Introduction to Auricular Acupuncture
Department of Integrative Medicine
Mount Sinai Beth Israel Medical Center
June 2014
...
 Brief introduction to auricular acupuncture through NADA ear
acupuncture protocol.
 Terry Oleson, “ Auriculotherapy man...
Brief history of NADA ear acupuncture
 In 1973 researchers in Hong Kong first published the effectiveness of ear
acupunct...
Brief introduction
 Cortical homunculus:
 Anatomical representation of human body
parts on the cerebral cortex
 Auricul...
Brief introduction
 Oleson et al, “An experimental evaluation of auricular
diagnosis: the somatotopic mapping of musculos...
East Asian medical theory
 Why do we choose these points?
 The Burning Candle analogy:
 Candle light is byproduct of fi...
Western scientific understanding
 Why do we choose these points?
 Ueno et al 1993: upper and lower concha of
ear are inn...
Auriculovagal afferent pathway
 Decreased electrical activity in vagal area of ear seen in pt’s w/
cognitive impairment:
...
Ear massage: self healing
Evidence based practice
 Valois et al 2012: NADA ear acupuncture for vasomotor symptoms due to
chemo in breast CA pt’s.
...
NADA for chemotherapy-related vasomotor symptoms
 Valois et al,“NADA ear acupuncture for breast cancer treatment-related ...
Ear acupuncture for dental procedure-related anxiety
 Karts et al, “Auricular acupuncture for dental anxiety: a randomize...
Ear acupuncture for dental procedure-related anxiety
 Outcome measures:
Anxiety level: - Spielberger Stait-Trait Anxiety ...
Ear acupuncture for dental procedure-related anxiety
 True AA and midazolam
significantly reduced dental
procedure-relate...
Ear acupuncture for anxiety and sedation
 Gagliardi et al, “Auricular
acupuncture in health care
volunteers: randomized c...
Ear acupuncture for anxiety and sedation
 Ear point location:
- Find most sensitive points when
applying pressure with a ...
Ear acupuncture for anxiety and sedation
 Outcome measures:
1. Numeric rating scale (NRS) for
anxiety
2. State-Trait Anxi...
Ear-seeding
 Ear-seeds.
 Locate and mark the ear points.
 Applying the ear-seeds on the ear points
chosen.
 Extended t...
Let’s practice
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NADA talk - June 2014

