Auricolotherapy for persisting postoperative pain caused by total knee replacement

Introduction: Total knee replacement (TKR) is a common procedure that entails severe postsurgical trauma, prolonged hospitalization, and impaired patient rehabilitation, especially in patients who are elderly. Among the nonpharmacologic methods used with TKR, auriculotherapy/ear acupuncture (AEA) has recently shown a favorable effect on perioperative/postoperative pain and disability in patients who have undergone TKR. Objective: The primary aim of this study was to examine the adjuvant effects of one session of auricular acupuncture on persisting pain and disability in patients hospitalized for TKR postoperative rehabilitation. The secondary aim was to propose a simplified diagnostic method for selecting the most effective points to treat in each patient. Materials and Methods: In 17 patients (14 females and 3 males; mean age 75.2 years) hospitalized for postoperative TKR rehabilitation, pain level and time for sit-to-stand were measured before, 30 minutes after, and 6 hours after one session of auricular acupuncture. In each patient, an electric skin resistance test (ESRT) was performed on both auricles, followed by a pain pressure test (PPT) for identifying the most sensitive points. A second PPT was consecutively performed on the previously located auricular points and only those ipsilateral to the operated knee were selected for treatment. Results: All 17 patients reported a having lower level of pain after the AEA treatment, and this effect was still maintained after 6 hours. A better performance in the sit-to-stand test was observed after 6 hours following treatment. Conclusions: The auricular points, which were effective for reducing pain and disability, were spread out over a broad area of the upper external ear, which overlaps both the French and Chinese somatotopic auricular representations of the knee joint.