Effects of auriculotherapy on stress, anxiety and depression in adults and older adults: a systematic review

Corrêa, Hérica Pinheiro; Moura, Caroline de Castro; Azevedo, Cissa; Bernardes, Mariana Ferreira Vaz Gontijo; Mata, Luciana Regina Ferreira Pereira da; Chianca, Tânia Couto Machado

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

REVIEW • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019006703626 copy

Effects of auriculotherapy on stress, anxiety and depression in adults and older adults: a systematic review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To identify evidence in scientific literature about the effects of auriculotherapy for treating stress, anxiety and depression in adults and older adults by analyzing the main protocols for applying the intervention.

Method

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Detailed individual search strategies were applied in February 2019 in the BDENF, CINAHL, Cochrane, CUMED, Embase, LILACS, PEDro, PubMed, Scopus, Segunda Opinião Formativa (SOF) and Web of Science databases. The methodological quality of the studies was assessed using the Jadad Scale.

Results

A total of 24 from the 859 articles found comprised the study sample. Of these, 22 (92%) showed a positive effect of auriculotherapy for stress, anxiety or depression.

Conclusion

The available evidence on the effects of auriculotherapy on stress, anxiety and depression proves the effectiveness of the technique in adults and older adults. However, the studies showed methodological weaknesses. Although the identified protocols are different, there are frequent similar points including Shenmen, Kidney, Autonomic Nervous System, Heart, Brain Stem and Liver 1 and 2 which can be used in new studies.

Auriculotherapy; Stress Psychological; Anxiety; Depression; Complementary Therapies; Review

