Ten Clinical Applications from the 8th International Auriculotherapy Symposium for the Treatment of Wounded Warriors

1. Scan and Treat Reflex (Active) Points in Three Phases

Throughout the symposium, nearly all of the speakers reminded us that while treatment protocol points serve practical purposes, in clinical settings we should look for and treat only reflex ear points. Our patients often present with a combination of acute and chronic conditions, and we scan for suspected dis-ease in corresponding areas in all three phases (phase 1 for acute, phase 3 for subacute, and phase 2 for chronic). If a patient does not have ear activity at a particular protocol point, we do not place a needle or treat that particular point even though it is indicated in the protocol. We have found that by scanning with the three phases in mind, we can understand better why a certain point may be active. At times, we are able to recognize additional chronic issues beyond the acute injuries and pain-related disorders that typically constitute the primary reason for acupuncture referral.

2. Utilize the Point-Finder with Battlefield Acupuncture (BFA)

BFA has been developed within the military setting and is being taught to a range of military health care providers from medics/corpsmen through physician specialists. It is learned easily, and is effective and safe. In addition BFA does not require other equipment, such as an ear-point finder. This is especially beneficial in the battlefield situation when fully trained acupuncturists may not be available and limiting narcotic use may be beneficial.

At a tertiary-care level facility, where more highly trained acupuncturists and point finders are available, it seems expedient to make use of the point finders when treating these patients. Based on the emphasis of treating only active points, we have since applied the following four additional practices to the BFA protocol in our clinical setting. First, we check for which BFA points are most active, as this might eliminate extra needle sticks in patients who are already getting frequent procedures. Second, we use other points that are specific to the point of injury, which may enhance effectiveness and reduce the total number of needles used. Third, we consider changes in ear phases over time in a group of patients who are often under care for extended periods of time. And fourth, we address the root causes with therapeutic impact in addition to addressing the analgesia.

3. Auriculotherapy Can Be an Efficient and Effective Application in Chronic Pain Management

In recent years there has been an ongoing effort to broaden the scope of acupuncture and integrative health within both the Military Health System (MHS) and the Veterans Administration (VA). However, the demand for acupuncture services has, at times, outpaced space and provider availability. During the symposium, a method was presented for doing simple, effective acupuncture that relied heavily on auricular acupuncture and providing care for significant numbers of patients with minimal human resources and examination-room space. With auricular acupuncture, patients can remain fully clothed and several patients can be treated in one examination room. This practice method could provide a useful model for introducing acupuncture further in smaller VA and MHS facilities without significantly increasing resources.

4. Use Auricular Brain Functional Points When Treating Pain

Several presenters encouraged adjunctive treatment of brain functional points (e.g., Cingulate Gyrus, Amygdala, Hippocampus, Thalamus, Hypothalamus) to address the emotional and memory components of pain. This is particularly relevant if addressing the pain alone does not provide lasting relief, leading to the recognition that the pain problem may be far deeper than simply existing on an anatomical level. Bourdiol's “R Zone” in particular focuses on eliciting and treating pain memory. Emotional components of pain affect how patients perceive pain, cope with it, and their level of focus upon it, and ultimately influence the autonomic nervous system, compounding a patient's hyperresponsiveness to pain and making an impact on his/her affective behavior. ²

In our patient population, many patients have PTSD and similar traumas leading to complex pain disorders. Hence, by treating these functional brain points, we have been able to get to the deeper roots of the problems and reach more effective and long-lasting results than a more superficial approach could accomplish.

5. Make Use of Various Ear Needle Options

Many symposium speakers focused on the variety of treatment and needle options in auricular therapy, and the therapeutic responses that can be achieved with each. In the wounded warrior population, many patients are already receiving numerous invasive and often painful therapies. While some patients accept Agile Semi-Permanent (ASP) needles well, others find the additional small increase in discomfort from ASP placement intolerable. Thus, having alternative auricular stimulation methods available is optimal. Among those discussed were seed pellets, ion pellets, Pyonex Press Tacks, Spinex^® Intradermal Needles, magnets, pressure stimulation, electrical stimulation, and a variety of laser devices. We have had good success adapting both individualized treatments as well as a variety of ASP protocols using these different tools. Patients who might otherwise have declined auricular treatment were receptive to these approaches.

