What is Auricular Acupuncture and how does it work?

Auricular acupuncture, also known as battlefield acupuncture, is a type of acupuncture that involves inserting tiny needles into specific points on the ear. These points are believed to correspond to different parts of the body, and stimulating them is thought to help alleviate pain, reduce stress, and promote overall health and wellness. Auricular acupuncture is often used as a complementary therapy alongside other forms of traditional medicine, and it is generally considered safe and effective when performed by a qualified practitioner.

The idea behind auricular acupuncture is that there is a homunculus of the human body on the ear and that the ear is a microcosm for the body (basically an inverted fetus). By stimulating certain points on the ear we influence the health of the corresponding body part. Needling of each area stimulates a somatotopic reflex in the brain. The brain sends signals to the spinal cord which influence the neurons in the affected area. In addition the brain releases neuro-chemicals such as endorphins and serotonin in response to auricular acupuncture and explains its success in relieving stress for example.

Because the ears are almost always accessible, Auricular acupuncture is very convenient and the patient need not undress.

Battlefield Acupuncture for pain relief:

Battlefield acupuncture was developed by Richard C. Niemtzow, MD, PHD, MPH a radiation oncologist in the Air Force and a certified acupuncturist, in 2001 to provide rapid pain relief using auricular acupuncture. The name battlefield was coined on the assumption it could be used on the military battlefield. It is currently used by both civilian and military acupuncturists. All military medics are now being trained in battlefield acupuncture. The technique delivers attenuation of pain in just a few minutes. The length of pain relief varies from minutes to months depending on the problem and the duration of treatment with needles, lasers, or acupoints.

Battlefield acupuncture uses points that relate to processing and modulating pain in the central nervous system including the hypothalamus, thalamus, cingulate gyrus and cerebral cortex. Research by Dr. ZH Cho shows involvement of these structures in processing pain through fMRI studies.

The following points are administered in the following sequence:

Cingulate Gyrus
Thalamus

(can be needles from the front or the back)

Omega 2
Point Zero
Shen Men

Point rationale:

Cingulate Gyrus – This point is used for pain, including emotional responses to pain and coordinating sensory input with emotions.
Thalamus – This point represents both the thalamus (which relays connections to the cerebral cortex) and hypothalamus (which regulates autonomic nerves and endocrine glands). It reduces shock, calms the mind, restores tranquility, strengthens the brain. It refines communication of the nervous system and the cerebral cortex and is used for most pain disorders, acute and chronic, frequently used in auricular acupuncture analgesia.
Omega 2 – This point is for pain in the limbs and psychosomatic disorders.
Point Zero – This point is at the center of the ear and is located where the umbilical cord would be of the homunculus. It brings the body towards homeostasis and has influence on the visceral organs. It supports the actions of other auricular points.
Shen Men – This point regulates excitation and inhibition of cerebral cortex, helps the body switch to a parasympathetic state. It is calming, used in neuropsychiatric disorders, helps with insomnia, decreases allergies and is used for pain reduction and is an important point for anesthesia.

For migraine headaches Niemtzow found that bilaterally needling Omega2, Shen Men and the Zero point are especially effective. Regular acupuncture needles are used first and then once the migraine has ended the points are replaced with ASP needles.

Note on needles, lasers etc.

Niemtzow typically uses ASP needles which are semi-permanent and remain in the ear acupoints for up to 3-4 days before being pushed out by the epidermis. Other alternatives include regular acupuncture needles, acupuncture tacks, lasers, and ear seeds.

Battlefield acupuncture can be repeatedly administered. Patients should experience pain relief that lasts between minutes to months depending on the problem treated. In some cases the patient will achieve long lasting relief from pain. Patients with more complicated pathology and who are older are more likely to need ongoing treatment (to take the place of, or reduce the use of pain medication). Niemtzow found that treating a patient biweekly with ASP needles is sufficient in most cases.

This technique has been successfully taught and implemented by many physicians. The majority report immediate results.

The NADA Protocol for addiction, disaster relief, behavioral health:

NADA stands for National Acupuncture Detoxification Association and was founded in 1985. The NADA protocol is an auricular acupuncture protocol that involves placing five acupuncture needles in each of the ears. It is used primarily in addiction treatment for detoxification, reduced withdrawal symptoms and cravings, as well as in disaster relief settings and mental health, behavioral health, trauma, PTSD, chronic stress, and associated symptoms. It is a protocol that is used all over the world in hospitals and treatment centers.