Authors/Year	Objective	Interventions		Main Results	Jadad*
Authors/Year	Objective	Experimental group(s)	Control group/placebo	Main Results	Jadad*
Rodrigues et al., 2019⁽²³⁾	To evaluate the effects of laser EA on the physical and emotional symptoms of patients with temporomandibular joint dysfunction in comparison with the occlusive plaque.	G1: Laser auriculotherapy (n = 20).	G2: Control with occlusive plate (n = 20).	In addition to improving pain in more facial regions, EA has positive effects on the function of the temporomandibular joint and on affective symptoms.	3
Mafetoni et al., 2018⁽¹⁶⁾	To assess the effectiveness of EA on anxiety in labor.	G1: Auriculotherapy with crystals (n = 34).	G2: Placebo with glass microspheres at different points (n = 34). G3: Control without intervention (n = 34).	The parturients had a lower level of anxiety in the experimental group compared to the placebo and control groups.	5
Ndubisi et al., 2018⁽¹⁷⁾	To evaluate pain management using EA as an adjunct to ibuprofen and paracervical block during the first trimester of uterine aspiration and to evaluate the effect of EA on anxiety.	G1: Auriculotherapy with semi-permanent needles and usual care (n = 52).	G2: Placebo with adhesive tape and usual care (n = 49). G3: Control with usual care with paracervical block and ibuprofen (n = 49).	The women in the experimental group reported substantial improvement in anxiety compared to the placebo and control groups.	5
Vieira et al., 2018⁽¹¹⁾	To evaluate the clinical effect of EA on university students’ anxiety levels.	G1: Auriculotherapy with semi-permanent needles (n = 25).	G2: Placebo with auriculotherapy at different points (n = 22). G3: Control without any auricular treatment (n = 22).	The experimental group showed a significant reduction in anxiety levels according to the applied scales.	4
Dellovo et al., 2018⁽¹³⁾	To compare the effects of EA and midazolam to control anxiety in patients undergoing extraction of the third molar.	G1: 15 mg Midazolam orally and auriculotherapy (n = not described).	G2: Placebo of oral midazolam and auriculotherapy (n = not described).	EA showed an equivalent anxiolytic effect to midazolam without the undesirable effects related to benzodiazepines.	2
Prado et al., 2018⁽⁴⁾	To compare the therapeutic efficacy of true EA and Sham in a control group without intervention in treating stress identified in nurses.	G1: Auriculotherapy with needles (n = 43).	G2: Control without intervention (n = 47). G3: Placebo with random needles (n = 43).	True EA was effective when compared to the control group and had faster and more effective results than the Sham group.	3
Valiani et al., 2018⁽³⁰⁾	To investigate the impact of EA on stress, anxiety and depression in patients with multiple sclerosis.	G1: Auriculotherapy with electrical stimulation and seeds (n = not described).	G2: Placebo with false stimulation and no seed fixation (n = not described).	The stress, anxiety and depression scores decreased significantly when compared to the placebo group.	2
Carter et al., 2017⁽²⁸⁾	To determine whether the National Acupuncture Detoxification Association (NADA) protocol and traditional treatments improve quality of life, depression, anxiety and substance withdrawal.	G1: Auriculotherapy with systemic needles and usual treatment (n = 50).	G2: Conventional treatment control with guidelines and therapy groups (n = 50).	The NADA group showed significant improvements in symptoms associated with depression.	3
Kurebayashi et al., 2017⁽²²⁾	To evaluate the effectiveness of an auricular protocol for reducing anxiety, pain and improving quality of life in the nursing staff of a hospital.	G1: Auriculotherapy with seeds (n = 35). G2: Auriculotherapy with semi-permanent needles (n = 34).	G3: Control without intervention (n = 31). G4: Placebo with auriculotherapy with adhesive tape at the same points as G1/G2 (n = 33).	The implemented protocol reduced the anxiety levels in the nursing team after 10 sessions. The group with semi-permanent needles achieved better results.	3
Bergdahl et al., 2017⁽²⁹⁾	To evaluate the effects of EA and cognitive behavioral therapy in relation to the discontinuation of hypnotic use for symptoms of anxiety, depression and insomnia.	G1: Auriculotherapy with systemic needles (n = 24).	G2: Control with cognitive behavioral therapy for insomnia (n = 25).	Short-term reductions occurred in the EA group regarding symptoms of anxiety and depression.	3
Ahlberg et al., 2016⁽²¹⁾	To investigate the effectiveness of two types of EA for anxiety, sleep, alcohol and drug use and the use of addiction services.	G1 (NADA)/G2 (Local protocol): Auriculotherapy with systemic needle (G1/G2 n = 80/80).	G3: Control with relaxation technique (n = 80).	No evidence was found that EA is more effective than relaxation for problems with anxiety in patients with psychiatric disorders and substance abuse.	3
Bergdahl et al., 2016⁽²⁶⁾	To compare the effectiveness of EA treatment versus cognitive behavioral therapy for insomnia.	G1: Auriculotherapy with systemic needles (n = 27).	G2: Control with cognitive behavioral therapy for insomnia (n = 32).	Depression scores declined regarding EA, but there were no significant changes in relation to anxiety.	3
