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The evaluation instruments were the State-Trait Anxiety Inventory, Pain Visual Analog Scale and Quality of Life instrument, applied at the start and after five and 10 sessions five weeks. Further studies are, however, suggested with new populations and desafil different contexts so that the results can be confirmed. Mental health is one of the great challenges of the twenty-first century.

Among the most common problems identified in the study were anxiety, behavioral changes and substance abuse. Although the individual clinical and sociocultural factors need to be considered, contextual factors inevitably have a heavy impact on the development of mental problems.

Among these, the economic crisis and rising unemployment levels can certainly contribute to a sense of general and collective insecurity 2. Brazil is experiencing a chaotic historical moment regarding political, economic, ethical and social aspects, with a tragic legacy of a driving motion of the economy that has acquired an astonishing rhythm of unbalance and overload over the past four years.

The result of government intervention in the economy associated with corruption has caused increased inflation, credit restriction, closure of businesses and rising unemployment, coupled with a lack of faith of the population in relation to the government 3.

In addition to the current economic and political developments, the process of rapid expansion and urbanization is an aggravating factor for the welfare of the residents, contributing to increased social insecurity, creating urban environmental problems and irregular settlements and prejudicing the quality of life 5.

Nursing workers represent one of the groups of professionals most susceptible to present health problems at work, as they perform complex tasks involving a high physical and mental workload 6. Other factors potentiate damage to their physical and mental integrity, causing pain and anxiety, such as: All this generates increased rates of absenteeism 7. In anticipation of proposing a preventive treatment to reduce levels of anxiety and pain in the nursing staff, the use of auriculotherapy has been proposed as a complementary and preventive practice.

Having participated as a specialist in auricular acupuncture for the creation of the protocol with 30 other experts from other countries, in the period from June to Julythe idea emerged of holding the first protocol trial in a hospital in Brazil, with a Nursing team.

The protocol was previously created for people living in situations of danger, conflict, disaster and poverty 8. While it was recognized that the scope of auricular technique can be greater when performed in an individualized way that does not follow a protocol and by professionals with theoretical and practical knowledge of diagnoses 9the possibility of using a protocol assists in the dissemination and popularization of the art, with the aim of benefiting more people.

It should also be noted that auriculotherapy has important advantages, being easily administered, very rapid, relatively inexpensive, achievable with non-invasive materials and presenting minimal adverse side effects The aim of the study was to evaluate the effectiveness of the auricular protocol for pain and anxiety APPA and improving the quality of life of nursing staff of a hospital. A total of nursing staff employees were initially contacted and people who presented high or moderate levels of anxiety, according to the State-Trait Anxiety Inventory over 33 pointswere invited to participate.

Pregnant women, subjects who would go on vacation and those taking sick leave during the survey period were excluded, as were those that started using allopathic medication for anxiety or antidepressants, those that initiated other energy therapies during the study period and those that were allergic to metal or adhesive tape.

Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial

However, those that were undergoing psychological therapy at this moment were not excluded, with the proviso that the treatment continued normally.

The eligible population obtained was subjects and completed the study Figure 1with a loss of 47 A total of 22 people missed at least two sequential sessions in a week due to sector rotation or sequential days off; 15 did not attend the second evaluation or did not turn up to respond to the questionnaires control ; five went on medical leave during the study period, three took holidays, one person stopped working for the hospital and one gave up due to feeling pain at the zero point, which is a point located in the center of the ear between the two shells, about the root of the helix.


For the allocation of the individuals, a random division was made into four groups, using the Research Randomizer program available at http: Control – G1 without intervention Auriculotherapy with seeds – G2, Auriculotherapy with semi-permanent needles – G3, and Auriculotherapy with adhesive tape – G4 placebo. The treatment consisted of ten twice weekly sessions for five weeks, which were performed in the sector where the professional worked, during the work time, with duration of 5 to 10 minutes.

The protocol was applied unilaterally in each session. The needles remained in place for two days, if there was no discomfort.

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For the seeds, the subjects were instructed to stimulate them 15 times, at least three times a day. All participants completed a biosociodemographic questionnaire and the instruments: Participants in the Control and Adhesive Tape groups were offered the opportunity to receive auriculotherapy after completion of the study.

For the descriptive analysis of the data, measures of central tendency and absolute and relative frequencies were used, with the repeated measures ANOVA used to compare the groups. Also Cohen’s d index was used to measure the effect size and the percentage of change in the three moments before, after 5 and after 10 sessions.

The mean age of the participants was At baseline, they presented moderate levels of state anxiety Circulatory and vascular system: The resafio with needles reduced anxiety levels, with a Cohen’s d index of 1. Cohen’s d for the mental domain was 0. Concerning e, levels, audiculoterapia Cohen’s d index for the needle group was 0. Only one person withdrew from the study due to pain with the needles. Other people who felt pain continued in the trial. The adhesive tape group did not function as a placebo, as the participants were not blinded and it also did not produce any effects.