Brief history:

The origins of the protocol started in 1972 in Hong Kong, where a neurosurgeon Dr Wen discovered that electrical stimulation of an ear point as a preoperative anesthetic helped with physical withdrawals from opium. In 1973 Dr Wen published his success in treating 40 heroin and opium addicted individuals. (Asian J Med 1973;9:138-141)

In the 1970’s Michael Smith a medical doctor at Lincoln Hospital in the South Bronx area of New York, began using auricular acupuncture for drug addictions. The point selection and method of stimulation evolved over time from electrical stimulation of the lung area in the ear, to the 5-point acupuncture protocol NADA is today. NADA has trained over 10,000 diverse health professionals to use the protocol in North America. They have trained medical doctors, nurses, counselors, social workers, psychologists, chiropractors, acupuncturists, outreach workers, corrections officers, drug court judges, family members and others. Forty-two countries internationally are practicing NADA, and fifteen of those have their own NADA websites.

The points:

Sympathetic (needled on the underside of this location)
Shen Men
Kidney
Liver
Lung

Point Rationale:

Sympathetic – This point is used for numerous diseases that relate to disruption of both sympathetic and parasympathetic nervous systems. It decreases fight or flight reflex. It has a strong analgesic and relaxing effect on internal organs. It lowers blood pressure and dilates blood vessels.
Shen Men (translation: Spirit Gate) – This point is used in many neuropsychiatric disorders. It regulates inhibition and excitation of the cerebral cortex. It has sedative and anti-allergy effects.

The following points relate to organs which all play significant roles in detox and have psychological influences as well.

Kidney – This point is used to strengthen the kidneys, and for urogenital problems. It strengthens the cerebrum and hematopoietic system. Psychologically it is associated with will power and also used for coping with fear.
Liver – This point is used for liver health, hepatitis, anemia, neuralgia, muscle spasms, and eye diseases. Psychologically it is associated with hope and with resolving anger and aggression.
Lung – Used for many types of respiratory conditions, analgesia, energy levels and sweating. Psychologically it is associated with the grieving process

Patients treated with the NADA protocol report a number of benefits: Improved sense of wellbeing, feeling energized, lighter and more relaxed. Improved retention in treatment programs, more optimistic attitudes about detoxification and recovery, reduced cravings and anxiety, less sleep disturbance, reduced need for pharmaceuticals.

Recent Research Highlights:

Studies on the NADA protocol have found that patients who underwent traditional substance abuse treatment and participated in NADA had better quality of life enjoyment and satisfaction (p<0.05), felt better and had improved energy (p<0.05), had decreased alcohol use at 3 month (p<0.05) and 6 month (p<0.01) follow up, less tobacco use at 6 months (p<0.05), likelihood of employment at discharge (p<0.05), compared to the control group who did not participate in NADA treatment. (Carter et al., 2017)

In a meta-analysis including 458 patients from six trials and two observational studies in which Battlefield acupuncture was the most commonly used technique, ear acupuncture significantly reduced pain scores and was determined to have potential benefits for use in the emergency department setting. (Jan et al., 2017)

Among 112 veterans receiving Battlefield Acupuncture for pain relief the mean pain score before treatment was 6.8, immediately after receiving Battlefield acupuncture the score decreased by 2.4 points. Patients reported decreased pain on days 0 (88.4% of patients), 1 (80.7%), 7 (52.4%) and day 30 (51%). (Federman et al., 2018)

Among 30 patients presenting with low back pain to the emergency department, 15 received standard care, and 15 received standard care and battlefield acupuncture. In the battlefield acupuncture group pain score were significantly lower (5.2 vs 6.9, p=0.04) (Wee et al., 2019)

Reference List:

Carter, K., Olshan-Perlmutter, M., Marx, J., Martini, J. and Cairns, S. (2017). NADA Ear Acupuncture: An Adjunctive Therapy to Improve and Maintain Positive Outcomes in Substance Abuse Treatment. Behavioral Sciences, 7(4), p.37.

Jan AL, Aldridge ES, Rogers IR, Visser EJ, Bulsara MK, Niemtzow RC. Does Ear Acupuncture Have a Role for Pain Relief in the Emergency Setting? A Systematic Review and Meta-Analysis. Medical Acupuncture. 2017;29(5):276-289.

Federman DG, Radhakrishnan K, Gabriel L, Poulin LM, Kravetz JD. Group Battlefield Acupuncture in Primary Care for Veterans with Pain. Southern Medical Journal. 2018;111(10):619-624.

Wee TC, Tan YL. Observations regarding battlefield acupuncture to treat low back pain in the emergency department? The American Journal of Emergency Medicine. 2019;37(1):151.

April 25, 2023 by Troy Laforteza

How does Auricular Acupuncture work?