Jonas et al., 2016⁽²⁷⁾	To determine whether two types of acupuncture (ear acupuncture and systemic acupuncture) are feasible and more effective than the usual treatment for headache related to traumatic brain injury.	G1 (EA): Auriculotherapy with semi-permanent needles (n = 15) G2 (systemic acupuncture) (n = 14).	G3: Conventional treatment included combined drugs. The non-drug treatment options were physical, occupational therapy and speech therapy.	No statistically significant results were found for depression and anxiety.	3
Klausenitz et al., 2016⁽¹²⁾	To investigate whether EA reduces anxiety before tests compared to a placebo group or without intervention.	G1: Auriculotherapy with semi-permanent needles (n = 12).	G2: Placebo with random needles (n = 13). G3: Control with conversation for distraction (n = 15).	The EA and placebo group reduced anxiety. In addition, EA had superior effects over placebo.	3
Rivadeneira et al., 2015⁽²⁾	To determine the effectiveness of EA in older adult patients suffering from anxiety compared to conventional treatment.	G1: Auriculotherapy with seeds (n = 30).	G2: Usual treatment with 10mg chlorodiazepoxide 3 times a day and 1 mg tifluoperacin 3 times a day (n = 30).	EA proved to be more effective. In addition, it is a practically harmless technique with which the use of psychotropic drugs can be reduced.	2
Iunes et al., 2015⁽²⁰⁾	To evaluate the role of EA in treating temporomandibular disorders, anxiety and electromyographic activity in university students.	G1: Auriculotherapy with seeds (n = 40).	G2: Placebo with seeds placed at distant points from the experimental group (n = 13).	Anxiety and pain were significantly reduced in individuals who received EA.	3
Jiao et al., 2015⁽²⁴⁾	To identify the ideal treatment protocol for insomnia between ear, body and abdominal needling procedures.	G1: Systemic Acupuncture (n = 12); G2: Auriculotherapy with systemic needles (n = 12); and G3: Abdominal Acupuncture (n = 12).	G1/G2/G3: Control without intervention in subgroups (n = 18).	Ear acupuncture had a clear therapeutic effect on insomnia, depression and anxiety.	2
Kurebayashi et al., 2015⁽¹⁵⁾	To evaluate the effectiveness of EA for improving quality of life and reducing stress in the nursing team.	G1 (protocol)/G2 (without protocol): EA with semi-permanent needles (G1/G2 n = 58/59).	G3: Control without intervention (n = 58).	Individualized auriculotherapy had a greater effect than auriculotherapy with a stress reduction protocol.	1
Rodríguez-Mansilla et al., 2015⁽²⁵⁾	To learn about the effectiveness of auricular acupressure and massage versus control group in improving pain, anxiety and depression in people diagnosed with dementia.	G1: Auriculotherapy with seeds (n = 40). G2: Massage with effleurage technique and deep kneading (n = 35).	G3: Control with usual care (n = 36).	Auricular acupressure and massage therapy showed better results than the control group in relation to anxiety and depression. A trial acupressure achieved more significant results.	5
Széchenyi et al., 2015⁽³⁾	To assess whether the EA protocol has immediate stress reduction (prolactin - PRL) and, if so, whether the effect is more significant than social support and informal support conversation.	G1: Auriculotherapy with systemic needles (n = 22).	G2: Control group with social support and informal conversation (n = 21).	The stress level (PRL and conductance) can be significantly reduced using the NADA protocol.	1
Kurebayashi et al., 2014⁽¹⁾	To identify the main diagnoses of TCM based on the analysis of the symptoms from the Stress Symptoms List which best responded to auriculotherapy treatment.	G1: Auriculotherapy with semi-permanent needles (n = 27). G2: Auriculotherapy with seeds (n = 26).	G3: Control without intervention (n = 22).	Better results were found for needles than for seeds.	3
Kurebayashi et al., 2014⁽¹⁴⁾	To evaluate the effectiveness of EA with and without a protocol for reducing the stress levels of the nursing team.	G1 (protocol)/G2 (without protocol): Auriculotherapy with semi-permanent needles (G1/G2 n = 58/59).	G3: Control without intervention (n = 58).	EA with and without protocol was effective in reducing stress levels. But the scope of the technique was extended without a protocol.	3
Gagliardi et al., 2014⁽¹⁹⁾	To evaluate the sedative-anxiolytic effect of EA in health professionals by comparing the effect of real and fake needles.	G1: Auriculotherapy with semi-permanent needles (n = not described).	G2: Placebo with false needles (n = not described).	Auriculotherapy had a significant effect on the volunteer’s state-anxiety compared with the placebo group.	0
Hadad-Rodrigues et al., 2013⁽¹⁸⁾	To evaluate the effectiveness of acupuncture versus placebo acupuncture in the anxiety of nursing mothers with preterm and low birth weight babies.	G1: Auriculotherapy with semi-permanent needles (n = 14).	G2: Placebo with customized needles which did not pierce the skin.	There was no difference between the acupuncture and placebo acupuncture groups for anxiety in mothers with preterm babies. However, there were statistically significant improvements for anxiety in the group analyzes.	5

