Auriculotherapy and reducing chronic musculoskeletal pain: integrative review

Morais, Bruna Xavier; Ongaro, Juliana Dal; Almeida, Franciele Ormizinda; Luz, Emanuelli Mancio Ferreira da; Greco, Patrícia Bitencourt Toscani; Magnago, Tânia Solange Bosi de Souza

doi:10.1590/0034-7167-2019-0394

Bruna Xavier Morais Corresponding author: Bruna Xavier Morais E-mail: bruna_morais100@hotmail.com

Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0002-0446-9231

Juliana Dal Ongaro

Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0003-0058-0132

Franciele Ormizinda Almeida

Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0001-6771-3863

Emanuelli Mancio Ferreira da Luz

Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0002-7799-5232

Patrícia Bitencourt Toscani Greco

Universidade Regional Integrada do Alto Uruguai e das Missões. Santiago, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0001-6999-5470

Tânia Solange Bosi de Souza Magnago

Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.

http://orcid.org/0000-0002-5308-1604

Corresponding author: Bruna Xavier Morais E-mail: bruna_morais100@hotmail.com

Title	Design, LE and year of publication	Type / location of pain	Participants and duration	Auricular points	Intervention and control	Evaluation and result
Auriculotherapy in the treatment of individuals affected by work-related musculoskeletal disorders (wrmd) / repetitive strain injuries (RSI) ⁽²²22 Araújo APS, Zampar R, Pinto SME. Auriculoterapia no tratamento de indíviduos acometidos por distúrbios osteomusculares relacionados ao trabalho (dort)/ lesões por esforços repetitivos (ler). Arq Ciên Saúde Unipar. 2006;10(1):35-42. doi: 10.25110/arqsaude.v10i1.2006.140 https://doi.org/10.25110/arqsaude.v10i1.... ⁾	Before and after clinical trial LE = 3 Year: 2006	Work-related diseases (WRD)	Participants: 12 (workers) Duration: Ten sessions (twice a week)	Apex of the ear, shen men, kidney, sympathetic, liver, spleen-pancreas, points related to painful areas	Rapeseed seeds	Evaluation: Visual Analog Scale Result: reduction of pain (p <0.001)
Evaluation of atrial acupressure in painful shoulder syndrome: a case study ⁽²³23 Zanelatto AP. Avaliação da acupressão auricular na Síndrome do Ombro Doloroso: estudo de caso. Rev Bras Enferm. 2013;66(5):694-701. doi: 10.1590/S0034-71672013000500009 https://doi.org/10.1590/S0034-7167201300... ⁾	Case study LE = 6 Year: 2013	Painful shoulder syndrome	Participants: 1 (military police) Duration: 12 sessions (weekly)	Shen men, kidney, sympathetic, shoulder, shoulder joint and clavicle	Crystal spheres	Evaluation: Penn Shoulder Score Result: pain reduction and sleep improvement
Exercise and Auricular Acupuncture for Chronic Low-back Pain: A Feasibility Randomized-Controlled Trial ⁽²⁴24 Hunter RH, McDonough SM, Bradbury I, Liddle SD, Walsh DM, Dhamija S, et al. Exercise and Auricular Acupuncture for Chronic Low-back Pain: a Feasibility Randomized-controlled Trial. Clin J Pain. 2012;28(3):259-67. doi: 10.1097/AJP.0b013e3182274018 https://doi.org/10.1097/AJP.0b013e318227... ⁾	Randomized clinical trial LE = 2 Year: 2012	Lower back	Participants: 51 (students) Duration: 12 weeks (6 faceto-face and 6 telephone support)	Shen men, lumbar spine and cushion	Intervention: auriculotherapy (semi-permanent needles) and physical exercise Control: physical exercise	Evaluation: Oswestry Disability Questionnaire; Analogic visual scale Result: reduction of pain; and use of pain relief medication in the intervention group (73.9%)
Multimodal Care in the Management of a Patient with Chronic Tendinopathy of the Biceps Femoris: a Case Report ⁽²⁵25 Martin BR. Multimodal Care in the management of a patient with chronic tendinopathy of the bíceps femoris: a case report. J Chiropr Med. 2017;16(2):156-62. doi: 10.1016/j.jcm.2017.01.006 https://doi.org/10.1016/j.jcm.2017.01.00... ⁾	Case study LE = 6 Year: 2017	Right femoral muscle	Participants: 1 (patient) Duration: Eight sessions (twice a week) and three sessions (weekly)	Apex of the ear, shen men, sympathetic, liver, spleen, kidney, liver yang, hip	Auriculotherapy combined with dry needling	Evaluation: Numerical Pain Scale Result: reduction of pain, fatigue, symptoms of anxiety and tension; and improving sleep quality
