Smoking is the leading preventable cause of death worldwide, responsible for more than 8 million deaths each year according to the World Health Organization (WHO). Despite the availability of pharmacologic treatments such as nicotine replacement therapy (NRT) and varenicline, long-term cessation rates remain low, and many patients seek alternatives with a lower burden of adverse effects. A meta-analysis published in Tobacco Induced Diseases in February 2025 systematically evaluated the efficacy and safety of auriculotherapy for smoking cessation, gathering 9 randomized clinical trials and 1,032 participants.
The study was conducted by Qindong Mi, Fei Bao, and colleagues. The auriculotherapy interventions evaluated included stimulation with semipermanent ear needles, Vaccaria seeds (Wang Bu Liu Xing), magnetic beads, and auricular electroacupuncture. The most frequently used auricular points were Shenmen, Lung, Mouth, Endocrine, and Subcortex — selected based on auricular somatotopic correspondence and on the mechanisms of craving and nicotine dependence. The outcomes evaluated included smoking cessation rate, intensity of withdrawal symptoms (Minnesota Nicotine Withdrawal Scale — MNWS), and occurrence of adverse events.
MAIN RESULTS — 9 RCTS, 1,032 PATIENTS
Cessation efficacy: equivalence with NRT
The most important and at the same time most nuanced finding of this meta-analysis is that auriculotherapy did not surpass nicotine replacement therapy in cessation rates — the RR of 0.91 did not reach statistical significance. This can be interpreted in two complementary ways: on one hand, auriculotherapy does not demonstrate superiority in total abstinence; on the other, it shows efficacy comparable to NRT without the associated adverse effects. For patients who cannot tolerate nicotine patches (skin irritation, sleep disturbances, palpitations) or who prefer non-pharmacologic approaches, auriculotherapy emerges as a clinically viable alternative. Protocols varied from 4 to 12 weeks of treatment, with frequency of 1 to 2 sessions per week.
Withdrawal symptoms: clinically meaningful difference
The most clinically relevant finding of this study may not be the cessation rate, but rather control of withdrawal symptoms. The difference of MD = 1.47 points on the MNWS scale in favor of auriculotherapy (P<0.05) is clinically significant because withdrawal symptoms are the main driver of relapse in the first weeks of cessation. The MNWS scale assesses irritability, anxiety, difficulty concentrating, restlessness, hunger, insomnia, depressed mood, and craving. Improving these symptoms — even without increasing absolute cessation rates — may extend the therapeutic window for other resources (counseling, psychosocial support) to become effective. Auriculotherapy, in this context, functions as a modulator of the withdrawal syndrome with an excellent safety profile.
Superior safety profile: 85% fewer adverse events
The most striking safety finding was the 85% reduction in the rate of adverse events compared with NRT (RR = 0.15, CI 0.04–0.56, P<0.01). The adverse effects of NRT included in the studies were: local skin irritation, nausea, insomnia, headache, palpitations, and nightmares. With auriculotherapy, the adverse events reported were essentially local and mild: temporary auricular discomfort, erythema at the application point, and, rarely, superficial infection. No serious adverse events were recorded across the 9 studies. This superior safety profile makes auriculotherapy particularly attractive for patients with contraindications to NRT — such as active cardiovascular disease, pregnancy, or hypersensitivity to exogenous nicotine.
Frequently Asked Questions
The studies in this meta-analysis used protocols of 4 to 12 weeks, with 1 to 2 sessions per week. Most effective protocols include at least 8 sessions in the first 6 weeks. It is important to understand that auriculotherapy is a support for cessation — success also depends on patient motivation and behavioral follow-up. Many patients report a reduction in craving as early as the first 2–3 sessions, but the full course is essential to consolidate cessation.
The Vaccaria seeds (or metal/plastic beads) are applied by the physician at the correct auricular points and kept in place for 3 to 5 days. The patient should press the points at home when feeling craving — this self-stimulation is an important part of the therapeutic protocol. However, the initial application of the seeds at the correct points should be performed by the medical acupuncturist, who identifies the points precisely and provides instruction on the pressure technique. It is not recommended to try to locate and apply the points without professional guidance.
The studies included in this review did not stratify results by dependence level (Fagerström scale). In clinical practice, auriculotherapy tends to be more effective for smokers with mild to moderate dependence (Fagerström 1–6). For smokers with high dependence (Fagerström 7–10), who smoke their first cigarette within 30 minutes of waking and consume more than 20 cigarettes per day, combined pharmacotherapy (varenicline or bupropion) is recommended as first-line, with auriculotherapy as an adjunct for control of withdrawal symptoms.
Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).