Auricular point acupressure for chronic low back pain: a feasibility study for 1-week treatment

Chao-Hsing Yeh, Lung-Chang Chien, Yi-Chien Chiang, Li-Chun Huang, Chao-Hsing Yeh, Lung-Chang Chien, Yi-Chien Chiang, Li-Chun Huang

Abstract

Objectives. The objective of this one-group, repeated-measures design was to explore the acceptance of auricular point acupressure (APA) to reduce chronic low back pain (CLBP) and estimate minimum clinically important differences (MCIDs) for pain intensity change. Methods. Subjects received 7-day APA treatment. After appropriate acupoints were identified, vaccaria seeds were carefully taped onto each selected auricular point for 7-day. The Brief Pain Inventory Short Form (BPI) was used to collect outcome data. Results. A total of 74 subjects participated in the study. Ten subjects dropped out and the retention rate was 87%. Subjects reported a 46% reduction in BPI worst pain, and over 50% reduction in BPI average pain, overall pain severity and pain interference by the end of study, and 62.5% subjects also reported less pain medication use. The MCIDs for the subscale of BPI ranged from .70 to 1.86 points. The percentage improvement of MCIDs from baseline was between 14.5-24.9%. Discussion. APA appears to be highly acceptable to patients with CLBP. A sham group is needed in order to differentiate the true effects of APA from the possible psychological effects of more frequent visits by the auricular therapist and patients' expectation of the APA treatment.

Figures

Figure 1
Figure 1
Auricular acupoints for low back pain treatment.
Figure 2
Figure 2
Acupoint finder.
Figure 3
Figure 3
Vaccaria seeds with tan colored tape.
Figure 4
Figure 4
Change patterns of worst pain, average pain, pain severity, and pain interference from baseline to day 7 between subjects who were self-rated “Improved” and “Stable” groups.