Electrical Stimulation of Auricular Acupuncture Points Is More Effective Than Conventional Manual Auricular Acupuncture in Chronic Cervical Pain: A Pilot Study ⁽²⁶26 Sator-Katzenschlager SM, Szeles JC, Scharbert G, Michalek-Sauberer A, Kober A, Heinze G, et al. Electrical stimulation of auricular acupuncture points is more effective than conventional manual auricular acupuncture in chronic cervical pain: a pilot study. Anesth Analog [Internet]. 2003 [cited 2019 May 6];97(5):1469-73. Available from: https://mail.vagusdent.gr/images/PDF/Klinikes-dokimes/anesth_analg_2003-97.pdf https://mail.vagusdent.gr/images/PDF/Kli... ⁾	Randomized clinical trial LE = 2 Year: 2003	Cervical	Participants: 21 (patients) Duration: Six sessions (weekly)	Shen men, cervical spine and cushion	Intervention: electroacupuncture Control: auriculotherapy (semi-permanent needles)	Evaluation: Visual Analog Scale Result: greater reduction in chronic cervical pain and medication use; improvement in sleep quality and psychological well-being in the intervention group, when compared to control (p <0.05)
The Short- and Long-Term Benefit in Chronic Low Back Pain Through Adjuvant Electrical Versus Manual Auricular Acupuncture ⁽²⁷27 Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, Szeles JC, Finster G, Schiesser AW, et al. The short-and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesth Analog [Internet]. 2004 [cited 2019 May 6];98(5):1359-64. Available from: https://www.dyansys.com/sites/default/files/anesthesia-acupuncture-back-pain.pdf https://www.dyansys.com/sites/default/fi... ⁾	Randomized clinical trial LE = 2 Year: 2004	Lower back	Participants: 61 (patients) Duration: Six sessions (weekly)	Shen men, lumbar spine and cushion	Intervention: electroacupuncture Control: auriculotherapy (semi-permanent needles)	Evaluation: Visual Analog Scale Result: greater pain reduction in the intervention group, when compared to control (p < 0.001) and medication use (p < 0.001); improvement in psychological wellbeing and sleep
Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial ⁽²⁸28 Ushinohama A, Cunha BP, Costa LOP, Barela AMF, Freitas PB. Effect of a single session of ear acupuncture on pain intensity and postural control in individuals with chronic low back pain: a randomized controlled trial. Braz J Phys Ther. 2016;20(4):328-35. doi: 10.1590/bjpt-rbf.2014.0158 https://doi.org/10.1590/bjpt-rbf.2014.01... ⁾	Randomized clinical trial LE = 2 Year: 2016	Lower back	Participants: 80 (patients) Duration: One session	Shen men, lumbar spine and cushion	Intervention: auriculotherapy (semipermaning needles) Control: ultrasound on but not activated	Evaluation: Numerical Pain Scale Result: greater pain reduction in the intervention group when compared to the control group (p = 0.032)
Auricular therapy for chronic pain management in adults: A synthesis of evidence ⁽²⁹29 Zhao HJ, Tan JY, Wang T, Jin L. Auricular therapy for chronic pain management in adults: a synthesis of evidence. Complement Ther Clin Pract. 2015;21(2):68-78. doi: 10.1016/j.ctcp.2015.03.006 https://doi.org/10.1016/j.ctcp.2015.03.0... ⁾	Systematic review and meta-analysis LE = 1 Year: 2015	Chronic pains	Participants: 12 to 265 (patients) Duration: One to 12 weeks	Most used: shen men	Vaccaria seeds and semi-permanent needles (electrostimulation)	Evaluation: Visual Analogue Scale; Numerical Pain Scale Result: reduced intensity of chronic low back pain and tension headaches
Efficacy of Auricular Acupressure for Chronic Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials ⁽¹⁴14 Yang LH, Duan PB, Hou QM, Du SZ, Sun JF, Mei SJ, et al. Efficacy of auricular acupressure for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2017.1-14. doi: 10.1155/2017/6383649 https://doi.org/10.1155/2017/6383649... ⁾	Systematic review and meta-analysis LE = 1 Year: 2017	Lower back	Participants: 19 to 74 (adult patients) Duration: Two to 12 weeks	Most used: shen men, subcortex, lumbosacral region, liver, kidney and sympathetic	Vaccaria seeds and metal spheres	Evaluation: Visual Analog Scale, Verbal Rating Scale, Brief Pain Inventory Short Form Result: pain reduction (p < 0.001)
