Auricular Point Acupressure Reduces Axial Neck Pain

Results of a randomized controlled trial suggest auricular point acupressure (APA) may help relieve axial neck pain in patients who have undergone anterior cervical discectomy and fusion (ACDF) surgery.¹

Axial neck pain is a frequent complication of ACDF surgery, affecting up to 38% of patients.¹ The pain is localized to the cervical spine, occipital areas, or the back of the shoulders and is often accompanied by headaches and muscle stiffness.^1,2 Although most cases of axial neck pain arise from a soft tissue injury, the precise mechanism is unknown. Standard treatments such as rest, analgesics, and physical therapy often fail to relieve axial neck pain, which then becomes a chronic disabling condition.

Acupressure is a traditional Chinese medicine therapy in which pressure is applied to the external ear at precise acupoints, each believed to correspond to a particular area of the body. Several clinical trials have examined the effectiveness of APA for the relief of different types of pain, including low back and postsurgical pain.^3,4

The current study, conducted at Shaoxing Hospital of Traditional Chinese Medicine, China, sought to assess the effectiveness of APA in a randomized controlled trial in patients who had undergone ACDF (n=29; age 35 to 65).¹ All patients experienced axial neck pain within 1 month of the surgery, with an intensity ≥4 on a 10-point rating scale. Study participants were randomly assigned to receive APA on 5 auricular points that corresponded to the location of their neck pain (ie, shenmen, sympathetic, subcortex, occiput, and cervical vertebra) or to 5 sham (all helix points) auricular points. The points were marked, and participants were instructed how to self-administer pressure with their fingers, which they were told to exert 3 to 5 times per day for 3 to 5 minutes each time over a  4-week period. The efficacy of self-administered APA was assessed at the end of the study and at 1-month follow-up.

After 1 month, participants in the real APA group were significantly less likely to experience severe or moderate axial neck pain than participants in the sham APA group. In the real APA group, 29% of participants had severe axial neck pain compared with 85% of participants in the sham APA group. In addition, 36% of participants in the real APA group had moderate axial neck pain compared with 92% of participants in the sham APA group. Supporting the finding of significant pain relief, analgesic use also declined in the real APA group.

Overall Brief Pain Inventory Short Form scores for overall pain improved significantly more in the real vs sham APA group, both at the end of treatment (2.6±0.8 vs  5.1±1.2; P =.005), and at 1-month follow-up (2.7±0.9 vs 5.0±1.1; P =.006). The 36-item Short Form Health Survey also revealed significantly greater improvement in individual physical and emotional parameters in the real vs sham APA group, with higher total mean scores, both at the end of treatment (63.5±13.4 vs 40.5±12.9; P =.004), and at 1-month follow-up (63.3±12.2 vs 39.4±13.5; P =.003). The investigators noted that these scores “indicated that quality of life improved significantly in the real APA group.”

The researchers noted that “Increasing evidence supports immune activation in the etiology and progression of pain,” and that “Changes in inflammatory cytokines, such as interleukin (IL)-1β, IL-6, and tumor necrosis factor (TNF)-α, have been linked to alteration in pain signaling pathways.”⁵ Therefore, they hypothesized that “the benefit of APA on axial neck pain after ACDF surgery would be based on the regulation of [these] inflammatory cytokines,” and sought to determine their plasma levels in study participants. Levels of these markers remained unchanged in the sham APA group, but decreased from baseline in the real APA group at the end of treatment, and at 1-month follow-up: for IL-1β, P =.002 and P =.004, respectively; for Il-6: P =.02 and P =.04, respectively; for TNF-α, P <.001 for both. The researchers noted that the mechanisms underlying the observed changes in levels of inflammatory cytokines following APA is unclear.

These findings suggest that APA may contribute to the relief of axial neck pain in some patients who have undergone ACDF surgery. Longer trials are needed to determine whether the pain relied obtained following APA would persist beyond 1 month.

Summary and Clinical Applicability

APA is a noninvasive technique that may help reduce axial neck pain in some patients who have undergone ACDF. More evidence from larger trials is needed to establish whether APA is truly effective, which patients are most likely to benefit, and how long any benefit will last.

Limitations and Disclosures

Limitations of the study include the small sample size (n=29) and the fact that patients were recruited from a single hospital. The results of this study, which was conducted in China, may not be applicable to patients in other countries.

The study was partially funded by the State Administration of Traditional Chinese Medicine of Zhejiang Province in China. 

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References

1. Xia B, Xie Y, Hu S, Xu T, Tong P. Effect of auricular point acupressure on axial neck pain after anterior cervical discectomy and fusion: a randomized controlled trial [published online May 13, 2017]. Pain Med. doi:https://doi.org/10.1093/pm/pnx112
2. Clarke MJ, Schiefer TK, Pichelmann MA, Krauss WE. Axial neck pain: a surgeon’s perspective. Therapy. 2011;8(6):763-770.
3. Yeh CH, Suen LKP, Chin LC, Margolis L, Liang Z. Day-to-day changes of auricular point acupressure to manage chronic low back pain: a 29-day randomized controlled study. Pain Med. 2015;16(10):1857-1869.
4. Liu XL, Tan JY, Molassiotis A, Suen LK, Shi Y. Acupuncture-point stimulation for postoperative pain control: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2015;2015:657809.
5. Slade GD, Conrad MS, Diatchenko L, et al. Cytokine biomarkers and chronic pain: association of genes, transcription, and circulating proteins with temporomandibular disorders and widespread palpation tenderness. Pain. 2011;152(12):2802-2812.