From Emergency Response to Complex Trauma Treatment: Applications of Neuro-Auricular Modulation

From Emergency Response to Complex Trauma Treatment: Applications of Neuro-Auricular Modulation

Emergency Response and the Auricular Link to Neuropsychiatry and Complex Trauma Treatment:

Emergency physicians, with even just brief training in auricular protocols, are able to use neuro-auricular modulation for acute pain treatment in cases where opioid analgesia was not otherwise an acceptable option. The National Institutes of Health and the World Health Organization recognize these auricular approaches — often applied via acupuncture, yet also able to be applied via laser (photobiomodulation), transcutaneous electrical nerve stimulation (TENS), or manually (ear seeds, clinical ear probes, etc).

The Department of Neuropsychiatry of Korean Medicine at the Pohang Korean Medicine Hospital and Daegu Haany University, has registered a protocol for systematic review of the efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters.[1] Emergency response training by the U.S. Armed Forces, which are already using neuro-auricular modulation protocols as funded by the U.S. Department of Defense, is also promoted and used for trauma-related aspects of chronic pain within the Veterans Affairs medical system[2] — chronic pain, like the chronic trauma of PTSD, taking hold of the nervous system by the “fire together, wire together” mirror neuron system.[3] Auricular protocols, reflecting this understanding of trauma as it relates to addiction, are also used by State agencies for substance abuse. The 5-point auricular protocol (NADA protocol) has been helping treatment centers to efficiently address national emergencies such as the opioid crises.[4-5]  

The Global Scale of Auricular-related Research & Clinical Application — especially for therapy-resistant populations:

The above mentioned auricular approaches for emergency response are just one example of medical application. They are based in the broader clinical work of medical doctors such as, Paul Nogier, Frank Bahr, Yves Rouxeville, André Lentz, Manfred Reininger, Beate Strittmatter, and thousands of other physicians in the fields of Auriculotherapy and Auricular Medicine. Auricular Medicine approaches, in particular, are used on many levels: from protocols for pain management (including insomnia, depression and anxiety)[5-14], to the deep insights offered by the use of the Vascular Autonomic Signal and application of medical frequencies (by low level laser therapy or electrostimulation) to address complex therapy resistant patients.[14-22,27] 

Furthermore, the use, investment into, and recognition of neuro-auricular modulation at institutions such as the Yale School of Medicine,[23] the Neural Engineering Group at The City College of New York,[24] and the Medical University of South Carolina,[25] highlight just a small fraction of the work by leading institutions that understand the importance of the ear as a “window to the brain.”[17]

Beyond Protocols to the Treatment of Complex Trauma:

Beyond 5-point protocols, and even transcutaneous auricular vagus nerve stimulation (taVNS)[10-12,17,24,25], all aspects of nerve stimulation (for both assessment and treatment) as practiced in Auricular Medicine, support treatment approaches to address the immediate impacts of trauma,[1,15] and, more importantly, to support the deeper ongoing treatment challenges of dissociation and processing through the use of neuro-auricular modulation by mental health professionals (as taught in related courses by internationally endorsed and recognized continuing education providers such as the Canadian Institute of Auricular Medicine).[17,26-30]

 

References:

[1] Kwon, Chan-Young MSc, KMDa; Lee, Boram MSc, KMDa,b; Kim, Sang-Ho PhD, KMDc,∗ Efficacy and safety of ear acupuncture for trauma-related disorders after large-scale disasters, Medicine: August 2019 - Volume 98 - Issue 31 - p e16631 doi: 10.1097/MD.0000000000016631

[2] Walker PH, Pock A, Ling CG, Kwon KN, Vaughan M. Battlefield acupuncture: Opening the door for acupuncture in Department of Defense/Veteran's Administration health care. Nurs Outlook. 2016 Sep-Oct;64(5):491-8. doi: 10.1016/j.outlook.2016.07.008. Epub 2016 Jul 20. PMID: 27601311.

[3] Shatz CJ. 1992. The developing brain. Sci. Am. 267, 60–67. (10.1038/scientificamerican0992-60)

[4] Carter, K. O., Olshan-Perlmutter, M., Norton, H. J., & Smith, M. O. (2011). NADA acupuncture prospective trial in patients with substance use disorders and seven common health symptoms. Medical Acupuncture,23(3), 139-135.

[5] Stuyt EB, Voyles CA. The National Acupuncture Detoxification Association protocol, auricular acupuncture to support patients with substance abuse and behavioral health disorders: current perspectives. Subst Abuse Rehabil. 2016;7:169-180. Published 2016 Dec 7. doi:10.2147/SAR.S99161

[6] Murakami M, Fox L, Dijkers MP. Ear acupuncture for immediate pain relief-A systematic review and meta-analysis of randomized controlled trials. Pain Med 2017;18:551–64.

[7] Tsai SL, Fox LM, Murakami M, Tsung JW. Auricular Acupuncture in Emergency Department Treatment of Acute Pain. Ann Emerg Med. 2016 Nov;68(5):583-585. doi: 10.1016/j.annemergmed.2016.05.006. Epub 2016 Jun 8. PMID: 27287548.

[8] Carter K, Olshan-Perlmutter M, Marx J, et al. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci (Basel) 2017;7

[9] Lan Y, Wu X, Tan HJ, et al. Auricular acupuncture with seed or pellet attachments for primary insomnia: a systematic review and meta-analysis. BMC Complement Altern Med 2015;15:103.

[10] de Lorent L, Agorastos A, Yassouridis A, et al. Auricular acupuncture versus progressive muscle relaxation in patients with anxiety disorders or major depressive disorder: a prospective parallel group clinical trial. J Acupunct Meridian Stud 2016;9:191–9.