Evaluation of the immediate effect of auricular acupuncture on pain and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: A randomized, single-blinded, sham-controlled, crossover study ⁽³⁰30 Silva ACO, Biasotto-Gonzalez DA, Dos Santos DM, Melo NC, Gomes CAFP, Amorim CF et al. Evaluation of the immediate effect of auricular acupuncture on pain and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: A randomized, single-blinded, sham-controlled, crossover study. Evid Based Complement Alternat Med. 2015.1-8. doi: 10.1155/2015/523851 https://doi.org/10.1155/2015/523851... ⁾	Randomized clinical trial LE = 2 Year: 2015	Músculo trapézio e cervicalgia unspecific	Participantes: 24 (pacientes) Duration: One session	Grupo-intervenção: Cintura escapular e ombro Placebo: regions that were unrelated to the outcome	Intervenção: agulhas semipermanentes Placebo: semipermanent needles	Avaliação: Escala Numérica da Dor Result: pain reduction (p <0.001) in both groups
Longitudinal changes in the disability level of the elders with low back pain after auriculotherapy ⁽³¹31 Suen LKP, Wong EMC. Longitudinal changes in the disability level of the elders with low back pain after auriculotherapy. Complement Ther Med. 2008;16(1):28-35. doi: 10.1016/j.ctim.2007.09.002 https://doi.org/10.1016/j.ctim.2007.09.0... ⁾	Randomized controlled clinical trial LE = 2 Year: 2008	Backache	Participants: 60 (elderly patients) Duration: Three sessions (weekly)	Shen men, kidney, bladder, region, lumbosacral region, liver, spleen and coccyx	Intervention: magnetic spheres Control: vaccaria seed	Evaluation: Aberdeen low back pain disability scale Result: the intervention group showed greater pain reduction, improved physical and functional capacity and abilities (p <0.001) when compared to the control group
Auriculotherapy on low back pain in the elderly ⁽³²32 Suen LKP, Wong TKS, Chung JWY, Yip VYB. Auriculotherapy on low back pain in the elderly. Complement Ther Clin Pract. 2007;13(1):63-9. doi: 10.1016/j.ctcp.2006.10.005 https://doi.org/10.1016/j.ctcp.2006.10.0... ⁾	Randomized controlled clinical trial LE = 2 Year: 2007	Backache	Participants: 60 (elderly patients) Duration: Three sessions (weekly)	Shen men, kidney, bladder, lumbosacral region, liver, spleen and coccyx	Intervention: magnetic spheres Control: vaccaria seed	Rating: Chinese Pain Intensity Verbal Rating Scale Result: the intervention group showed greater pain reduction when compared to the control group (p <0.001)
Effects of auricular acunpucture on chonic pain in people with back musculoskeletal disorders: a randomized clinical trial ⁽³³33 Moura CC, Chaves ECL, Chianca TCM, Ruginsk SG, Nogueira DA, Iunes DH. Effects of auricular acunpucture on chonic pain in people with back musculoskeletal disorders: a randomized clinical trial. Rev Esc Enferm USP. 2019;53:e03418. doi: 10.1590/s1980-220x2018009003418 https://doi.org/10.1590/s1980-220x201800... ⁾	Randomized clinical trial LE = 2 Year: 2019	Pain in the spine	Participants: 110 (adults and the elderly) Duration: Five sessions (weekly)	Intervention group: Shen men, kidney, sympathetic nerve, points of restoring energy balance, cervical, thoracic and / or lumbar vertebrae Placebo group: Eye point	Intervention and placebo: semipermanent needles Control: received no intervention	Evaluation: Brief Inventory of Pain; digital algometry Result: there was a reduction in pain intensity in the intervention and placebo group between the initial and final evaluation (p < 0.05), and in the intervention group between the initial and follow-up evaluation (p < 0.05)
Auricular Acupuncture for Chronic Pain and Insomnia: A Randomized Clinical Trial ⁽³⁴34 Garner BK, Hopkinson SG, Ketz AK, Landis CA, Trego LL. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Med Acupunct. 2018;30(5):262-72. doi: 10.1089/acu.2018.1294. https://doi.org/10.1089/acu.2018.1294... ⁾	Randomized clinical trial LE = 2 Year: 2018	Chronic pains ^* * Study contemplates the treatment of chronic pain and insomnia.	Participants: 45 active and / or retired military personnel Duration: 1 session	Cingulate Gyrus, Thalamus point, Omega 2, Point Zero and Shenmen	Intervention: semipermanent needle Control: actigraph device (noninvasive method to monitor human rest / activity cycles)	Assessment: Brief Inventory of Pain Result: the intervention group showed greater reduction in pain (p = 0.001), insomnia (p = 0.018) and better satisfaction with life (p = 0.007) when compared to the control group

