INSERM has published in 2013 a report evaluating the therapeutic efficacy of auricular acupuncture
The French Report by Gueguen and his colleagues, published by INSERM in 2013, analyzing the clinical benefit of acupuncture at ear level, otherwise known as auriculotherapy in several health disorders and diseases: smoking cessation or alcoholic, pain, dermatology, nausea or vomiting, preoperative anxiety, sleep disorders, allergic rhinitis, hypo-galactorrhe post-cesarean and endometriosis. For the majority of these disorders, the available scientific and clinical evidence does not prove the effectiveness of auriculotherapy. The most likely benefits concern the treatment of post-operative pain and preoperative anxiety.
The Report Rationale
Auriculotherapy is a therapeutic approach reflex that involves stimulating specific areas of the ears, either by stitching or by another type of stimulation (electrical stimulation, massage, magnetic field, laser, etc.). This practice is meant to relieve various ailments: pain, addictions, anxiety and depressive disorders, functional disorders. It is often associated with acupuncture but these two techniques are based on two radically different theoretical corpus. In France, the legal framework of auriculotherapy is not defined. Yet, social security reimburses acts of auricular therapy as well as acupuncture stimulation acts when the procedures used are recognized by health insurance and performed by a professional belonging to the medical profession.
Auriculotherapy is part of complementary therapeutic practices. The development of such therapies requires health authorities to verify their effectiveness and safety.
Is auriculotherapy therapeutic effective and safe?
A working group of INSERM has carried out a report on the effectiveness and safety of auriculotherapy. This report is based on 43 randomized controlled trials and a Cochrane meta-analysis type. The total number of participants in each group should be greater than 25, all ages. Study populations should have an identified disease (smoking or alcohol dependence, pain, skin disorder, nausea or vomiting, preoperative anxiety, sleep disorders, allergic rhinitis, hypo-galactorrhée post-cesarean and endometriosis). The tests combining auriculotherapy with other interventions were not included. Intervention in auriculotherapy was compared to a control group without treatment, placebo and / or using another active treatment.
The outcomes were generally self-reported by patients (pain evaluation, substance use, evaluating the mental state, etc.).
The Non-Pharmacological Intervention (NPI) assessed
According to the HAS (2000, 2004), auriculotherapy is not suitable for drug intervention functional urogenital diseases (bedwetting), anxio-depressive syndromes, allergies (asthma, rhinitis), and functional gastrointestinal diseases ( nausea and vomiting), pain and addictive behaviors (smoking, alcoholism, drug addiction).
Several techniques are used by practitioners: stimulation needles, electrical stimulation, liquid nitrogen injection, the micro-grooves, the laser stimulation, stimulation by magnetic fields, pressure stimulation, stimulation by applying Local heat stimulation projection of colored lights on the ear points.
The frequency and duration of treatment recommended by practitioners will vary depending on the pathology. Successful clinical trials have evaluated the efficacy of auricular acupuncture in the following indications: withdrawal (cocaine, smoking, alcohol, opiates, miscellaneous), pain (peri and / or post-surgical, chronic lumbar and pelvic during pregnancy , and acute migraine), dermatology (flat warts, psoriasis, acne), nausea and vomiting (postoperative, of pregnancy), preoperative anxiety. The techniques used included stimulation by needles, needles by semi-permanent and semi-permanent pins, by microsaignées, by electro-acupuncture, laser, magnetic stimulation and massage. The number of sessions varied from one to 40 sessions over eight weeks maximum depending on the study.
This report summarizes the different results depending on the condition treated by auriculotherapy. This intervention appears effective in the case of preoperative pain and preoperative anxiety. Studies of other health problems are too heterogeneous and too have significant methodological limitations to conclude at a profit. Auriculotherapy brings up undesirable side effects such as vagal (quite common), vertigo (rare), chondrites (exceptional). The risk of auricular acupuncture are common to those of body acupuncture. Usually they are minor and transient.
Vis-à-vis issues auriculotherapy remain: who does this procedure work? What are the responders and non-responders? Is the observed benefit of a placebo effect or a real therapeutic effect?
This intervention appears effective in the case of preoperative pain and preoperative anxiety. Studies of other health problems are too heterogeneous and too have significant methodological limitations to conclude at a profit.
What it means for Patients
Auriculotherapy aims to treat various diseases and symptoms for using stimulations performed on the pinna. It is proposed as a complementary therapy by some practitioners but at present it is impossible to conclude on its efficacy and safety. However auriculotherapy appears effective in the case of post-operative pain and preoperative anxiety.
What it means for Healthcare Professionals
In France, unlike acupuncture IUD, IUD auriculotherapy is not recognized by the National Council of the Medical Association. This implements a reflection on complementary and alternative medicine (CAM). For the majority of information presented in this report, the data is inconclusive. However, auriculotherapy appears effective in the case of post-operative pain and preoperative anxiety. Monitoring of side effects is still required.
What it means for Researchers
The report of INSERM has selected 43 randomized comparative studies to evaluate the efficacy and safety of auriculotherapy. Most of these studies, although the observed results seem promising, have real methodological limitations. More rigorous studies are needed. In the case of post-operative pain and preoperative anxiety, new studies should be conducted to confirm or refute these findings and better understand the mechanisms of action. Thus, ultimately, it will be possible to prove whether auriculotherapy has its place or not in the therapeutic arsenal.
What it means for Policymakers
The data available in the literature do not allow to clarify the risk / benefit of auriculotherapy. The cases of post-operative pain and preoperative anxiety seem most promising. This raises questions about the place to give this non-drug intervention in health care provision.
Gueguen J, Barry C, Seegers V, Falissard B (2013). Evaluation de l’efficacité de la pratique de l’auriculothérapie. Paris: Les éditions Inserm.
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To reference this Blog en Sante © article
Ninot G (2015). The efficacy of auriculotherapy. Blog en Sante, A68.
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