The best result for reducing state anxiety was produced by the auriculotherapy with needles. Similarly, in a study conducted in a university hospital, there was a greater reduction of stress by auriculotherapy with needles compared to that with seeds, using the Shenmen, Kidney and Brainstem points.

Unlike seeds, needles do not need to be stimulated, however, may produce local pain and run a risk of infection. Even with lower results, there is an advantage in the use of seeds as they produce less discomfort 13 and can be applied by people only trained for the protocols. In this regard, the first test of the APPA protocol in Nepal obtained positive results after the earthquake that devastated the country in Crisis situations compromise the mental health and the usefulness of the APPA was only observed with regards to anxiety, perhaps because the pain level was not an inclusion criterion for the present study.

Each auricular protocol has a pathophysiological rational, which often aims to approximate the Western knowledge with the Eastern, and also considers the perception that the researchers have about the phenomenon of traumatic situations. In this sense, starting from a more Eastern assumption, the NADA The National Acupuncture Detoxification Association protocol has been developed to reduce stress and alleviate trauma in communities suffering from disasters or conflicts.

It was previously developed for the well-being of communities, mental health and the control of drug abuse and smoking, among other conditions The points common to both protocols are the Shenmen and Sympathetic or Autonomic points. Regarding the APPA protocol, the most painful point reported was the Zero point, when using semi-permanent needles.

There was no reported discomfort in relation to the other points. The Zero point was used postoperatively in another study, as a regulator of the autonomic nervous system and of parasympathetic activity, together with the Dessfio point, with positive results based on the analysis of heart rate variability Auriculotherapy points for anxiety were evaluated in 14 articles, with the Shenmen Other points used for emotional problems were: Auriculotherapy has also been studied as a less invasive method of vagus nerve stimulation for the treatment of patients resistant to therapy, with disorders such as depression and epilepsy.


A trial used stimulation of the dfsafio concha achieving positive results with electro-stimulation. This area shows neuroanatomical auriculoterapa of vagal afferents The Shenmen, in the triangular fossa, is a region innervated by a branch of the vagus nerve, with anti-inflammatory and calming actions Specific points for musculoskeletal or visceral pain were not used, opting for the use of general points, such as the Shenmen, Thalamus, which are indicated for pain.

Auriculiterapia is in the thalamus that painful information is located and projected to the structures of the limbic, motor and cortical systems. Thus, the painful impulse reaches the limbic system, carrying the experience as something unpleasant and emotional, resulting in the interpretation of pain Other studies with the APPA protocol have suggested the evaluation of the effects on pain and the investigation of whether zuriculoterapia complementary points may eventually be needed.

Mental and physical health are two closely intertwined and interdependent elements of life and the APPA seeks to influence both aspects. Currently, the intrinsic and strong relationship between the physical and emotional aspects of anxiety is recognized and accepted.

There is a significant correlation between pain and symptoms of anxiety and depression, especially chronic pain Considering the limitations of the study, it was not possible to ensure the proper participation of the subjects who were treated with seeds, as the seeds need to be pressed to achieve better results.

As it is important for the APPA Protocol that the auriculotherapy is made with non-invasive materials, further studies with other materials, such as magnets or magnetic crystals, are recommended. The location of the points was performed manually, without the use of electronic devices or of the atrio-cardiac reflex proposed in French auriculotherapy for the location of points.

The group with adhesive tape did not function as a ariculoterapia, due to failing to blind the subjects.

Perhaps the auriculotherapy with seeds would achieve better results if the number of participants was greater or if a longer treatment time was used. Other points could possibly be added or changed in the APPA protocol, in order to intensify its effect in relation to pain. It is suggested that other studies consider these aspects.

The group with semi-permanent needles presented a Cohen’s d index of 1. Further studies are suggested with new populations and in different contexts and situations so that the results can be confirmed. It is also recommended that other auricular points are tested to intensify the effects in relation to pain. How to cite this article: Auriculotherapy to reduce anxiety and pain in nursing professionals: National Center for Biotechnology InformationU.

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Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial

Find articles by Karen Charlesworth. Author information Article notes Copyright and License information Disclaimer. Received Jul 14; Accepted Sep This is an open-access article distributed under the terms of the Creative Commons Attribution License.

Introduction Mental health is one of the great challenges of the twenty-first century. Open in desaafio separate window. Flowchart of participants involved in the study. Results The mean age of the participants was D 1 Means and standard deviation of STAI-state levels, pain visual analogue scale, physical SF12 F auricuoterapia mental SF12 M domains of the quality of life scale, in the four groups and at the three moments.

Evolution of state anxiety levels in the four groups, at the three moments. Evolution of pain levels VAS in the four groups, at the three moments.