CJ, Jackson JR, Dimick AR. Effects of auricular acupuncture-like transcutaneous electric nerve stimulation on pain levels following wound care in patients with burns: a pilot study. Journal of Burn Care & Rehabilitation. 1990;11(4):322–329.
    1. Longobardi AG, Clelland JA, Knowles CJ, Jackson JR. Effects of auricular transcutaneous electrical nerve stimulation on distal extremity pain: a pilot study. Physical Therapy. 1989;69(1):10–17.
    1. Romoli M, van der Windt D, Giovanzana P, et al. International research project to devise a protocol to test the effectiveness of acupuncture on painful shoulder. Journal of Alternative and Complementary Medicine. 2000;6(3):281–287.
    1. Sator-Katzenschlager SM, Wölfler MM, Kozek-Langenecker SA, et al. Auricular electro-acupuncture as an additional perioperative analgesic method during oocyte aspiration in IVF treatment. Human Reproduction. 2006;21(8):2114–2120.
    1. Usichenko TI, Hermsen M, Witstruck T, et al. Auricular acupuncture for pain relief after ambulatory knee arthroscopy—a pilot study. Evidence-based Complementary and Alternative Medicine. 2005;2(2):185–189.
    1. Usichenko TI, Dinse M, Hermsen M, Witstruck T, Pavlovic D, Lehmann C. Auricular acupuncture for pain relief after total hip arthroplasty—a randomized controlled study. Pain. 2005;114(3):320–327.
    1. Yeh ML, Tsou MY, Lee BY, Chen HH, Chung YC. Effects of auricular acupressure on pain reduction in patient-controlled analgesia after lumbar spine surgery. Acta Anaesthesiologica Taiwanica. 2010;48:80–86.
    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. Evidence-based Complementary and Alternative Medicine. 2013;2013:9 pages.196978
    1. Yeh M, Hung Y, Chen H, Lin J, Wang Y. Auricular acupressure combined with an internet-based intervention or alone for primary dysmenorrhea: a control study. Evidence-based Complementary and Alternative Medicine. 2013;2013:8 pages.316212
    1. Wang S-M, DeZinno P, Lin EC, et al. Auricular acupuncture as a treatment for pregnant women who have low back and posterior pelvic pain: a pilot study. The American Journal of Obstetrics and Gynecology. 2009;201(3):271.e1–279.e1.
    1. Wang XQ, Ye TS, Chen ER, Dong XC. Effect of perioperative strapping and pressing on the ear acupoint for pain management after laparoscopic cholecystectomy. Nursing Journal of Chinese People's Liberation Army. 2007;24:14–16.
    1. Yang CY, Zhang CL. Auricular seed treatment to reduce pain intensity for constipation. Henan Traditional Chinese Medicine. 2011;31:504–505.
    1. Ma LC, Fang HC. Auricular magnetic therapy for rental chronic pain. Journal of Nurses Training. 2011;26:934–935.
    1. Zhang C, Tzu WH. Auricular seed therapy for pain relief in post-operative replantation of digits: 50 cases. Zhejiang Journal of Traditional Chinese Medicine. 2011;46:650–651.
    1. Li J, Li X, Wang M, Shi F, Yu H. Effects of transcutaneous electrical stimulation of auricular Shenmen point on postoperative nausea and vomiting and patient-controlled epidural analgesia in cesarean section. Zhonghua Yi Xue Za Zhi. 2012;92(27):1892–1895.
    1. Wang J, Bao H, Cai Y, Zhang J, Tong P. Case-control study on application of auricular acupuncture for the treatment of analgesia during perioperative period in total hip arthroplasty. Zhongguo Gu Shang. 2012;25(3):220–223.
    1. Gilbert JG. Auricular complication of acupuncture. The New Zealand Medical Journal. 1987;100(819):141–142.
    1. Wang M, Hsu M, Chien L, Kao C, Liu C. Effects of auricular acupressure on menstrual symptoms and nitric oxide for women with primary dysmenorrhea. Journal of Alternative and Complementary Medicine. 2009;15(3):235–242.
    1. Lewers D, Clelland JA, Jackson JR, Varner RE, Bergman J. Transcutaneous electrical nerve stimulation in the relief of primary dysmenorrhea. Physical Therapy. 1989;69(1):3–9.
    1. Hwang LC, Lai TY, Wu HH, Lin JD, Chen LL. Exploring the effect of auricular acupressure in caring dysmenorrhea. The Journal of Health Sciences. 2005;7:236–245.
    1. Jiang J. Clinical study and application of auricular magnet anesthesia for the operation of the thyroid. Zhen Ci Yan Jiu. 1995;20(3):4–8.
    1. Wu H, Bi L, Shen P, Li Z, Zhu P. Clinical observation and mechanism study on application of auricular-pressing pill for postoperative analgesia. Journal of Traditional Chinese Medicine. 1997;17(1):26–31.
    1. Felhendler D, Lisander B. Pressure on acupoints decreases postoperative pain. Clinical Journal of Pain. 1996;12:326–329.
    1. Suen LKP, Wong TKS, Chung JWY, Yip VYB. Auriculotherapy on low back pain in the elderly. Complementary Therapies in Clinical Practice. 2007;13(1):63–69.
    1. Suen LKP, Wong TKS, Chung JWY, Yip VYB. Auriculotherapy on low back pain in the elderly. Complementary Therapies in Clinical Practice. 2007;13:63–69.
    1. Bao T, Ye X, Skinner J, et al. The analgesic effect of magnetic acupressure in cancer patients undergoing bone marrow aspiration and biopsy: a randomized, blinded, controlled trial. Journal of Pain and Symptom Management. 2011;41(6):995–1002.