6. Apply Auricular Diagnostic Protocol

We often use auricular techniques for treatment, but not as often for diagnosis. There may be value in applying the auricular diagnostic protocol to enhance the information obtained from the physical examination, perhaps even using this protocol to detect premorbid conditions. In the acute trauma setting of many of our wounded warriors, with resultant frequent surgeries, the marked pain issues frequently become the predominant concern of the patients and their caregivers.

Acupuncture is also focused prominently on pain relief and, to a lesser extent, on such things as sleep, anxiety, and PTSD. Early symptoms of other disorders can easily be overlooked by patients and providers, or covered up by the medications used. The technique of ear evaluation by systems presented during the symposium is a useful bedside method for early detection of other medical problems that might be otherwise be missed or presumed related to some other cause. An emphasis on treating the early bioelectrical malfunction using acupuncture and/or other integrative health techniques might help prevent further complications in this already very impaired group of patients.

7. The Ear Is a Microsystem

Raphaël Nogier, MD eloquently summarized his father's (Paul Nogier, MD) work in identifying and mapping the corresponding body organs to ear points. ³ This evolution of auriculotherapy was explained by Nader Soliman's further review of the ear's rich nerve supplies (e.g., CN V, VII, IX, X, C2–C3 cervical roots and cervical sympathetic plexus) and connection with the reticular formation, which collectively provide a picture of the body. ⁴ Thus, in essence, the ear is a microsystem, a reflection of the body. The explanation of the anatomical and embryologic origins of auricular therapy provide for a better understanding for patients and their families.

8. Integrate Behavioral Therapy with Acupuncture

Terry Oleson, PhD's presentation on integration of cognitive behavioral therapy with acupuncture for treating addictions, pain, and psychosomatic disorders is easily applied to our clinical setting, and is an especially useful adjunct in the wounded warrior population. ⁵ Many wounded warriors often experience survivor guilt with elements of shame and blame. During the relaxed state associated with acupuncture treatment, there is an ideal time to include elements of cognitive behavioral therapy. We have found this to be extremely effective for addressing the negative thoughts associated with traumatic events as well as providing patients with additional resiliency skills. Techniques to guide our patients in understanding the conscious and unconscious mind, such as mindfulness meditation, do not take much more time and have enhanced treatment effectiveness.

9. Use the Concept of Symmetry and Laterality

Dr. Raphaël Nogier presented on symmetry and laterality, whose corresponding treatment points at and around the tragus help us first correct problems of symmetry, the underpinning of mobility, and then laterality, the uniquely human asymmetrical brain functions that affect handedness and learning. ⁶ These imbalances are associated with learning disabilities, attention-deficit hyperactivity disorder, and even chronic physical and psychologic pathology. With his humorous reminder of the better effect of whispering rather than shouting to our loved ones “I love you!,” Dr. Raphaël Nogier instructed us on the impact of choosing the precise auricular therapy frequencies for treating imbalances of symmetry, laterality, and mixed disorders. We have found that wounded warriors with profound physical injuries do have symmetry and laterality issues, both of which need correction to facilitate more complete and longer lasting healing.

10. Let Our Patients Determine Treatment Priority

Several speakers highlighted the fact that patients often present with multiple problems. As we empower our patients to define and prioritize treatment based on their concerns, we become more effective in meeting their goals, and we get better overall results. For example, we often see patients referred for pain, but we discover that the patient's more immediate priorities are insomnia, anxiety, or even constipation. We have found that by addressing our patients' primary concerns first, we gain their confidence to let us tackle additional acute and chronic issues.