Auriculotherapy focuses on the use of auricular points to treat several conditions, including pain. A recent study at the University of Pittsburgh explored the role that auriculotherapy might have in reducing postoperative opioid requirements in patients after elective rotator cuff surgery.1

"The investigation concluded that use of the complementary therapy in conjunction with an interscalene block significantly reduced both opioid consumption and pain with movement in the first five days after hospital discharge following shoulder surgery compared with only the block," according to a November 2, 2022, news article about the study in Anesthesiology News (https://www.anesthesiologynews.com/Pain-Medicine/Article/10-22/Auriculotherapy-M). The study was presented as an abstract at the 2022 spring meeting of the American Society of Regional Anesthesia and Pain Medicine.2

"Even though regional anesthesiologists are extremely good at performing single-shot and continuous peripheral nerve blocks for shoulder surgery, I believe we are only covering the tip of the iceberg," said author Jacques Chelly, MD, PhD, MBA, a professor of anesthesiology and perioperative medicine at the University of Pittsburgh Medical Center, quoted in an article in Anesthesiology News.2

"This is not to say anything against the effectiveness of peripheral nerve blocks; I don't think you will ever hear me say something like this," Chelly told peers at the presentation, according to the Anesthesiology News article. "But this is a complementary technique to effectively prolong the analgesia that these patients require after surgery, with the added benefit of reducing the use of opioids in these patients."

In the study by Chelly, 39 opioid-naive patients were randomized to undergo either active auriculotherapy treatment (n = 20) or sham auriculotherapy treatment (n = 19) postoperatively. Auriculotherapy was performed on the same side as the surgery using a device called a cryoauriculopunctor (generates cryogenic needles), and comprises 9 ear points based on Alimi cartography.1

The primary end point measured overall opioid consumption in oral morphine equivalents (OMEs) on postoperative day 5. Secondary outcomes included assessment of pain, nonopioid analgesic consumption, time to discharge from the postanesthetic care unit, time to hospital discharge, overall patient satisfaction, and functional recovery.

The researchers demonstrated that, in the first 5 days after surgery, patients in the auriculotherapy group consumed 35% less opioids (mean of 62-mg OMEs) than the control group (96-mg OMEs) (P = 0.0307). Similarly, 20% of patients in the active auriculotherapy group did not use any opioids during the study period, compared with 11% of controls.

Patients treated with auriculotherapy reported a 16% decrease in pain with movement (area under the curve, 21.08 vs 24.97; P = 0.0827).

On day 14, patients in the auriculotherapy group were assessed at a mean pain-with-movement numerical rating scale score of 4, compared with 6 in the control group (P = 0.394). The differences between groups were not statistically significant at days 30, 60, or 90.

The principal author, Chelly, noted that auriculotherapy is relatively easy to master and can also be used for multiple conditions, such as depression, anxiety, and menopausal symptoms. The cryogenic needle contains nitrogen gas, as a white powder, equivalent to semi-permanent needles. With these needles, he noted a much longer effect of at least 14 days postoperatively.

At the meeting when he presented his findings, Santhanam Suresh, MD, MBA, a professor of anesthesiology and pediatrics at Northwestern University Feinberg School of Medicine, asked about the nitrogen in the needle, whether it was liquid.

Chelly replied, "It is not liquid when I do the treatment. It's a white powder, and it's equivalent to semi-permanent needles. To our knowledge, it was the first study using cryogenic needles to provide a treatment."2

Chelly told those in attendance that an acupuncture treatment lasts for 2 or 3 days, but that "With semi-permanent needles, you have a much longer effect, and with this technique you have at least 14 days postoperatively that can help the patient."2

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