Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis

Abstract

Objective: Ear acupuncture might be the form of acupuncture best suited to improving acute pain management in the emergency department (ED). The primary aim of this review was to assess the analgesic efficacy of ear acupuncture in the ED. Secondary outcomes included measures of patient satisfaction, adverse effects, cost, administration techniques, and reduction of medication usage. Methods: Seven databases and Google Scholar were searched up to April 27, 2017, using MeSH descriptors for three overarching themes (ear acupuncture, pain management, and emergency medicine). Meta-analyses were performed in 3 comparator groups: (1) ear acupuncture versus sham; (2) ear acupuncture-as-adjunct to standard care; and (3) ear acupuncture (both as sole therapy and adjuvant) versus control to calculate the standardized mean difference (SMD) and weighted mean difference (WMD) for pain scores out of 10. Results: Six randomized controlled trials and 2 observational studies, totaling 458 patients, were retrieved after exclusions. The meta-analysis used data from 4 randomized studies representing 286 patients. The above 3 comparator groups resulted in SMDs of 1.69, 1.68, and 1.66, and WMDs of 2.47, 2.84, and 2.61 respectively, all favoring acupuncture. Battlefield (ear) acupuncture was the most commonly used technique. There were no significant adverse effects and patient satisfaction improved. Results regarding if acupuncture reduced medication use were equivocal. Significant study bias and heterogeneity were found. Conclusions: While study numbers are limited, ear acupuncture, either as stand-alone or as-an-adjunct technique, significantly reduced pain scores and has potential benefits for use in the ED. Further studies will define acupuncture's role and if it reduces use of analgesic medications.

Battlefield Acupuncture for Chronic Pain Management in Patients on Long-Term Opioid Therapy

“…Anecdotally, clinical documentation indicated that the veterans: ''Feel much better with BFA'' and ''Is even going off methadone and has better mental clarity.'' Overall, the numbers of the Fargo VA population were similar to larger populations in previous studies 7,8,[12][13][14][15][16][17][18][19][20] with a significant average decrease of 1.3 points on the 0-10 NRS (P < 0.01). See Table 2.…”

“…The first meta-analysis on BFA-either as a stand-alone treatment or coordinated with other methods in an ER setting-was performed by the United Air Force Acupuncture and Integrative Medicine Center in 2017. 12 The researchers there analyzed 6 randomized controlled trials (RCTs) 7,13-17 and 2 observational studies 18,19 and found significant results in decreased post treatment pain in all reviewed articles by an average of 2.5 points on a numeric rating scale (NRS) with no significant adverse effects and overall improved patient satisfaction.…”

“…Significant study bias and heterogeneity were found in several studies. 7,[12][13][14][15][16][17][18][19] Limitations of these studies are the small populations, uncontrolled clinical trials, and no blinding of patients or providers. In addition, previous research on the topic was quite limited and many researchers could have overestimated their results.…”

“…Among the literature there was no RCT comparing the effects of BFA and opioid use as a primary outcome measure. In the previously mentioned meta-analysis, 12 prescription medication usage for pain management post ER treatments was measured as a secondary outcome. There was one RCT showing that patients who received BFA had reduction in their use of nonsteroidal anti-inflammatory drugs for sore throats.…”

Auricular Acupuncture and Skin-Cancer Detection: An Opportunity

“…E ar acupuncture has been shown to be effective in pain-score reduction for acute and chronic pain in a variety of comparator groups and settings. 1,2 Battlefield Acupuncture (BFA), a subset of auricular acupuncture developed by Richard C. Niemtzow, MD, PhD, MPH, has been promoted by a project called the Acupuncture Across Clinical Settings (ATACS) program, and has led to widespread promulgation of this simple 5-point auricular technique used to treat both acute and chronic pain. 3,4 It has been anticipated that the number of patients undergoing BFA will increase markedly over the upcoming years.…”