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INDICATIONS
OF
PERIOPERATIVE
AURICULOTHERAPY FOR
DEGENERATIVE HAND DISEASES CHRISTIAN COUTURIER MD
ARAGO CLINIC, PARIS
LIMC: LONDON INTERNATIONAL MEDICAL CLINIC,
LONDON
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WHAT IS AURICULOTHERAPY ?
HOW DOES IT WORK ?
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Paul NOGIER
TURKISH: XIII Century
Paul Nogier’s Auriculotherapy Chart (1966)
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WFCMS (World Federation of Chineses Medicine Societies)
London, September 3, 2011
Published in September 2011 (Nomenclature Normative
Internationale)
Edition Desclée de Brouwer. Pges 372 à 375
Nomenclature
Pr Alimi
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Literature
EVIDENCE - PAIN
Etudes sur les potentiels évoqués
Etude de certains points auriculaires par les potentiels évoqués corticaux. Revue Franc ̧aise de Médecine Traditionnelle Chinoise 1994;162:62-69.
IRM fonctionnelle
Alimi D, Geisdsmann A, Gardeur D, Auricular acupuncture stimulation measured on functional magnetic , Imaging. 2002; Med Acup ,13:18-21
Romoli M et al. Ear acupuncture and fMRI: a pilot study for assessing the specificity of auricular points. Neurol Sci 2014; 35 (Suppl 1) : S189-93
Alimi D., Geissmann A., Gardeur D., Bahr F. Study in fMRI of the stimulation of the auricular areas of the knee as the French – German and Chinese localizations. The Journal of Radiology. Photon 2014; 125, 133-141. : POUCE et GENOU
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Literature
CLINICAL TRIAL
Juliette Gueguen , Caroline Barry , Valérie Seegers , Bruno Falissard INSERM 2013. Evaluation of the efficacy and safety of the practice of auriculotherapy
GN. Asher, DE. Jonas, RR. Coeytaux, AC. Reilly, YL. Loh, AA. Motsinger-Reif, and SJ. Winham. Auriculotherapy for Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials .The Journal of alternative and complementary medicine Volume 16, Number 10, 2010, pp. 1097–1108.
IT CAN BE EFFICIENT FOR PERI-OPERATIVEPAIN MANAGEMENT
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Literature
CLINICAL EVIDENCE
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WHO?
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DIPLÔME INTERUNIVERSITAIRE D’AURICULOTHÉRAPIE SCIENTIFIQUE
(PARIS-STRASBOURG)
MEDICAL
DOCTOR
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WHY ?
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ADVANTAGES OF NOT HAVING
TO USE PAIN DRUGS
No opiate dependency
Decrease CRPS
Better sleep and decrease stress
Faster recovery
1970’s :
PCA opioids gold standard for postoperative pain
Problem : recent multimodal approach, 13%
patients become addicted to opioids following
surgery
(Johnson SP, Chung KC, Zhongshan L, Shauver MJ, Engelsbe MJ, Brummett Ch, Wajee J. Risk of prolonged opioid
use among opioid-naive patients following common hand
surgery procedures. J hand Surg Am 2016; 41: 947-57
USA : 7000 death/y due to opioids
FRANCE 4 death/week due to opioids
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IT IS POSSIBLE TO PERFORM
SURGICAL INTERVENTIONS
WITHOUT
USE OF OPIOIDS
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RESEARCH STUDIES INTO AURICULOTHERAPY PAIN MANAGEMENT
CONDUCTED BY Pr. CHELLY
2017 - 19: Auriculotherapy recently proven to be effective alternative to opioids
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MY EXPERIENCE
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38 patients :
19 stimulated (group AT)
19 placebo (group P)
Control group:
30 patients
Randomized
Double blind
Control group
Cryopuncture (5
points)
CARPAL TUNNEL
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RESULTS
10,7 0,8
3
2
0,6
0
0,5
1
1,5
2
2,5
3
3,5
Category 1 Category 2 Category 3
D1 D2 D3
AT
P
Significant difference
Pain level D1 (p < 0,05)
Pain level D2 (p < 0,01)
Pain level D1-D3 (p < 0,03)
AREA UNDER THE CURVE
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RESULTS
Significant difference AREA UNDER THE CURVE
VAS D1-D3 (p < 0,05)
AT 0,82 P 1,86 T 3,5
Opioids D1-D3 (p < 0,05)
AT 1 P 1,84 T 4,5
1 1,84
4,53
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ARTHRITIS
WITHOUT SURGERY
AT AVE 2,3 SESSIONS 3 MONTH
VAS AVE PRE AT 6,95/10 WITH OPIOIDS
VAS AVE POST AT 3,55/10 WITHOUT OPIOIDS
14 PATIENTS ALL STAGES
4 failures – STAGE 4
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ARTHRITIS
WITHOUT SURGERY
AT AVE 2,3 SESSIONS 3 MONTH
VAS AVE PRE AT 6,67/10 WITH OPIOIDS
VAS AVE POST AT 1,43/10 WITHOUT OPIOIDS
10 PATIENTS stages 1-3
5 PIP
1 PID
1 CMC
3 CARPUS
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TENDINITIS
WITHOUT SURGERY
AT AVE 1,6 SESSIONS 3 MONTH
VAS AVE PRE AT 6,4/10 WITH OPIOIDS
VAS AVE POST AT 3/10 WITHOUT OPIOIDS
5 PATIENTS
3 De Quervain
1 Flexor tendons
1 ECU
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PAIN NEURO
AFTER SURGERY
AT AVE 2,2 SESSIONS 3 MONTH
VAS AVE PRE AT 7,5/10 WITH OPIOIDS
VAS AVE POST AT 3,17/10 WITHOUT OPIOIDS
12 PATIENTS
10 neuromas
6 median nerve
2 ulnar nerve
2 PION
2 failures : 1 fibromyalgy
1 nervous breakdown
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5 PATIENTS
AT 1 SESSION 1-3 DAYS PRE OP
VAS AVE D1-D3 0,6/10
NB OPOIDS AVE D1-D3 1
PRE OP
CMC
ARTHROPLASTY
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DISCUSSION
Auriculotherapy / carpal tunnel surgery
Decrease significantly pain D1-3 post op
AT > P >> C
Decrease using Opioids > 50%
Decrease risk of CRPC (chelly 2017)
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TODAY: SURGERY that involve low level pain
TOMORROW: more intense pain situations
AURICULOTHERAPY
Proven effective
In low Level Pain
…
BUT HOW FAR
IT CAN BE TAKEN ?
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Not having
- to use pain drugs- reducing complications in surgical practice.
Usefull to prevent stress before surgery
IMAGINE THE BENEFITS
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Welcome to the new world of
peri-operative pain management