Authors/Year	Treatment points	Device	Sessions
Authors/Year	Treatment points	Device	Number	Frequency	Duration
Rodrigues et al., 2019⁽²³⁾	G1: Shenmen, Temporamandibular dysfunction, heart.	Laser irradiation at 4 J/cm² for 24 seconds	8 sessions	1x/week	1 week
Mafetoni et al., 2018⁽¹⁶⁾	G1: Shenmen, Uterus, Neurasthenia, Endocrine.	Polished crystal microspheres (1.5 mm)	1 session	1x	1 day
Ndubisi et al., 2018⁽¹⁷⁾	G1: Cingulate gyrus, Thalamus, Zero point, Cervix, Uterus, Shenmen.	Semi-permanent needles (0.2x1.2 mm)	-	-	-
Vieira et al., 2018⁽¹¹⁾	G1: Diazepam, Pulmonary parenchyma, Anxiety, Psychosomatic, Happiness.	Semi-permanent needles (3 mm)	1 session	1x	2 days
Dellovo et al., 2018⁽¹³⁾	G1: Shenmen, Kidney, Sympathetic, Anxiety, Neurasthenia, Heart, Liver.	Mustard seed (Brassica juncea)	1 session	1x/week	5 days
Prado et al., 2018⁽⁴⁾	G1: Shenmen and Brainstem.	Semi-permanent needle	12 sessions	2x/week	6 weeks
Valiani et al., 2018⁽³⁰⁾	G1: Shenmen, Relaxing, Zero, Talamic, Shoulder Master, Tranquilizer, Thymus, Adrenal, Master Oscillation, Brain Stem.	Cow seed	10 sessions	2x/week	3 days
Carter et al., 2017⁽²⁸⁾	G1 (NADA Protocol): Sympathetic, Shenmen, Lung, Kidney, Liver.	Stainless steel needle with fluorescent plastic handles (0.20x7 mm)	24 sessions	2x/week	10 to 12 weeks
Kurebayashi et al., 2017⁽²²⁾	G1/G2: Shenmen, Tranquilizer, Thalamus, Autonomic or Sympathetic System, Zero Point.	Semi-permanent needle and seed	10 sessions	2x/week	5 weeks
Bergdahl et al., 2017⁽²⁹⁾	G1 (NADA Protocol): Shenmen, Kidney, Sympathetic, Lung, Liver.	Zhongyan Taihe sterile stainless systemic acupuncture needle (0.18x13 mm)	8 sessions	2x/week	4 weeks
Ahlberg et al., 2016⁽²¹⁾	G1 (NADA Protocol): Sympathetic, Shenmen, Kidney, liver, lung. G2 (Local protocol): not described.	Stainless steel systemic acupuncture needle (0.25x13 mm)	G1: 15/G2: 10 sessions	-	-
Bergdahl et al., 2016⁽²⁶⁾	G1 (NADA Protocol): Shenmen, Kidney, Sympathetic, Liver, Lung.	Zhongyan stainless steel systemic acupuncture needle	8 sessions	2x/week	4 weeks
Jonas et al., 2016⁽²⁷⁾	G1: Point N, Omega 2, Shenmen, Point Zero, Cingulate gyrus, External thalamus.	SEIRIN L needle (20x30 mm) or semi-permanent gold needle	10 sessions	2x/week	6 weeks
Klausenitz et al., 2016⁽¹²⁾	G1: Lung, Shenmen, Kidney, Subcortex, Adrenal.	New Pyonex fixed needle (1.5x0.22 mm)	1 session	1x	2 days
Rivadeneira et al., 2015⁽²⁾	G1: Shenmen, Occipital, Heart, Liver, Spleen, Kidney.	Argemona Mejicana L. Seed	8 sessions	1x/week	8 weeks
Iunes et al., 2015⁽²⁰⁾	G1: Shenmen, Kidney, Sympathetic, Brainstem, Temporamandibular dysfunction.	Mustard seed	10 sessions	2x/week	6 weeks
Jiao et al., 2015⁽²⁴⁾	G2: Subgroup 1: Shenmen, Occipital, Chuiqian, Subcortex. Subgroup 3 (TCM): basic points + Spleen, Stomach, Heart, Liver.	1 cun systemic acupuncture needle (0.25x25 mm)	20 sessions	-	6 weeks and 2 days
Kurebayashi et al., 2015⁽¹⁵⁾	G1 (with protocol): Shenmen, Brain Stem, Kidney, Liver Yang 1 and 2. G2 (without protocol): practically the same as the protocol, with Stomach, Spleen and musculoskeletal pain points.	Semi-permanent needle	12 sessions	2x/week	6 weeks
Rodríguez-Mansilla et al., 2015⁽²⁵⁾	G1: Shenmen, Muscle Relaxer, Xin Heart.	Vacaria seed (Ener-Qi®)	6 sessions	2x/month	3 months
Széchenyi et al., 2015⁽³⁾	G1 (NADA Protocol): Shenmen, Sympathetic, Kidney, Liver, Lung.	Systemic acupuncture needle	-	-	-
Kurebayashi et al., 2014⁽¹⁾	G1/G2: Shenmen, Kidney, Cerebral Stem.	Semi-permanent needle and seed	8 sessions	1x/week	8 weeks
Kurebayashi et al., 2014⁽¹⁴⁾	G1 (with protocol): Shenmen, Brain Stem, Kidney, Liver Yang 1 and 2. G2 (without protocol): Kidney, Brain Stem, Shenmen, Liver Yang 1 and 2, Cervical, Lumbar, Stomach, Spleen, Liver, Lung, Endocrine, Apex.	Semi-permanent needle	12 sessions	2x/week	6 weeks
Gagliardi et al., 2014⁽¹⁹⁾	G1: Not described.	Semi-permanent needle (0.22x1.5 mm)	-	-	-
Hadad-Rodrigues et al., 2013⁽¹⁸⁾	G1: Shenmen, Muscle Relaxation, Tension, Anxiety 1, Anxiety 2.	Semi-permanent needles (1.0 × 1.5 mm)	12 sessions	1x/week	16 to 83 days

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author:Hérica Pinheiro Corrêa Av. Augusto de Lima, 345 – Centro CEP 30190-000 – Belo Horizonte, MG, Brazil hericapc@yahoo.com.br