Discussion
Pain, fatigue, gastrointestinal and nervous systems, presenteeism, physical disability, pain, musculoskeletal pain, migraines, chronic pain
CHRONIC LOW BACK PAIN, PHYSICAL DISABILITY, MUSCULOSKELETAL DISORDERS, ADVERSE EFFECTS, MIGRAINES, CHRONIC PAIN
Auriculotherapy with seeds presented positive effects as a therapeutic practice in reducing pain intensity among health workers who had chronic pain in the spine. However, there was no statistical difference in the intergroup analysis. In other words, both groups obtained similar results during the treatment. In the follow-up segment, however, a significant 34% reduction was observed in the IG (3.32 ± 0.42) in relation to the CG (5.00 ± 0.43) (p=0.007). The IG maintained the treatment effect after the end, and the CG did not maintain the reduction in pain intensity.A study conducted with German soldiers verified a reduction in chronic pain intensity between the groups (p=0.001), with the CG corresponding to usual care and the IG related to the application of auriculotherapyAccording to the Brief Pain Inventory, pain intensity did not differ between the groups. However, it is noticed that the most expressive results occurred in IG; in other words, between the first session and the follow-up period, auriculotherapy showed a reduction in the mean pain intensity percentages: IG (34.3%) and CG (23.3%). The same result was obtained in relation to the evaluation of pain interference in activities of daily living, in which there was a reduction in the mean percentages in the IG (55%) and the CG (43%), although with no difference between them (p>0.05).A similar result was found in a study from São Paulo conducted with individuals who had chronic pain in the spine. Auriculotherapy with semi-permanent needles in the treated (4.86 ± 2.79) and placebo (4.89 ± 2.74) groups presented a reduction in pain intensity (3.78 ± 3.49; 3.61 ± 3.49, respectively) and, in the CG (without intervention), there was no change in the mean values during the intervention periodGiven the above, it becomes necessary to consider that the health workers surveyed had high levels of chronic MSP in the spine (first phase of the study) and remained in an active work situation, that is, they continued to work even with high pain intensity. Some studies have deepened on the theme of presenteeism among health professionals, revealing permanence in activities even if they feel sick (either physically or emotionally)The work context in which health workers are inserted requires knowledge, technical skills and a need for constant attention. They are exposed to biological and/or psychosocial risks, high workloads and direct contact with pain, suffering and lossesIn addition to that, these professionals perform activities that expose them to ergonomic risks, such as the adoption of static postures, anterior inclination of the trunk and asymmetrical load liftingAccording to the Traditional Chinese Medicine assumptions, pain occurs due to Thus, when performing auriculotherapy, considering the viscero-somatic stimuli achieved by its application at the auricular points, the intention is to achieve regulation of this flow in the body, maintaining the Simulation of the kidney auricular point, for example, has an important action for strengthening the low back region and the spine, and other analgesic and tranquilizing points help reestablish energy balance throughout the bodyRegarding the physical disability assessment, it is considered that there is clinical improvement when the score is reduced by 30% from the baselineA Brazilian study that applied auriculotherapy to Nursing professionals with chronic low back pain also evidenced no statistical difference. In relation to the physical disability scores between the IG (seeds), there was an Initial/Final mean difference of 1.4 ± 5.2 when compared to the CG (foam), which presented an Initial/Final mean difference of 1.8 ±2.4 (p<0.778)The auriculotherapy practice can be developed through various materials and techniques. A systematic review evidenced that varied auriculotherapy modalities such as auricular acupressure, auriculotherapy with seeds and/or semi-permanent needles, with magnetic granules, can exert different effects even in the case of a similar condition, as the forms of stimulation of the auricular reflex points differ from each otherIn relation to the impact of the auriculotherapy protocol for chronic pain on quality of life, in this research, better results were observed in the physical and mental aspects in the IG when compared to the CG. However, only the “vitality” and “limitation due to emotional aspects” domains presented significant results. The “pain” domain did not display statistical differences between the groups, converging with the results of the other instruments that evaluated the musculoskeletal symptoms.The “vitality” domain deals with the individual’s perception of their energy levels and fatigue for developing activitiesChronic pain negatively influences quality of life in relation to mental health and maintenance of activities related to work and leisureIn this way, quality of life is promoted from the balance between a person’s physical, emotional and social aspects. A literature review evidenced that MSP severity exerts an influence on the physical and emotional dimensions, whereas pain chronicity interferes negatively in all the quality of life dimensionsA Brazilian study, which evaluated the effects of auriculotherapy (Control Group) and auriculotherapy associated with cupping therapy (Experimental Group) on the improvement of quality of life in adults with chronic low back pain, found significant changes in the social relations” and “psychological” domains, respectivelyIn relation to the consumption of medications for pain relief, it was observed that a higher percentage of the IG reduced their use and that the CG maintained it. Auriculotherapy reduced medication use in the workers who received it in the true points. These findings are important, as most of the participants suffered from musculoskeletal disorders, with the use of frequent medications.Among the individuals with chronic pain, pharmacological treatments are the main method for controlling pain symptoms. However, their excessive use can trigger adverse effects and can cause harms in the gastrointestinal and nervous systems. Thus, these results reinforce the importance of offering new therapeutic practices, not pharmacological, that can contribute to relieving MSPBased on the results presented and the improvement in the CG parameters evaluated in relation to the baseline, it is important to address the placebo effect. This effect can occur due to psychological mechanisms involved during the process, such as beliefs, previous experiences and personal motivationSimilar placebo effects are observed in studies with pharmacological treatments. For example, a research study conducted with patients with migraines provided three envelopes, labeled as “Maxalt” (name of the medication used to treat migraines), “Placebo” and “Maxalt or Placebo”, each one containing one tablet of the active drug and another with placebo. The patients who used the placebo, called “Maxalt”, presented 30% effect on pain reduction; when they received the “Maxalt” labeled as “Placebo”, they showed a 38% improvement; and when they received the active medication labeled as “Maxalt”, they reported a 62% reductionIn relation to auriculotherapy, it is noted that there is a range of ear points and maps. In this way, finding In this research, in order to minimize this bias, the strategy was using a point locator that detects the internal resistance of the auricular pavilion. In the CG protocol, we searched for the region of the reflex point where there was less resistance, unlike the IG, where the one with more internal resistance was sought.The pandemic context restricted the researchers entering the research locus, which represented a limitation. The possibility of failure in manual stimulation of the points under the participants’ responsibility can also be considered a limitation; this is because if the seeds are not pressed with the recommended frequency, there might be a reduction in the effect of auriculotherapy. In addition to that, it is considered that the moisture factor, due to the bath, can reduce local pressure and/or displace the seeds, which also reduces the effect.As a contribution to science and the Nursing area, the objective was to highlight the benefits of a simple, fast and low-cost therapy with few side effects for health promotion to individuals, especially health workers, relieving high musculoskeletal pain levels. We understand that investing in promoting workers’ health, either through auriculotherapy, as in the case of this study, or with other Integrative and Complementary Practices (ICPs), will result in healthier workers, both physically and mentally.