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Efeitos da auriculoterapia sobre o estresse, ansiedade e depressão em adultos e idosos: revisão sistemática

Efectos de la auriculoterapia sobre el estrés, la ansiedad y la depresión en adultos y ancianos: una revisión sistemática

RESUMO

Objetivo

Identificar evidências na literatura científica acerca dos efeitos da auriculoterapia no tratamento do estresse, ansiedade e depressão em adultos e idosos, analisando os principais protocolos para a aplicação da intervenção.

Método

Revisão sistemática seguindo os principais itens para relatar revisões sistemáticas e meta-análises (PRISMA). Em fevereiro de 2019, foram desenvolvidas estratégias detalhadas de busca individual para BDENF, CINAHL, Cochrane, CUMED, Embase, LILACS, PEDro, PubMed, Scopus, Segunda Opinião Formativa e Web of Science. A qualidade metodológica dos estudos foi avaliada por meio da Escala de Jadad.

Resultados

Dos 859 artigos encontrados, 24 compuseram a amostra do estudo. Destes, 22 (92%) evidenciaram efeito positivo da auriculoterapia para estresse, ansiedade ou depressão.

Conclusão

As evidências disponíveis acerca dos efeitos da auriculoterapia sobre o estresse, ansiedade e depressão comprovam a efetividade da técnica em indivíduos adultos e idosos. No entanto, os estudos apresentaram fragilidades metodológicas. Apesar dos protocolos identificados serem diferentes, existem pontos frequentes, dentre os quais estão Shenmen, Rim, Sistema Nervoso Autônomo, Coração, Tronco Cerebral e Fígado 1 e 2 que podem ser utilizados em novos estudos.

Auriculoterapia; Estresse Psicológico; Ansiedade; Depressão; Terapias Complementares; Revisão

RESUMEN

Objetivo

Identificar la evidencia en la literatura científica sobre los efectos de la auriculoterapia em tratamiento del estrés, la ansiedad y la depresión en adultos y ancianos, analizando los principales protocolos para la aplicación de la intervención.

Método

Examen sistemático siguiendo las principales los elementos para informar sobre los exámenes sistemáticos y metaanálisis (PRISMA). En febrero de 2019, fueron desarrolladas estrategias detalladas de búsqueda individual para BDENF, CINAHL, Cochrane, CUMED, Embase, LILACS, PEDRo, PubMed, Scopus, Segunda Opinión Formativa (SOF) y Web of Science. La calidad metodológica de los estudios se evaluó mediante la Escala de Jadad.

Resultados

De los 859 artículos encontrados, 24 componían la muestra del estudio. De estos, 22 (92%) mostraron un efecto positivo de la auriculoterapia para el estrés, la ansiedad o la depresión.

Conclusión

Las pruebas disponibles sobre los efectos de la auriculoterapia en el estrés, la ansiedad y la depresión demuestran la eficacia de la técnica en personas adultas y de edad avanzada. Sin embargo, los estudios mostraron deficiencias metodológicas. A pesar de los protocolos identificadas como diferentes, hay puntos frecuentes, entre los que se encuentran Shenmen, Riñón, Sistema Nervioso Autónomo, Corazón, Tronco Cerebral e Hígado 1 y 2 que pueden ser utilizados en nuevos estudios.

Auriculoterapia; Estrés Psicológico; Ansiedad; Depresión; Terapias Complementarias; Revisión

ABSTRACT

Objective

To identify evidence in scientific literature about the effects of auriculotherapy for treating stress, anxiety and depression in adults and older adults by analyzing the main protocols for applying the intervention.

Method

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA). Detailed individual search strategies were applied in February 2019 in the BDENF, CINAHL, Cochrane, CUMED, Embase, LILACS, PEDro, PubMed, Scopus, Segunda Opinião Formativa (SOF) and Web of Science databases. The methodological quality of the studies was assessed using the Jadad Scale.

Results

A total of 24 from the 859 articles found comprised the study sample. Of these, 22 (92%) showed a positive effect of auriculotherapy for stress, anxiety or depression.

