Re: “Self-Administration of Auricular Acupuncture in Rural Veterans with Chronic Pain: A Pilot Project” by James et al.

Dear Editor:

It is with great interest that we read the pilot study by James et al. ¹ wherein the authors report that they were successful in teaching a selected group of veterans how to self-administer battlefield acupuncture (BFA) after they attended a 2-hour class, and were given 240 gold-plated auricular semi-permanent needles and followed for 6 months.

Although studies have shown that BFA is generally safe and a very effective tool in the treatment of pain,^2–4 as those charged with oversight of BFA and battlefield auricular acupressure within the Department of Veterans Affairs, we cannot presently endorse the self-administration of BFA. Acupuncture needles are medical equipment not intended for patient self-use. Although this novel application of BFA showed potential benefit in a rural veteran population, the risks would need to be examined on a larger scale.

We also believe that correctly placing needles within “the zone” is difficult, and in this selected group of individuals, 17% dropped out. Asking a caregiver to help in this task would equate to practicing acupuncture without a license. Furthermore, although the risk of infection is low, we feel that safer alternatives exist. The self-administration of nonpiercing seeds or magnets as a form of battlefield acupressure can be promoted after adequate patient education. Yeh et al. showed auricular acupressure to be superior to auricular acupuncture for pain relief. ⁵ We acknowledge that the clinical benefits of battlefield acupressure have not been well studied and that there is a more robust compilation of published benefits of BFA. However, we strongly believe in primum non nocere, first do no harm.