Published on: Mar 3, 2016
Source: www.slideshare.net


Transcripts - NADA talk - June 2014

  • 1. Introduction to Auricular Acupuncture Department of Integrative Medicine Mount Sinai Beth Israel Medical Center June 2014 Quang “Nick” Nguyen, MD, LAc Acupuncture Fellow
  • 2.  Brief introduction to auricular acupuncture through NADA ear acupuncture protocol.  Terry Oleson, “ Auriculotherapy manual: Chinese and Western systems of ear acupuncture” 2nd ed, 1996.  Huang, “Auricular medicine” 2nd ed, 2006.  Outline:  Brief history of NADA ear acupuncture in the US  Brief introduction to ear acupuncture and NADA protocol  Scientific evidence for the effect of ear acupuncture  Evidence through clinical studies for the benefits of EA for vasomotor symptoms, anxiety, and sedative effect.  How to apply ear-seeds, safety and precautions.  Practice ear-seeding.
  • 3. Brief history of NADA ear acupuncture  In 1973 researchers in Hong Kong first published the effectiveness of ear acupuncture for drug addiction (1).  Dr. Smith, a psychiatrist, pioneered in using ear acupuncture in a detox clinic at Lincoln Hospital, Bronx.  Mitchell, “Fighting drug abuse with acupuncture: the treatment that works” Pacific View Press 1995.  NADA ear acupuncture protocol widely used for detoxification and some psychiatric conditions.  2010 Evidence Based Practice Guideline of the VA and DOD: “good” quality of evidence to support use of acupuncture to treat PTSD (2).  2011 Yale Medical School established NADA training program for its psychiatric residents. (1) Wen et al,“How acupuncture can help addiction” Drug & Society 1973; “Treatment of drug addiction by acupuncture and electrical stimulation” American Journal of Acupuncture 1973. (2) VA/DOD Clinical Practice Guideline , “Management of Post Traumatic Stress” 2010.
  • 4. Brief introduction  Cortical homunculus:  Anatomical representation of human body parts on the cerebral cortex  Auricular homunculus: (Oleson 1996)  From ancient time, different interventions (ie. scarring, bleeding,..) on external ear to bring some beneficial medical effects.  Dr. Nogier discovered anatomical representation of human body on external ear in a shape of an inverted fetus.  MSK pain of certain part of body appears as a reactive tender point on the ear.
  • 5. Brief introduction  Oleson et al, “An experimental evaluation of auricular diagnosis: the somatotopic mapping of musculoskeletal pain ear acupuncture points” Pain 1980.  40 pts had their ears examined for areas of increased skin conductivity or tenderness in order to determine areas of their body having MSK pain.  The concordance b/w established medical dx and auricular dx was 75.2%.  NADA protocol: Shenmen, Sympathetic, Kidney, Liver, and Lung points (Oleson 1996)  European auricular system uses different set of points: Shenmen, Relaxation, Tranquilizer, Master Cerebral, and Mid-ear (?).
  • 6. East Asian medical theory  Why do we choose these points?  The Burning Candle analogy:  Candle light is byproduct of fire that lights up the candle (Yang) and wax (Yin).  Human body: Yang energy comes from KI yang and Yin substance is abundant in KI/LV/LU yin.  Drug addiction and many psychiatric conditions have the root pattern of yin deficiency.  NADA ear acupuncture protocol: Shenmen, Sympathetic, KI, LV, and LU points (Oleson 1996).  Point location:
  • 7. Western scientific understanding  Why do we choose these points?  Ueno et al 1993: upper and lower concha of ear are innervated by a branch of vagus nerve (4).  Basic neurophysiology: Vagus nerves regulate the viscera. A tract from nuclei of vagus nerves in the brainstem connects w/ thalamus and limbic systems.  Henry et al 2002: “auriculovagal afferent pathway” -> “both autonomic and CNS could be modified by auricular vagal stimulation” (5). (4) Ueno et al, “Innervation of the external ear in humans and the musk shrew” Nihon Jibiinkoka Gokkai Kaiho 1993. (5) Henry et al, “Therapeutic mechanism of vagus nerve stimulation” Neurology 2002
  • 8. Auriculovagal afferent pathway  Decreased electrical activity in vagal area of ear seen in pt’s w/ cognitive impairment:  Fallgatter et al 2005 “Age effect on far field potentials from the brain stem after transcutaneous vagus nerve stimulation” -> seen in elderly  Metzger et al 2005 “Vagus somatosensory evoked patentials - possibility for diagnostic improvement in pts w/ mild cognitive impairment”  Polak et al 2014 “Vagus somatosensory evoked potentials are delayed in Alzheimer’s disease, but not in major depression”.  Diagnostic tool for early detection of cognitive impairment ???
  • 9. Ear massage: self healing
  • 10. Evidence based practice  Valois et al 2012: NADA ear acupuncture for vasomotor symptoms due to chemo in breast CA pt’s.  Karts et al 2007: ear acupuncture for anxiety and anesthetic effect in dental procedure.  Gagliardi et al 2014: ear acupuncture for anxiety and sedative effect.
  • 11. NADA for chemotherapy-related vasomotor symptoms  Valois et al,“NADA ear acupuncture for breast cancer treatment-related hot flashes and night sweat: an observational study” Medical Acupuncture 2012.  Single-arm, observational study at a cancer center in England.  n=50: women ≥ 35 yr, ≥ 6 mo. s/p chemo, ≥ 4 HF & NS incidents a day for ≥ 3 mo.  Intervention: weekly NADA for 8 weeks in small groups of < 5 pt’s.  Outcome measures: primary outcome - frequency of HF and NS incidents, secondary outcome - Women’s Health Questionnaire (WHQ) score assessing physical and emotional wellbeing before and after tx’s.  Results: a> mean HF and NS frequency - 35.9% (95% CI 25.4-45.4, p < 0.0001) b> significant reduction in anxiety, depressed mood, memory and concentration issues, and sleep issues.
  • 12. Ear acupuncture for dental procedure-related anxiety  Karts et al, “Auricular acupuncture for dental anxiety: a randomized control trial” Anesthesia and Analgesia Journal 2007  Dep’t of Anesthesiology, Hannover Medical School, Germany  Randomized, placebo-controlled study comparing efficacy of AA and intranasal midazolam in reducing anxiety due to dental procedure  N=67: undergoing dental extraction  Interventions: at 35 min before dental procedures - N1=19: real AA group, 3 ear points (Relaxation, Tranquilizer, and Master Cerebral) - N2=19: sham AA, unrelated ear points and non-penetration method - N3=19: intranasal midazolam, 3 puffs each nostril, average dosage 4mg - N4=10: no treatment, control group
  • 13. Ear acupuncture for dental procedure-related anxiety  Outcome measures: Anxiety level: - Spielberger Stait-Trait Anxiety Inventory (STAI) score: measured at 40 min before dental procedure (baseline) - Visual analog scale (VAS) of anxiety: measured at 5 min after the intervention or 30 min before dental procedure (follow-up 1) and after the procedure (follow-up 2) Sedation score Quality of dental treatment condition
  • 14. Ear acupuncture for dental procedure-related anxiety  True AA and midazolam significantly reduced dental procedure-related anxiety than sham AA (p=0.012 and <0.001).  Significant improvement in pt compliance w/ AA and midazolam (p=0.032 and 0.049).  Pattern of positive effect of placebo is different from therapeutic effect of true AA and medazolam.  Conclusion: AA and intranasal midazolam are similarly effective for tx of dental procedure-related anxiety.
  • 15. Ear acupuncture for anxiety and sedation  Gagliardi et al, “Auricular acupuncture in health care volunteers: randomized crossover study comparing real and sham needles” Medical Acupuncture, 2014  A randomized, placebo controlled study  N=20 : healthy volunteers  Interventions: - Real group: real ear tag with sharp tip (top) - Placebo group: sham ear tag without sharp tip (bottom)
  • 16. Ear acupuncture for anxiety and sedation  Ear point location: - Find most sensitive points when applying pressure with a device that allows 250 gr of maximal pressure (Pain Pressure Test). - The points were then marked and recorded on an ear chart, Romoli’s Sectogram (picture). - Similarity of the points b/w 2 groups: A (real) and B (sham). - Correlation b/w the points found by palpation and the traditional points in textbook .
  • 17. Ear acupuncture for anxiety and sedation  Outcome measures: 1. Numeric rating scale (NRS) for anxiety 2. State-Trait Anxiety Inventory (STAI) score 3. Bispectral Index System (BIS) – using EEG to assess the level of sedation
  • 18. Ear-seeding  Ear-seeds.  Locate and mark the ear points.  Applying the ear-seeds on the ear points chosen.  Extended therapeutic effect.  2-7 days  Safety and precautions: clean technique, avoid skin breaks, remove when excessive pain and redness, pay attention and use common sense to avoid infection.  Benign procedure.
  • 19. Let’s practice

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