Conclusion

The available evidence on the effects of auriculotherapy on stress, anxiety and depression proves the effectiveness of the technique in adults and older adults. However, the studies showed methodological weaknesses. Although the identified protocols are different, there are frequent similar points including Shenmen, Kidney, Autonomic Nervous System, Heart, Brain Stem and Liver 1 and 2 which can be used in new studies.

Auriculotherapy; Stress Psychological; Anxiety; Depression; Complementary Therapies; Review

INTRODUÇÃO

O enfrentamento das situações de vida diária desencadeia diferentes reações nos indivíduos, dentre as quais estão o estresse, a ansiedade e a depressão. Nessas situações, os indivíduos demonstram respostas gerais ou inespecíficas, de caráter fisiológico e psicológico do organismo frente a um estressor ou ameaças externas e internas(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...

2. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...

3. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.

4. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
-55. Telles-Correia D, Barbosa A. Ansiedade e depressão em medicina: modelos teóricos e avaliação. Acta Med Port. 2016;22:89-98.).

Uma intervenção que pode ser utilizada para a prevenção e controle da ansiedade, do estresse e da depressão é a auriculoterapia, uma prática integrativa e complementar em saúde(66. Brasil. Ministério da Saúde. Portaria n. 849, de 27 de março de 2017. Inclui a Arteterapia, Ayurveda, Biodança, Dança Circular, Meditação, Musicoterapia, Neturopatia, Osteopatia, Quiropraxia, Reflexologia, Reiki, Shantala, Terapia Comunitária Integrativa e Yoga à Política Nacional de Práticas Integrativas e Complementares. Diário Oficial da União, Brasília, 27 mar. 2017.-77. Brasil. Ministério da Saúde. Portaria n. 702 de 21 de março de 2018. Altera a Portaria de Consolidação nº 2/GM/MS de 28 de setembro de 2017 para incluir novas práticas na Política Nacional de Práticas Integrativas e Complementares – PNPIC. Diário Oficial da União, Brasília, 22 mar. 2018.), que pode ser aplicada pelos enfermeiros em sua prática clínica(88. Bulechek GM, Butcher HK, Dochterman J. Classificação das intervenções de enfermagem (NIC). Rio de Janeiro: Elsevier; 2016.-99. Garcia TR. Classificação Internacional para a prática de enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2018.), mediante a capacitação destes. O mecanismo de ação da intervenção pode ser explicado pela função somatotrópica, devido à presença de células pluripotentes com informações de todo o organismo na orelha; pela rica inervação e irrigação sanguínea da região auricular; e também pela relação dessa parte do corpo com os meridianos energéticos e com os órgãos e vísceras, conforme teorias da Medicina Tradicional Chinesa (MTC)(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
-1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.). Ao contrário de muitas drogas alopáticas, a prática não é tóxica e não provoca dependência ou abuso, e as contraindicações são mínimas(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
-1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
).

Evidências científicas apontam os efeitos da intervenção para o estresse(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.-44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
), ansiedade(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.

12. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
-1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...

18. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...

19. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...

20. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...

21. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
-2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
) e depressão(2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.) de forma isolada ou associando apenas ansiedade e depressão(2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...

25. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.

26. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...

27. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...

28. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
). No entanto, até o presente momento, são escassos os estudos que avaliaram os três desfechos conjuntamente(3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.). Assim, o objetivo da presente revisão é identificar as evidências disponíveis na literatura científica acerca dos efeitos da auriculoterapia no tratamento do estresse, da ansiedade e da depressão em adultos e idosos, analisando os principais protocolos para a aplicação da intervenção.

MÉTODO

TIPO DO ESTUDO

Trata-se de uma revisão sistemática da literatura baseada nas recomendações do Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)(3131. Moher D, Liberati A, Tetzlaff J, Altman DG; The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med [Internet]. 2009 [cited 2018 May 13];6(7):e1000097. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2707599/
https://www.ncbi.nlm.nih.gov/pmc/article...
). O protocolo foi registrado no International Prospective Register of Systematic Reviews (PROSPERO), sob o número CRD42018102691. A pergunta que norteou a condução do estudo foi: Quais os protocolos e efeitos da auriculoterapia (Intervention) sobre os níveis de estresse ansiedade e depressão (Outcome) em pacientes adultos e idosos (Population), se comparada a grupos placebos, tratamentos convencionais ou nenhuma intervenção (Comparison)?