    1. Asher GN, Jonas DE, Coeytaux RR, et al. Auriculotherapy for pain management: a systematic review and meta-analysis of randomized controlled trials. Journal of Alternative and Complementary Medicine. 2010;16(10):1097–1108.
    1. Usichenko TI, Lehmann C, Ernst E. Auricular acupuncture for postoperative pain control: a systematic review of randomised clinical trials. Anaesthesia. 2008;63(12):1343–1348.
    1. Ter Riet G, Kleijnen J, Knipschild P. Acupuncture and chronic pain: a criteria-based meta-analysis. Journal of Clinical Epidemiology. 1990;43(11):1191–1199.
    1. Ter Riet G, Kleijnen J, Knipschild P. A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice. 1990;40(338):379–382.
    1. Kleijnen J, Knipschild P, Ter Riet G. Clinical trials of homoeopathy. British Medical Journal. 1991;302(6772):316–323.
    1. Kleijnen J, Ter Riet G, Knipschild P. Acupuncture and asthma: a review of controlled trials. Thorax. 1991;46(11):799–802.
    1. Cohen D. Statistical Power Analysis for the Behavioral Sciences Hillsdale. Mahwah, NJ, USA: Lawrence Erlbaum Associates; 1988.
    1. Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Statistics in Medicine. 2002;21(11):1539–1558.
    1. Tekeoglu I, Adak B, Ercan M. Investigation into the possibilities of using ear acupressure for increasing the pain threshold during athletic training. The American Journal of Acupuncture. 1998;26(1):49–52.
    1. Zoghi M, Jaberzadeh S. Effects of high voltage electro-auriculotherapy on experimental pain threshold. Physiotherapy. 2002;88(11):658–666.
    1. Wetzel B, Pavlovic D, Kuse R, et al. The effect of auricular acupuncture on fentanyl requirement during hip arthroplasty: a randomized controlled trial. The Clinical Journal of Pain. 2011;27(3):262–267.
    1. Kager H, Likar R, Jabarzadeh H, Sittl R, Breschan C, Szeles J. Electrical punctual stimulation (P-STIM) with ear acupuncture following tonsillectomy, a randomised, controlled pilot study. Acute Pain. 2009;11(3-4):101–106.
    1. Holzer A, Leitgeb U, Spacek A, Wenzl R, Herkner H, Kettner S. Auricular acupuncture for postoperative pain after gynecological surgery: a randomized controlled trail. Minerva Anestesiologica. 2011;77(3):298–304.
    1. Ahn C, Lee S, Lee J, Fossion JPJ, Sant'Ana A. A clinical pilot study comparing traditional acupuncture to combined acupuncture for treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy. JAMS Journal of Acupuncture and Meridian Studies. 2011;4(1):29–43.
    1. Ceccherelli F, Tortora P, Nassimbeni C, Casale R, Gagliardi G, Giron G. The therapeutic efficacy of somatic acupuncture is not increased by auriculotherapy: a randomised, blind control study in cervical myofascial pain. Complementary Therapies in Medicine. 2006;14(1):47–52.
    1. Chen WT, Fu GQ, Shen WD. Progresses of studies on acupuncture analgesia for postoperative reaction. Zhen Ci Yan Jiu. 2013;38(1):83–87.
    1. Chen Q, Wei Q, Zhang X. Effects of electroacupuncture on supplementary analgesia and improvement of adverse reactions induced by dolantin in oocyte retrieval. Zhongguo Zhen Jiu. 2012;32(12):1113–1116.
    1. Yang D, Ma Z, Han J, et al. Migraine without aura treated by comprehensive auricular acupuncture: a multicentral controlled study. Zhongguo Zhen Jiu. 2012;32(11):971–974.
    1. Melzack R, Katz J. Auriculotherapy fails to relieve chronic pain. A controlled crossover study. Journal of the American Medical Association. 1984;251(8):1041–1043.
    1. Nogier P. Handbook to Auriculotherapy. Moulins-les-Metz, France: Maisonneuve; 1968.
    1. Yeh CH, Huang LC. Comprehensive and systematic auricular diagnosis protocol. Medical Acupuncture. 2013;25(6):423–436.
    1. Ezzo J, Berman B, Hadhazy VA, Jadad AR, Lao L, Singh BB. Is acupuncture effective for the treatment of chronic pain? A systematic review. Pain. 2000;86(3):217–225.
    1. Yeh C-H, Chien L-C, Chiang Y-C, Huang L-C. Auricular point acupressure for chronic low back pain: a feasibility study for 1-week treatment. Evidence-Based Complementary and Alternative Medicine. 2012;2012:9 pages.383257
    1. Alimi D, Geissmann A, Gardeur D. Auricular acupuncture stimulation measured on functional magnetic resonance imaging. Medical Acupuncture. 2002;13:18–21.
    1. Zhao Z. Neural mechanism underlying acupuncture analgesia. Progress in Neurobiology. 2008;85(4):355–375.
    1. Zijlstra FJ, van den Berg-de Lange I, Huygen FJPM, Klein J. Anti-inflammatory actions of acupuncture. Mediators of Inflammation. 2003;12(2):59–69.
    1. Kim H, Roh D, Yoon S, et al. The anti-inflammatory effects of low- and high-frequency electroacupuncture are mediated by peripheral opioids in a mouse air pouch inflammation model. Journal of Alternative and Complementary Medicine. 2006;12(1):39–44.
    1. Wilkinson J, Faleiro R. Acupuncture in pain management. Continuing Education in Anaesthesia, Critical Care & Pain. 2007;7(4):135–138.

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