https://orcid.org/0000-0002-6488-9692
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ABSTRACT
Objectives
Auricular acupuncture (AA) is becoming increasingly common in primary care clinics, emergency departments and peri-operatively for pain relief. Over the last decade, since the last comprehensive reviews were published, the literature has expanded. In this scoping review, we seek to document the efficacy of AA in treating both acute and chronic pain, describe the mechanism of action of AA in treating pain, and discuss how AA has been integrated into Western medicine to date.
Methods
The authors performed a MEDLINE search inclusive of articles from 1966 to June 2023 including articles written in English identifying literature. We included human studies when more than 3 patients were included. Three hundred and fourteen unique articles were identified and 152 were selected by title screen. After abstract review, 117 were chosen for full-text review. Following full-text review, 33 articles were excluded and 21 added from references, totaling 105 articles included in our scoping review.
Results
AA reduces pain severity in patients with both acute and chronic pain. The best studies in the acute settings have occurred in the peri-operative setting where sham AA is employed, multiple sessions of AA are given, and medication dosing is carefully monitored. In these cases, AA reduced pain and post-operative medications. In patients with chronic pain, multiple sessions of AA resulted not only in pain relief but also in improvements in function and disability. Literature suggests that AA works through multiple mechanisms with the most compelling data coupled to the autonomic nervous system and neuroendocrine system. Curriculums designed to teach AA and aid in implementation have been published.
Conclusion
AA is an accessible, effective means of pain relief. AA is relatively straightforward to learn, and protocols and curriculums exist to teach healthcare professionals this valuable skill. Overcoming implementation barriers, including patient education, are essential next steps.
Plain Language Summary
This review was written to analyze the current research on an increasingly popular pain relief treatment, auricular acupuncture. Auricular acupuncture has been an effective method of pain relief for patients with short-term pain. People who experienced pain after surgery and received auricular acupuncture experienced a decrease in pain and pain medications. Patients with chronic pain who underwent auricular acupuncture experienced pain relief and an increase in their functional abilities. Auricular acupuncture is thought to affect the body’s autonomic nervous system and neuroendocrine system as it creates its source of pain relief for the body. Auricular acupuncture is increasingly popular in the education of healthcare workers and clinical practice. Research shows auricular acupuncture is an effective, easy, and less expensive method of pain relief, whose growth in pain management use may benefit from further education, especially for patients.
Acronym list
| AA | = | Auricular Acupuncture |
| BFA | = | Battlefield Acupuncture |
| VA | = | Department of Veterans Affairs |
| PTSD | = | Post-Traumatic Stress Disorder |
| RCT | = | Randomized Controlled Trial |
| ED | = | Emergency Department |
| LBP | = | Low Back Pain |
| BMT | = | Best Medical Treatment |
| NRS | = | Numerical Rating Scale |
| VAS | = | Visual Analog Scale |
| EAA | = | Electrical Auricular Acupuncture |
| CLBP | = | Chronic Lower Back Pain |
| QoL | = | Quality of Life |
| APA | = | Auricular Pressure Acupuncture |
| RMDQ | = | Roland Morris Disability Questionnaire |
| ODI | = | Oswestry Disability Index |
| ASP | = | Semi-Permanent Needles |
| ABVN | = | Auricular Branch of the Vagal Nerve |
| NTS | = | Nucleus of the Solitary Tract |
| ACTH | = | Adrenocorticotropic Hormone |
| APRN | = | Advanced Practice Registered Nurse |
| USUHS | = | Uniformed Services University of Health Services |
| CIM | = | Complementary and Integrative Medicine |
| ATACS | = | Acupuncture Training Across Clinical Settings |
| IV | = | Intravenous |
| CIH | = | Complementary and Integrative Health |
Declaration of financial/other relationships
J.G. Pilitsis has received grant support from Medtronic, Boston Scientific, Abbott, NIH 2R01CA166379, NIH ROH1EB030324, and NIH U44NS115111. She is the medical advisor for Aim Medical Robotics and has stock equity. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgments
This work has previously been presented at a conference or similar as: Trish Elliott, Maria P. Merlano, Marisa DiMarzio, Deborah R. Morris, Candy Wilson, Julie G. Pilitsis. Mechanisms of Auricular Acupuncture in Neuromodulation. E-Poster Presentation. ASRA. 2023; and Trish Elliott, Maria P. Merlano, Marisa DiMarzio, Deborah R. Morris, Candy Wilson, Julie G. Pilitsis. Mechanisms of Auricular Acupuncture in Neuromodulation. E-Poster Presentation. NANS 2024.
Author contributions
Trish Elliott: literature search, literature analysis, writing, figure creation; Maria Merlano Gomez: literature analysis, writing; Deborah Morris: literature analysis, writing; Candy Wilson: literature analysis, writing; and Julie G. Pilitsis: literature search, literature analysis, writing.