Auricular Acupuncture Relieves Acute Pain; Larger Trials Could Boost Adoption

LAS VEGAS—Battlefield acupuncture (BFA), which uses five small dart-shaped needles to stimulate points on the ear thought to trigger pain relief, is practiced across healthcare facilities associated with the Department of Veterans Affairs and by physicians worldwide. Despite its growing popularity, large trials confirming its benefits are lacking. A systematic review of BFA’s efficacy for treating acute pain, presented at the 2024 annual meeting of the American Society of Regional Anesthesia and Pain Medicine, found evidence supporting its use. However, other trials with more robust designs could help propel this low-cost, drug-free practice further into mainstream pain management.

Battlefield acupuncture shows promise for immediate, short-term pain relief in various acute pain conditions, with multiple studies reporting significant pain reduction in 75% to 82% of patients with results that are at least as good as, if not better than, standard treatments, explained study author Anna Woodbury, MD, the vice chair of research anesthesiology in the Pain Medicine Department at Emory School of Medicine, in Atlanta.

Researchers conducted their review by searching for clinical trials evaluating the efficacy of BFA in relieving acute pain, published between 2004 and July 2024. After combing through three databases, they identified 17 articles, with nine trials (involving a total of 889 patients) deemed eligible for analysis. All studies assessed BFA as an adjunct therapy used alongside standard-of-care (SOC) analgesics.

Six trials included in the study demonstrated significant benefit to patients from BFA. For instance, a 2018 study published in the American Journal of Emergency Medicine randomized 30 patients with low back pain to receive either BFA plus SOC or just SOC analgesics. Pain was assessed using a 10-point numerical pain rating scale, with 0 representing no pain and 10 representing the most severe pain. The BFA group had significantly lower post-intervention back pain scores than the SOC group (5.2 vs. 6.9; P=0.04).

A 2022 study published in the Journal of Integrative and Complementary Medicine (JICM) randomized 72 veterans undergoing major surgery to receive either postsurgical BFA plus SOC or sham BFA plus SOC. The study demonstrated that patients receiving BFA had significantly lower postoperative pain scores (measured using a visual analog scale) at six, 12, 18 and 24 hours post-surgery: 4.3 versus 6.8, 3.6 versus 6.4, 3.1 versus 5.6 and 2.3 versus 5.2, respectively. Furthermore, patients who received BFA used significantly lower average morphine milligram equivalents (MME) 24 hours post-surgery compared with those receiving sham acupuncture (18.3±12.2 vs. 38.6±15.9; P<0.001).

Author of the JICM study, Padmavathi Patel, MD, of the Department of Surgical Services at the John D. Dingell VA Medical Center, in Detroit, further noted that “there are no side effects with BFA, no nausea, vomiting or any constipation like we see with narcotics use. Nor are there any liver toxicities or kidney problems like we can see with the use of non-narcotic pain medications. This is the very easy modality to help veterans manage pain after surgical procedures.”

Despite positive results from a majority of the studies included in the literature review, three studies did not offer any evidence that patients benefits from BFA. A 2019 randomized controlled trial, published in Military Medicine, analyzed SOC for treating postsurgical lower extremity pain versus SOC plus BFA and SOC plus sham BFA. Results indicate that there was no statistically significant difference in Pain Impact Questionnaire-6 pain scores, which measures the severity of pain and its impact on work and leisure activities, as well as on emotional well-being, and opioids MME between study arms.

The study had some limitations, including the small number of patients enrolled in each trial and the heterogeneous nature of measures of patient performance, types of pain treated and SOC analgesics between trials. However, she noted that regardless of these limitations, “multiple studies have reported significant immediate pain reduction in a high percentage of patients for various types of pain, and BFA is accessible, easy to administer, can be performed by multiple providers and is widely available in VA settings, so it should still be considered as a reasonable option [for acute pain relief].”

Many of the individual studies’ authors and Woodbury concluded that more rigorous, high-quality clinical trials are necessary to determine the optimal settings and pain types for administration of BFA and to fully understand its optimal use.

Andrew Jan, PhD, an adjunct professor at the School of Medicine at the University of Notre Dame, in Fremantle, Australia—who has spent a decade teaching and researching BFA—noted that the literature review presented sufficient evidence for people to use BFA to treat acute pain. However, he acknowledged that small studies, often limited due to a lack of financial incentive, struggle to prove the efficacy of BFA with issues around blinding and sham treatment.

Jan suggested that researchers focus their attention on creating pragmatic, large noninferiority trials of BFA against SOC analgesics. “If BFA proves to be as effective as SOC in such a trial, it will enable a wider group of physicians to incorporate an acute pain management technique that considers the long-term health of the patient while avoiding the significant adverse effects, including misuse of nonsteroidal anti-inflammatories and opioids.”

Woodbury and her team plan to contribute to this effort by conducting a large, randomized controlled peri-procedural trial that utilizes BFA to treat acute pain.

—Myles Starr

Woodbury’s views do not represent the views of the Department of Veterans Affairs or the U.S. government.

Jan and Patel reported no relevant financial disclosures.