Auricular acupuncture

in treatment of pain
Taras Usichenko

Department of Anaesthesiology and Intensive Care Medicine

Ernst Moritz Arndt University of Greifswald

Outline

Intoduction
Potential mechanisms
Indications for treatment of acute pain & chronic pain
How to avoid side effects and complications

Demonstration with practice

Identification of AA points
Needling

Auricular acupuncture stimulation of cranial & cervical nerves

fMRI-investigation of electric
stimulation applied to auricular concha
Innervation of external auricle
Sources of afferent nerve supply
Trigeminal

Auriculotemporal n.

Vagal

Auricular branch
of vagal n.

Cervical

Greater
occipital n.

Increase of neuronal activity

in brain stem (locus coeruleus)

Peuker Dtsch Z Akupunktur 2003

Dietrich et al Biomed Techn 2008

Potential analgesic mechanisms of auricular stimulation - summary

Activation of:
- descending noxious inhibitory system (DNIC) including
- antinociceptive endogeneous opioid system of brain stem
- cholinergic anti-inflammatory pathway via vagal nuclei

Clinical indications for auricular

stimulation in treatment of pain

 auriculotherapy reduced analgesic use for perioperative pain

for acute pain and chronic pain, auriculotherapy reduced pain intensity

Patients, who received PERIOPERATIVE auriculotherapy,

required less analgesics than those from the control group
Auriculotherapy vs. control condition in treatment of POSTOPERATIVE PAIN after:
molar extraction
hip arthroplasty
knee arthroscopy
Outcome: analgesic requirement

Asher et al J Alternat Compl Med 2010

Auricular acupuncture reduced opioid

requirement after hip arthroplasty by 36%
Main Result

Indwelling
AA needles

Patients with CHRONIC PAIN, who received auriculotherapy,

reported less pain than the patients from the control group
Auriculotherapy vs. control condition in treatment of CHRONIC PAIN:
cancer pain
chronic pain in patients with TMD
distal arm chronic pain
cervical pain
low-back pain
Outcome: analgesic requirement

Asher et al J Alternat Compl Med 2010

Auricular electroacupuncture in patients with CHRONIC low-back pain

Results

Methods
Patients with chronic low back pain randomised to:
- auricular electroacupuncture (EA)
- auricular acupuncture (CO)
Intervention:
- stimulation P-StimTM 48 hours weekly for 6 weeks
- rectangular pulse 0.1 ms, 1Hz, max. 4 mA

P-Stim device at acupuncture points: lumbar

spine (40), shen 6 men (55) and cushion (29)

Sator-Katzenschlager et al Anesth Analg 2004

Case of chronic low-back pain treated with transcutaneous fentanyl

History

Surgery
Dorsal & ventral osteosynthesis,
spondylodesis & hemilaminektomy

Female, 77 yrs old, 45 kg

Chronic low-back pain because of
lumbal stenosis L4/5 due to spondylolisthesis
coronary artery disease, 2 myocardial infarction

Fentanyl-patch 75 mcg/h

since 1 yr

Auricular acupuncture to assist opioid reduction for chronic low-back pain

Acupuncture using indwelling fixed

needles to support fentanyl reduction

FNT t.c. 75 ~ 31,88 EUR

It is expedient to take care because of known

ADVERSE EFFECTS and COMPLICATIONS of AA

The most common complication of AA is infection

Vasovagal reactions are possible

Recommendations:
- puncture in supine (or at least sitting) position
- desinfection
- avoid needling, choose acupressure in patients with
cardiac valve disease, diabetes mellitus, suppressed immunity

White AR Acupunct Med 2004

Acute perichondritis of the ear.

From: Manual of ENT surgery,
Thieme, 1989.

Search for stimulation points,

when you already know the diagnosis

Inspection
acute inflammation: discolorations (red or brown)
chronic conditions: flaky white dry areas

Palpation

Detection of skin areas with lower impedance

Palpation and detection of areas with lower skin impedance

Palpation only

Ogal 1998

Usichenko et al Acupunct & Electrother Res 2003

It is assumed that the skin impedance of acupuncture

point is lower compared to surrounding tissues
Electrical resistance in dependence
from distance to acupuncture point

Hyvarinen & Karlsson 1977

Clean with C2H5OH

Auricular acupuncture points vs. body points:

smaller

closer to surface

have lower resistance

Even small lesions of epidermis lead to strong

reduction of skin impedance at lesion points

Stratum corneum has

the highest resistivity

Bossy Am J Acupunct 1983

Even minimal lesions of stratum corneum

lead to dramatic reduction of skin resistance

McCarroll & Rowley IEEE Trans Biomed Eng 1979

Conclusions

Analgesic effects of auricular stimulation can be explained

using the modern data from neurophysiology research
AA can be recommended for treatment of:
- chronic pain of various origin
- postoperative pain as complementary method
Serious side effects can be easily avoided