[11] Shiozawa P, Silva ME, Carvalho TC, et al. Transcutaneous vagus and trigeminal nerve stimulation for neuropsychiatric disorders: a systematic review. Arq Neuropsiquiatr. 2014; 72: 542-7.

[12] Kong J, Fang J, Park J, et al. Treating Depression with Transcutaneous Auricular Vagus Nerve Stimulation: State of the Art and Future Perspectives. Front Psychiatry. 2018; 9: 20.

[13] Fang J, Rong P, Hong Y, Fan Y, Liu J, Wang H, Zhang G, Chen X, Shi S, Wang L, Liu R, Hwang J, Li Z, Tao J, Wang Y, Zhu B, Kong J. Transcutaneous Vagus Nerve Stimulation Modulates Default Mode Network in Major Depressive Disorder. Biological Psychiatry. 2016 Feb 15;79(4):266-73.

[14] Kurebayashi LF, Turrini RN, Souza TP, Marques CF, Rodrigues RT, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Lat Am Enfermagem. 2017;25:e2843. Published 2017 Apr 6. doi:10.1590/1518-8345.1761.2843

[15] Badran B, Dowdle L, Mithoefer O, Austelle C, McTeague L, George M. Neurophysiologic effects of transcutaneous auricular vagus nerve stimulation (taVNS) via electrical stimulation of the tragus: A concurrent taVNS/fMRI study and review. Brain Stimulation. 2017; 11(3):492-500. DOI: https://doi.org/10.1016/j.brs.2017.12.009

[16] Lamb D, Porges E, Lewis G, Williamson JB. Front. Non-invasive Vagal Nerve Stimulation Effects on Hyperarousal and Autonomic State in Patients with Posttraumatic Stress Disorder and History of Mild Traumatic Brain Injury: Preliminary Evidence. Frontiers in Medicine. July 31, 2017. https://doi.org/10.3389/fmed.2017.00124

[17] Strittmatter B. Identifying and Treating Blockages to Healing: New Approaches to Therapy-Resistant Patients. Stuttgart, Germany: Thieme; 2004: V, 128.

[18] Agnes, Muriel. Auricular Medicine: Window to the Brain. Blurb, 2018

[19] Mercante B, Deriu F, Rangon CM. Auricular Neuromodulation: The Emerging Concept beyond the Stimulation of Vagus and Trigeminal Nerves. Medicines (Basel). 2018;5(1):10. Published 2018 Jan 21. doi:10.3390/medicines5010010

[20] Hays SA. Enhancing Rehabilitative Therapies with Vagus Nerve Stimulation. Neurotherapeutics. 2016;13(2):382-394. doi:10.1007/s13311-015-0417-z

[21] Edgerton R., Gad P. Spinal Cord Injury: Is the vagus nerve our neural connectome? eLife 2018;7:e35592 DOI: 10.7554/eLife.35592

[22] Stanton G. Auriculotherapy in Neurology as an Evidence-Based Medicine: A Brief Overview. Med Acupunct. 2018;30(3):130–132.

[23] Alimi D. Medical Auriculotherapy: Scientific Bases, Principals and Therapeutic Strategies.[in French]. Paris: Elsevier–Masson; 2017

[24] Bruce L. Ear Acupuncture: A Tool for Recovery — interview with Katurah Bryant, LMFT, Associate Director Substance Abuse Treatment Unit of the Connecticut Mental Health Center. Yale School of Medicine website. November 14, 2011. Accessed November 2021. https://medicine.yale.edu/news-article/ear-acupuncture-a-tool-for-recovery/

[25] Biksom M. CCNY Neural Engineering Group: Selected Publications of Marom Biksom, PhD. The Neural Engineering Group at The City College of New York website. 2021. Accessed November 2021.https://www.neuralengr.org/bikson

[26] McLeod M. Advanced taVNS Conference Archived Presentations: Advanced Transcutaneous Auricular Vagus Nerve Stimulation.College of Health Professions, Medical University of South Carolina website. 2020. Accessed November 2021. https://chp.musc.edu/research/nc-nm4r/learning-opportunities/past-events-and-archives/tavns-video-archive

[27] Our International Collaborations: Independent cooperation in Auricular Medicine education with the Canadian Institute of Auricular Medicine. German Akademie for Acupuncture website. Accessed November 16, 2021. https://www.akupunktur.de/daa/netzwerk/kooperationen-international.html

[28] Seminars: Laser therapy, acupuncture, TCM, ear acupuncture. Reimers & Janssen GmbH website. Accessed November 16, 2021. https://rj-laser.com/en/seminarfair

[29] Zhao B. Beijing University of Chinese Medicine Interest in the VAS: Institutional testimonial for the academic collaboration with DAA (an independent cooperation school endorsing the Canadian Institute of Auricular Medicine (CIAM). CIAM website. December 24, 2018. Accessed November 16, 2021. https://integrateauricular.com/blogs/testimonials/video-we-got-interested-in-vas-so-bucm-gave-support-from-the-chinese-government-to-invite-dr-bahr-and-dr-wirz

[30] Strittmatter B. Endorsement of the Canadian Institute of Auricular Medicine (CIAM). CIAM website. June 11, 2021. Accessed November 16, 2021. https://integrateauricular.com/blogs/testimonials/ciam-has-developed-a-comprehensive-training-program-in-german-auricular-medicine

[31] NCCAOM Institutional Endorsement of CIAM: Featured PDA Programs (un-sponsored PDA Spotlight). Canadian Institute of Auricular Medicine website. September 26, 2019. Accessed November 16, 2021. https://integrateauricular.com/blogs/testimonials/featured-pda-programs-1

 


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