MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

Auriculotherapy (or ear acupuncture) is the use of electrical, mechanical, or other stimuli at specific points on the outer ear for therapeutic purposes. It was invented by the French neurologist Paul Nogier (1908–1996) who published his “Treatise of Auriculotherapy” in 1961. Auriculotherapy is based on the idea that the human outer ear is an area that reflects the entire body. Proponents of auriculotherapy refer to maps where our inner organs and body parts are depicted on the outer ear. These maps are not in line with our knowledge of anatomy and physiology. Auriculotherapy thus lacks plausibility.

This single-blind randomized, placebo-controlled study aimed to investigate the effect of auriculotherapy on the intensity of Premenstrual Syndrome (PMS) symptoms.

Ninety-one women were randomly assigned to

  • Auriculotherapy (AG),
  • Placebo (PG),
  • Control (CG) groups.

The intervention was 8 weeks long, done once per week. At each session in AG the microneedles were placed in seven points related to PMS symptoms (Anxiety; Endocrine; Muscle relaxation; Analgesia; Kidney; Shen Men; and Sympathetic). At PG the microneedles also were placed in seven points but unrelated to PMS symptoms (Tonsils; Vocal cords; Teeth; Eyes; Allergy; Mouth; and External nose). The women allocate in the CG received o intervention during the evaluation period.

Assessments of PMS symptoms (Premenstrual Syndrome Screening Tool), musculoskeletal pain (Nordic Musculoskeletal Questionnaire), anxiety (Beck Anxiety Inventory), and quality of life (WHOQOL-Bref) were done at baseline, before the 5th session, after program completion, and a month follow-up.

The AG and PG showed significantly lower scores of PMS symptoms, musculoskeletal pain, and anxiety. On the quality of life and follow-up analysis, the significance was observed only in PG.

The authors concluded that auriculotherapy can be used as adjunctive therapy to reduce the physical and mood PMS symptoms.

If I understand it correctly (the paper is unclear), verum and placebo were both better than no intervention but showed no significant differences when compared to each other. This is strong evidence that auriculotherapy is, in fact, a placebo. To make matters worse, in the follow-up analysis placebo seems to be superior to auriculotherapy.

Another issue might be adverse effects. Microneedle implants can cause severe complications. Thus it is mandatory to monitor adverse effects in clinical trials. This does not seem to have happened in this case.

The mind boggles!

How on earth could the authors conclude that auriculotherapy can be used as adjunctive therapy to reduce the physical and mood PMS symptoms.

The answer: a case of scientific misconduct?

7 Responses to Auriculotherapy for Premenstrual Syndrome (PMS) – a case of scientific misconduct?

  • Dear Edzard,
    please allow me some corrections and additions.
    Indeed, the so-called “auriculo-therapy” is one of many examples of naïve physicians in China and the West willing to believe any kind of speculation. The idea of Paul Nogier was that the outer human ear resembles the position of a head-down fetus in the mother womb. If such a connection really existed, the ear form of any mammals should be more or less the same, because all those fetuses have more or less the same form – so that just looking at dogs’ ears should be enough falsify this hypothesis.
    Nevertheless, like Columbus heading for India and finding America, at least theoretically there might be a certain connection between the auricle zones and the organs which according to Nogier’s theory they represent.

    Nogier’s ideas were first promoted by Gerhard Bachmann, founder of the “Deutsche Gesellschaft für Akupunktur” (1951), who in fact was one of many frauds in the field of Traditional Chinese Medicine (TCM). After he met Nogier in 1956 and mentioning his ideas in his acupuncture journal “Deutsche Zeitschrift für Akupunktur” 1957 No.1-2, in the 1957 No.3-4 edition Nogier first presented his ideas in detail.
    Nogier always emphasized that the outer ear was not only useful for therapy, but also for diagnostic purposes, claiming that in case of some disease or dysfunction the corresponding zone of the auricle would either show some morphological changes or become sensible to pressure.
    Very quickly – still in 1957 – journals in China wrote about Nogier’s ideas. Indeed, nothing would have been easier than checking his hypothesis: just take 20 patients with 20 different diseases from different departments of any hospital, hide their bodies and faces and let several physicians believing in this “auriculo-therapy/diagnosis” check all those 40 ears by pressing the relevant auricle zones. However, SUCH A TEST WAS NEVER DONE, neither in China nor in the West.
    Instead, some Chinese authors immediately claimed that “ear acupuncture” was in fact an ancient Chinese method, so that beginning in 1958, the first Chinese books dedicated to this form of acupuncture were published. Since then – without ever looking for reliable evidence – “ear acupuncture” is part of every Chinese acupuncture book.
    In Germany, Dr. Frank Bahr – another one of many dubious TCM prophets – for some years even coined the term “Aurikulomedizin”, claiming that its rank was comparable to pharmacology or surgery.
    But although I myself am convinced that “ear acupuncture” is a complete hoax, I have to admit that I know some respectable acupuncturists who fervently believe in the Nogier theory and claim to achieve good successes with it.
    Hanjo Lehmann, Berlin

  • An interesting concept of using the ear for vagal stimulation.

    https://www.frontiersin.org/articles/10.3389/fnins.2019.00772/full#B69

  • From the paper:

    Conclusion: Auriculotherapy can be used as adjunctive therapy to reduce the physical and mood PMS symptoms.

    Dr. Ernst writes:

    verum and placebo were both better than no intervention but showed no significant differences when compared to each other. This is strong evidence that auriculotherapy is, in fact, a placebo. To make matters worse, in the follow-up analysis placebo seems to be superior to auriculotherapy.

    Their placebo group also got auricular acupuncture, but at acupuncture points that aren’t thought to be related to PMS.

    They don’t actually claim that auricular acupuncture had benefits that were specific to the acupuncture points that are thought to help with PMS, just that it had more benefits than no intervention. From the paper,

    The placebo effect, also find in the present study, classified as an opportunity for introducing a more inclusive psychosocial therapeutic approach, can be explained by the interaction amongst the professional and the participant; by the body self-healing properties and by the natural regression of the disease symptoms. Other studies suggested the psychological traits role on the therapeutic effect, including hopefulness, expectations, beliefs and the contextual factors linked to treatment-related expectations, conditioning and learning. Placebos within a set of sensory and social stimuli can induce biochemical and cellular changes in a patient’s brain that can simulate and improve beneficial responses of pharmacological agents. Additionally, one more explanation for the placebos’ improvement might be that the acupoints were located very close to each other, and therefore sham and true stimuli may be subject to the same meridian transmission processing.

    So their results don’t distinguish between the placebo effect of auricular acupuncture, and possible non-placebo effects from their “placebo” intervention. The possible non-placebo effect they discuss is

    The possible mechanism of action of auriculotherapy in PMS symptoms can be explained by stimulation of auricular branch of the vagus nerve (ABVN).

    • the conclusions are wrong

      • the conclusions are wrong

        You mean, because of possible harm from the acupuncture? It would cause adverse effects aside from the possible physical adverse effects

        Another issue might be adverse effects. Microneedle implants can cause severe complications.

        such as costing more money than a gentle ear rub, or convincing people that something that isn’t proved to be better than a placebo, actually is. Deceiving them, in other words.
        And supporting the acupuncture industry, which might do harm in other ways as well.

  • Acupuncture in someone’s ears or their face seems a bit scary, because it’s close to the brain. Does this actually aggravate the risks?

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