Ear Acupuncture for Acute Sore Throat: A Randomized Controlled Trial

David A. Moss, MD; Paul Crawford, MD


J Am Board Fam Med. 2015;28(6):697-705. 

In This Article

Abstract and Introduction


Background: Sore throat is a common cause of pain in outpatient encounters. Battlefield auricular acupuncture (the placing of needles in specific points in the ear) is a modality used to treat acute pain associated with a variety of ailments. The aim of our study was to determine whether auricular acupuncture reduces pain, medication usage, and missed work hours when added to standard therapy in adult patients with acute sore throat.

Methods: We conducted an unblinded, pragmatic, randomized controlled trial among adult, nonpregnant patients presenting to an Air Force family medicine clinic with pain from acute sore throat. A total of 54 patients were followed for 48 hours after treatment.

Results: Patients receiving auricular acupuncture reported lower pain scores than those who did not at 15 minutes (6.0 [95% confidence interval (CI), 5.4–6.6] vs 2.6 [95% CI, 1.7–3.5]; P < .0001), 6 hours (4.8 [95% CI, 4.0–5.6] vs 2.5 [95% CI, 1.6–3.4]; P = .0005), and 24 hours (4.1 [95% CI, 3.3–4.9] vs 1.3 [95% CI, 1.0–2.8]; P = .0006). They also reported taking fewer cumulative doses of pain medication at 6 hours (1.07 [95% CI, 0.69–1.45] vs 0.39 [95% CI, 0.2–0.58]; P = .003), 24 hours (2.63 [95% CI, 1.95–3.31] vs 1.37 [95% CI, 0.92–1.82]; P = .004), and 48 hours (4.07 [95% CI, 2.9–5.24] vs 2.19 [95% CI, 1.44–2.94]; P = .009). There was no difference in time missed from work between the auricular acupuncture and standard therapy groups.

Conclusions: Compared with usual treatment, battlefield auricular acupuncture was associated with reduced sore throat pain for 24 hours and decreased use of pain medication for up to 48 hours. There was no apparent effect on hours missed from work.


Acute sore throat resulting from various upper respiratory infections is a common cause of doctor visits—15 million in 2009—and lost work.[1] Regardless of its cause, symptomatic treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is often implemented despite whether antibiotics are appropriate.[2,3] NSAIDs are associated with gastrointestinal bleeding, renal failure, and other serious adverse events. Thus, patients often use alternative remedies such as salt water gargles, throat spray, lozenges, or ice chips to alleviate their pain.[4,5] Auricular acupuncture is another modality that is reported to be effective at relieving many types of pain.

Auricular acupuncture (placing needles in various points in the ear) is a form of integrative medicine in which particular points on the ear, when stimulated, are believed to correspond with specific areas of the body. The purpose of auricular acupuncture, similar to traditional acupuncture, is to balance the flow of the body's energy, or qi. Mechanisms for its effectiveness are thought to relate to the inhibition of neurotransmitters and inflammatory markers such as substance P and interleukins, as well as the release of endogenous opioids.[6,7] Studies using functional magnetic resonance imaging and positive electron tomography also show that specific areas of the brain relating to pain sensation are either stimulated or inhibited when auricular acupuncture needles are in place.[8]

Battlefield acupuncture (BFA) is a specific auricular acupuncture technique developed by Niemtzow[9] and refers to placing needles in 5 specific points on the ear (see Figure 1). This is done using semipermanent acupuncture needles in a rapid fashion for acute pain relief. As opposed to traditional auricular acupuncture, which can be complicated and requires extensive training, this technique uses a simple, systematic approach to placing the needles that can be learned by physicians in a 4-hour workshop. In addition, BFA takes only 3 to 10 minutes to administer to patients. Because the needles are semipermanent and very small, the needles stay in place after the patient leaves the encounter and are allowed to fall out on their own over 3 to 7 days. There are limited data regarding this specific technique, though auricular acupuncture itself has been practiced since the 1950s.[10]

Figure 1.

Semipermanent ASP needle placement in battlefield acupuncture.

Many physicians currently use BFA, and the technique is taught in multiple venues.[11] BFA has not been studied extensively, but there is a growing body of evidence supporting auricular acupuncture as an effective modality in relieving acute pain. This includes pain in the intra- and postoperative periods,[12–14] low-back pain and pelvic pain associated with pregnancy,[15] migraines,[16] and acute pain syndromes in an emergency department setting.[17] Not all studies show positive results,[18–20] but a recent meta-analysis showed an average mean difference in pain scores of −1.89 on a 10-point visual analog scale.[21]

The purpose of this study is to evaluate the efficacy of BFA in addition to standard therapy compared with standard therapy alone in relieving pain from acute sore throat. Secondary measures included total doses of oral analgesics and time lost from work/activity.