Evaluation tool	Groups	Pain intensity^* * Pain intensity patterns vary according to the instruments used.		Number of sessions
Evaluation tool	Groups	Before	After	Number of sessions
Analogic visual scale ⁽²²22 Araújo APS, Zampar R, Pinto SME. Auriculoterapia no tratamento de indíviduos acometidos por distúrbios osteomusculares relacionados ao trabalho (dort)/ lesões por esforços repetitivos (ler). Arq Ciên Saúde Unipar. 2006;10(1):35-42. doi: 10.25110/arqsaude.v10i1.2006.140 https://doi.org/10.25110/arqsaude.v10i1.... ⁾	-	5.86 (±2.23)	1.19 (±1.18)	10
PSS-Brazil ⁽²³23 Zanelatto AP. Avaliação da acupressão auricular na Síndrome do Ombro Doloroso: estudo de caso. Rev Bras Enferm. 2013;66(5):694-701. doi: 10.1590/S0034-71672013000500009 https://doi.org/10.1590/S0034-7167201300... ⁾	-	0.0%^ǂ ǂ Percentage of improvement.	46.7%^ǂ ǂ Percentage of improvement.	12
Analogic visual scale ⁽²⁵25 Martin BR. Multimodal Care in the management of a patient with chronic tendinopathy of the bíceps femoris: a case report. J Chiropr Med. 2017;16(2):156-62. doi: 10.1016/j.jcm.2017.01.006 https://doi.org/10.1016/j.jcm.2017.01.00... ⁾	-	6	1	19
Numerical Pain Scale ⁽³⁰30 Silva ACO, Biasotto-Gonzalez DA, Dos Santos DM, Melo NC, Gomes CAFP, Amorim CF et al. Evaluation of the immediate effect of auricular acupuncture on pain and electromyographic activity of the upper trapezius muscle in patients with nonspecific neck pain: A randomized, single-blinded, sham-controlled, crossover study. Evid Based Complement Alternat Med. 2015.1-8. doi: 10.1155/2015/523851 https://doi.org/10.1155/2015/523851... ⁾	Intervention	4,25 (±1,13)	2,25 (± 0,97)	4
	Placebo	4,00 (±0,73)	2,33 (±1,07)	4
Chinese Pain Intensity Verbal Rating Scale ⁽³²32 Suen LKP, Wong TKS, Chung JWY, Yip VYB. Auriculotherapy on low back pain in the elderly. Complement Ther Clin Pract. 2007;13(1):63-9. doi: 10.1016/j.ctcp.2006.10.005 https://doi.org/10.1016/j.ctcp.2006.10.0... ⁾	Intervention	2.73 (±0.74)	1.87 (±0.68)	3
	Control	2.47 (±0.78)	2.27 (±0.58)	3
Brief Inventory of Pain ⁽³³33 Moura CC, Chaves ECL, Chianca TCM, Ruginsk SG, Nogueira DA, Iunes DH. Effects of auricular acunpucture on chonic pain in people with back musculoskeletal disorders: a randomized clinical trial. Rev Esc Enferm USP. 2019;53:e03418. doi: 10.1590/s1980-220x2018009003418 https://doi.org/10.1590/s1980-220x201800... ⁾	Intervention	4.86 (±2.79)	2.46 (±3.03)	5
	Placebo	4.89 (±2.74)	2.89 (±2.98)
	Control	3.68 (±3.11)	3.65 (±3.35)
Brief Inventory of Pain ⁽³⁴34 Garner BK, Hopkinson SG, Ketz AK, Landis CA, Trego LL. Auricular acupuncture for chronic pain and insomnia: a randomized clinical trial. Med Acupunct. 2018;30(5):262-72. doi: 10.1089/acu.2018.1294. https://doi.org/10.1089/acu.2018.1294... ⁾	Intervention	4.7 (±2.0)	3,1 (±1.8)	1
	Control	3.6 (±1.7)	3.6 (±2.3)	1

[1] Corresponding author: Bruna Xavier Morais E-mail: bruna_morais100@hotmail.com

Brasil

Brasil

Auriculotherapy and reducing chronic musculoskeletal pain: integrative review

Auriculoterapia y reducción del dolor musculoesquelético crónico: revisión integrativa

ABSTRACT

Objectives:

Methods:

Results:

Conclusions: