Effectiveness of auricular acupuncture in the treatment of cancer pain: randomized clinical trial
Ruela et al. · Revista da Escola de Enfermagem da USP · 2018
Evidence Level
STRONGOBJECTIVE
To evaluate the effectiveness of auriculotherapy in the treatment of cancer pain in patients undergoing chemotherapy and changes in analgesic consumption
WHO
31 cancer patients undergoing chemotherapy with pain ≥4 on the numerical scale
DURATION
8 weekly sessions of auriculotherapy with semipermanent needles
POINTS
Experimental group: Shenmen, Kidney, Sympathetic, Muscle Relaxation, and energy-balance points. Placebo group: Eye and Trachea
🔬 Study Design
Experimental
n=16
Auriculotherapy with specific points for pain and energy balance
Placebo
n=15
Auriculotherapy with fixed placebo points (Eye and Trachea)
📊 Results in numbers
Significant reduction in pain intensity
Decrease in analgesic consumption
Experimental group — initial pain
Experimental group — final pain
Placebo group maintained pain
📊 Outcome Comparison
Final pain intensity (0-10 scale)
Pain reduction from baseline
This study demonstrated that auriculotherapy is effective in reducing pain in cancer patients. Patients who received the active treatment had significant reduction in pain and were able to decrease their use of analgesics. It is a safe technique and can be used as a complementary treatment alongside conventional medication.
Article summary
Plain-language narrative summary
This randomized clinical trial investigated the effectiveness of auriculotherapy in treating cancer pain in 31 Brazilian patients undergoing chemotherapy. The study was conducted at the Federal University of Alfenas between 2015 and 2016, with patients who reported pain at or above 4 on the numerical scale. Participants were randomly divided into two groups: experimental (n=16) and placebo (n=15). The experimental group received auriculotherapy with specific points for pain (Shenmen, Kidney, Sympathetic, Muscle Relaxation) and individualized energy-balance points based on the Five Elements theory of Traditional Chinese Medicine.
The placebo group received application at fixed points unrelated to pain (Eye and Trachea). Both groups received 8 weekly sessions with 0.20 mm × 1.5 mm semipermanent needles, alternating between ears. Pain assessment was carried out using the 11-point Numerical Scale, and analgesic consumption was monitored according to the WHO Analgesic Ladder. The results demonstrated a statistically significant difference between the groups (p<0.001) in the reduction of pain intensity.
The experimental group showed a mean pain reduction from 7.36±1.74 to 2.09±1.44 (from moderate pain to mild pain), while the placebo group maintained similar levels (6.00±1.5 to 6.33±2.14). In addition to pain reduction, a significant decrease was observed in analgesic consumption in the experimental group, including reductions in daily doses (p=0.010), the number of medications consumed (p=0.019), and changes in patients' position on the WHO Ladder steps (p=0.026). The individualized approach, considering each patient's specific energy imbalance through the Five Elements theory, was fundamental to the positive results. No significant adverse events were observed, only mild pain at the application site for up to 3 days in some participants.
The study population was predominantly female (78%) with breast cancer (52%), and 43.5% of participants had stage III-IV disease, indicating more advanced forms of the disease. The study has limitations, such as the relatively small sample size due to losses during follow-up (mainly deaths), the population's resistance to treatment with needles, and difficulties in standardizing the protocol due to the different schools of auriculotherapy. The findings suggest that auriculotherapy may be a valuable complementary therapy in the management of cancer pain, offering a safe and effective alternative that may reduce dependence on analgesics and their adverse effects, which is especially important in the context of palliative care.
Strengths
- 1Randomized controlled design with placebo group
- 2Individualized protocol based on TCM theory
- 3Objective assessment of medication consumption
- 4Safe technique without serious adverse events
- 5Application by certified professional ensuring homogeneity
Limitations
- 1Small sample size due to losses from death
- 2No long-term follow-up
- 3Population's resistance to treatment with needles
- 4Difficulty in standardization due to different schools of auriculotherapy
- 5Assessor not fully blinded due to the nature of the intervention
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Cancer pain remains underestimated and undertreated in much of Brazilian oncology services, even with the well-established WHO analgesic ladder. This work opens an important window by demonstrating that auriculotherapy, applied weekly for eight weeks, produced substantial pain reduction in patients undergoing chemotherapy — many of whom had advanced-stage disease (III-IV). The most clinically relevant point is not the analgesic relief itself, but the concomitant reduction in analgesic consumption, with measurable changes on the WHO ladder steps. For physicians working in oncology or palliative care, this means a concrete possibility of reducing the opioid burden and its adverse effects — constipation, sedation, tolerance — without giving up pain control. The predominantly female population with breast cancer represents exactly the profile we encounter in oncology supportive care clinics, making the findings directly applicable to daily practice.
▸ Notable Findings
The magnitude of the response in the experimental group deserves careful attention: the reduction from 7.36 to 2.09 on the numerical scale represents not only robust statistical significance (p < 0.001) but also a clinical transition from moderate-to-severe pain to mild pain — a difference any patient and any clinician will recognize as meaningful. In parallel, the placebo group, which also used semipermanent needles at points unrelated to pain, maintained practically stable scores (going from 6.00 to 6.33), reinforcing that the observed effect is not explained merely by the procedural ritual. Individualization through the Five Elements model — adding energy-balance points beyond the classic Shenmen, Kidney, and Sympathetic — is another relevant finding: it suggests that protocols personalized according to TCM theory may potentiate results that fixed protocols would not achieve, an argument that speaks directly to the debate about standardization versus individualization in acupuncture.
▸ From My Experience
In my practice at the Pain Center, I have been incorporating auriculotherapy into the oncology supportive care protocol for many years, and the response pattern described in this article is consistent with what we observe routinely: most patients begin to report perceptible improvement after the third or fourth session, and at the end of eight weekly sessions a significant proportion are able to reduce or reorganize the analgesic regimen with the responsible oncologist. I usually combine auriculotherapy with systemic acupuncture techniques and, whenever possible, with a light assisted-movement program, especially in patients with musculoskeletal pain associated with chemotherapy toxicity. The profile that responds best, in my experience, is exactly the one described here: women with breast cancer, with moderate-to-severe pain intensity, still in active treatment. I prefer not to indicate the technique alone when there is intense neuropathic pain without adequate baseline analgesia — in those cases auriculotherapy enters as an adjuvant after pharmacological stabilization, never as a substitute.
Full original article
Read the full scientific study
Revista da Escola de Enfermagem da USP · 2018
DOI: http://dx.doi.org/10.1590/S1980-220X2017040503402
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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