ESTRATÉGIA DE BUSCA

A estratégia de busca utilizada na Medline via US National Library of Medicine (PUBMED) foi: ((“Auriculotherapy”[Mesh] OR “Acupuncture, Ear”[Mesh]) OR (“Auricular Acupuncture”[Title/Abstract] OR “Ear Acupuncture”[Title/Abstract] OR “Auricular Acupunctures”[Title/Abstract] OR Auriculotherapy[Title/Abstract] OR auriculopressure[Title/Abstract])) AND ((((“Anxiety”[Mesh] OR “Stress, Psychological”[Mesh]) OR “Burnout, Professional”[Mesh]) OR “Depression”[Mesh]) OR (Anxiety[Title/Abstract] OR “Psychological Stresses”[Title/Abstract] OR stress[Title/Abstract] OR Stresses[Title/Abstract] OR Burnout[Title/Abstract] OR “Professional Burnout”[Title/Abstract] OR Depression[Title/Abstract])).

Com auxílio de um bibliotecário da área de ciências da saúde, os termos utilizados na busca Medline via PubMed foram considerados com adaptação das estratégias de busca para todas as bases de dados. As demais bases utilizadas foram LILACS via Biblioteca Virtual em Saúde (BVS), Segunda Opinião Formativa (SOF) via BVS, Centro Nacional de Informação de Ciências Médicas de Cuba (CUMED) via BVS, Base de Dados Enfermagem (BDENF) via BVS, Physiotherapy Evidence Database (PEDro), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, SCOPUS, Cochrane e EMBASE. Todas as buscas em bases eletrônicas de dados foram realizadas no dia oito de fevereiro de 2019. Ressalta-se que artigos da literatura cinzenta não foram avaliados.

CRITÉRIOS DE SELEÇÃO

Os critérios de inclusão adotados foram: ensaios clínicos randomizados (ECR) publicados em inglês, espanhol ou português, nos últimos seis anos (2013 a 2019); e estudos que tivessem como objeto de investigação o efeito da auriculoterapia sobre os níveis de estresse, ansiedade e/ou depressão em indivíduos maiores de 18 anos.

ANÁLISE E TRATAMENTO DOS DADOS

Todos os títulos encontrados foram agrupados em duas planilhas do Microsoft Excel® para serem avaliados de maneira independente por dois revisores. Em seguida, realizou-se a leitura do título e resumo dos artigos, também de forma independente, a fim de comparar os resultados da seleção individual e discutir as divergências. Ao atingir a concordância de 100% entre as planilhas, os artigos foram incluídos para leitura na íntegra.

Os artigos incluídos foram analisados por meio de um instrumento(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
) adaptado pelos pesquisadores com itens do Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA)(3232. MacPherson H, Altman DG, Hammerschlag R, Youping L, Taixiang W, White A, et al. Revised standards for reporting interventions in clinical trials of acupuncture (STRICTA): extending the CONSORT statement. PLoS Med [Internet]. 2010 [cited 2018 July 6]; 7(6):1-11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2882429/
https://www.ncbi.nlm.nih.gov/pmc/article...
). A qualidade metodológica dos estudos foi avaliada por dois revisores, de maneira independente, pela escala de Jadad(3333. Jadad AR, Moore RA, Caroll D, Jenkinson, C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials [Internet]. 1996 [cited 2018 July 6];17(1):1-12. Available from: https://www.sciencedirect.com/science/article/pii/0197245695001344?via%3Dihub
https://www.sciencedirect.com/science/ar...
). Ao final do processo de avaliação, houve consenso de 100% das notas atribuídas por cada pesquisador.