References

    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. 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. Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. Journal of Bone and Joint Surgery A. 2006;88(2):21–24.
    1. Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine Journal. 2008;8(1):1–7.
    1. Lin CWC, Haas M, Maher CG, Machado LAC, van Tulder MW. Cost-effectiveness of general practice care for low back pain: a systematic review. European Spine Journal. 2011:1012–1023.
    1. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine. 2005;142(8):651–663.
    1. Furlan AD, van Tulder MW, Cherkin DC, et al. Acupuncture and dry-needling for low back pain. Cochrane Database of Systematic Reviews. 2005;(1)CD001351
    1. Yuan J, Purepong N, Kerr DP. Effectiveness of acupuncture for low back pain: a systematic review. Spine. 2009;34(15):p. 1630.
    1. Lu W, Rosenthal DS. Recent advances in oncology acupuncture and safety considerations in practice. Current Treatment Options in Oncology. 2010;11(3-4):141–146.
    1. Ammendolia C, Furlan AD, Imamura M, Irvin E, van Tulder M. Evidence-informed management of chronic low back pain with needle acupuncture. Spine Journal. 2008;8(1):160–172.
    1. Huang LC. Auricular Medicine: A Complete Manual of Auricular Diagnosis and Treatment. Orlando, Fla, USA: Auricular International Research and Training; 2005.
    1. Oleson T. Auriculotherapy Manual: Chinese and Western Systems of Ear Acupuncture. 3 edition. Kidlington, UK: Churchill Livingstone; 2003.
    1. World Health Organization. WHO Report of the Working Group on Auricular Nomenclature. France, Lyons: 1990.
    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. 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. 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 and 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. Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia. 2004;98(5):1359–1364.
    1. Sator-Katzenschlager SM, Szeles JC, Scharbert G, et al. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesthesia and Analgesia. 2003;97(5):1469–1473.
    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. McDonough SM, Liddle SD, Hunter R, et al. Exercise and manual auricular acupuncture: a pilot assessor-blind randomised controlled trial. (The acupuncture and personalised exercise programme (APEP) Trial) BMC Musculoskeletal Disorders. 2008;9, article 31
    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. Kober A, Scheck T, Schubert B, et al. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology. 2003;98(6):1328–1332.
    1. Mora B, Iannuzzi M, Lang T, et al. Auricular acupressure as a treatment for anxiety before extracorporeal shock wave lithotripsy in the elderly. Journal of Urology. 2007;178(1):160–164.
    1. Jaeschke R, Singer J, Guyatt GH. Measurement of health status. Ascertaining the minimal clinically important difference. Controlled Clinical Trials. 1989;10(4):407–415.
    1. Copay AG, Subach BR, Glassman SD, Polly DW, Jr., Schuler TC. Understanding the minimum clinically important difference: a review of concepts and methods. Spine Journal. 2007;7(5):541–546.
    1. Mease PJ, Spaeth M, Clauw DJ, et al. Estimation of minimum clinically important difference for pain in fibromyalgia. Arthritis Care and Research. 2011;63(6):821–826.
    1. Yost KJ, Sorensen MV, Hahn EA, Glendenning GA, Gnanasakthy A, Cella D. Using multiple anchor- and distribution-based estimates to evaluate clinically meaningful change on the functional assessment of cancer therapy-biologic response modifiers (FACT-BRM) instrument. Value in Health. 2005;8(2):117–127.
    1. Mathias SD, Crosby RD, Qian Y, et al. Estimating minimally important differences for the worst pain rating of the Brief Pain Inventory-short form. Journal of Supportive Oncology. 2011;9(2):72–78.
    1. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Annals of the Academy of Medicine Singapore. 1994;23(2):129–138.
    1. Harden RN, Weinland SR, Remble TA, et al. Medication Quantification Scale version III: update in medication classes and revised detriment weights by survey of American Pain Society physicians. Journal of Pain. 2005;6(6):364–371.
    1. Dunbar-Jacob J, Sereika S, Burke L, et al. Perceived treatment efficacy: assessment in rheumatoid arthritis. Annals of Behavioral Medicine. 1993;14:p. S147.
    1. Engberg S, Sereika SM, McDowell BJ, Weber E, Brodak I. Effectiveness of prompted voiding in treating urinary incontinence in cognitively impaired homebound older adults. Journal of Wound, Ostomy, and Continence Nursing. 2002;29(5):252–265.
    1. Frank BL, Soliman N. Shen men: a critical assessment through advanced auricular therapy. Medical Acupuncture. 1999;10(2):17–19.
    1. Längler A, Spix C, Gottschling S, Graf N, Kaatsch P. Parents-interview on use of complementary and alternative medicine in pediatric oncology in Germany. Klinische Padiatrie. 2005;217(6):357–364.
    1. Gottschling S, Längler A, Tautz C, Graf N. Complementary and alternative medicine in pediatric oncology. Klinische Padiatrie. 2006;218(3):157–164.
    1. Hastie T, Tibshirani R. Generalized Additive Models. 1st edition. London, UK: Chapman and Hall; 1990.
    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. Roland M, Fairbank J. The Roland-Morris disability questionnaire and the Oswestry disability questionnaire. Spine. 2000;25(24):3115–3124.
    1. Farrar JT, Young JP, LaMoreaux L, Werth JL, Poole RM. Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale. Pain. 2001;94(2):149–158.
    1. Sierpina VS, Frenkel MA. Acupuncture: a clinical review. Southern Medical Journal. 2005;98(3):330–337.
    1. Lind BK, Lafferty WE, Tyree PT, Sherman KJ, Deyo RA, Cherkin DC. The role of alternative medical providers for the outpatient treatment of insured patients with back pain. Spine. 2005;30(12):1454–1459.
    1. Cherkin DC, Eisenberg D, Sherman KJ, et al. Randomized trial comparing Traditional Chinese medical acupuncture, therapeutic massage, and self-care education for chronic low back pain. Archives of Internal Medicine. 2001;161(8):1081–1088.
    1. Thomas KJ, MacPherson H, Ratcliffe J, et al. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technology Assessment. 2005;9(32):1–109.
    1. Brinkhaus B, Witt CM, Jena S, et al. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Archives of Internal Medicine. 2006;166(4):450–457.
    1. Asher GN, Motsinger-Reif AA, Jonas DE, Viera AJ. Quality of reporting on randomised controlled trials of auriculotherapy for pain. Acupuncture in Medicine. 2011;29(2):122–126.
    1. Lanas A. Nonsteroidal antiinflammatory drugs and cyclooxygenase inhibition in the gastrointestinal tract: a trip from peptic ulcer to colon cancer. American Journal of the Medical Sciences. 2009;338(2):96–106.
    1. Irving G, Pénzes J, Ramjattan B, et al. A randomized, placebo-controlled phase 3 trial (study sb-767905/013) of alvimopan for opioid-induced bowel dysfunction in patients with non-cancer pain. Journal of Pain. 2011;12(2):175–184.

Source: PubMed

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