A escala de Jadad é um instrumento composto por questões que avaliam a randomização, o mascaramento e a perda de seguimento no estudo, além da adequabilidade metodológica desses itens. As questões possuem opção de resposta sim/não, com um escore total de cinco pontos: três vezes um ponto para as respostas sim, e dois pontos adicionais para métodos apropriados de randomização e sigilo de alocação. Estudos pontuados com nota menor que três são de baixa qualidade metodológica e, seus resultados não são adequados para a prática clínica(3333. Jadad AR, Moore RA, Caroll D, Jenkinson, C, Reynolds DJM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials [Internet]. 1996 [cited 2018 July 6];17(1):1-12. Available from: https://www.sciencedirect.com/science/article/pii/0197245695001344?via%3Dihub
https://www.sciencedirect.com/science/ar...
).

RESULTADOS

Foram encontrados 859 artigos. Destes, 209 (24%) foram excluídos, pois estavam duplicados e 363 (42%) porque foram publicados há mais de seis anos. Dessa forma, permaneceram 287 (33%) citações e, após a leitura de títulos e resumos, 236 foram excluídos. Com isso, 51 artigos foram lidos na íntegra sendo que destes, 27 foram excluídos e 24 incluídos na análise qualitativa (Figura 1).

Figura 1
– Fluxograma de seleção dos artigos da revisão sistemática.

Os artigos incluídos foram realizados em hospitais (n=14)(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...

15. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
-1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
-2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
-3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.), universidades (n=2)(1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
), centros de especialidades médicas (n=4)(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
-33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
), organização não governamental (n=1)(2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.), instituição de longa permanência (n=1)(2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
), dentre outros(1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.). Desses, 22 foram desenvolvidos no ocidente e dois no oriente(2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.). A maioria dos textos foi publicada em inglês (n=18; 72%), seguida de textos em português (n=6; 24%) e espanhol (n=1; 4%).

A amostra das investigações foi constituída por mulheres (n=1412) e homens (n= 403) com idade entre 20 e 91 anos. Três dos estudos(1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
-1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
) foram realizados apenas com mulheres; e três(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
-1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
) não descreveram a quantidade de participantes de acordo com o gênero, de modo que, em conjunto, tiveram 265 indivíduos incluídos. Os objetivos, variáveis de investigação, intervenções, principais resultados e a qualidade metodológica dos estudos incluídos na revisão sistemática estão descritos no Quadro 1.

Quadro 1
– Caracterização dos estudos – Belo Horizonte, MG, Brasil, 2019.

Dos artigos, 22 (92%) evidenciaram efeito positivo da auriculoterapia para estresse(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.-44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.), ansiedade(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.

12. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
-1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...

18. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
-1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...

25. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.
-2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...

29. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
-3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.) ou depressão(2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.

24. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...

25. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.
-2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...

29. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
-3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.). As principais ferramentas de mensuração dos desfechos foram: Lista de Sintomas de Estresse (LSS)(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
), Inventário de Ansiedade Traço-Estado (IDATE)(1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.-1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...

18. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...

19. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
-2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
), Escala de Ansiedade e Depressão de Hamilton(2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
).

As principais linhas de raciocínio empregadas nos estudos para aplicação da auriculoterapia foram a chinesa(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
-22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.,1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...

14. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...

15. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...

16. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...

18. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...

19. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
-2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
-2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.), o protocolo National Acupuncture Detoxification Association (NADA)(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
), a linha francesa(2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
), o The Auricular Protocol for Pain & Anxiety (APPA)(2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
), e o Gold Protocol(1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
). Dois dos estudos não definiram a fundamentação teórica(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.).

A formação de base dos terapeutas foi enfermagem (n=8)(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
-22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...

15. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
-1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
), medicina (n=5)(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
), odontologia (n=2)(1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.) e psicologia (n=2)(1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
). Destes, cinco tinham especialização em acupuntura(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
). Ademais, quatro estudos caracterizam os intervencionistas apenas como acupunturistas(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
-2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.), dois relataram que os profissionais fizeram curso(2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
) e cinco não definiram a área de formação do terapeuta(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.-44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.,1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.). O tempo de experiência na área variou entre dois e vinte anos(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
-2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
).

A auriculoterapia foi realizada por meio de protocolos pré-estabelecidos(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...

2. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...

3. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.
-44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.

12. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
-1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...

18. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...

19. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...

20. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...

21. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...

22. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...

23. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.

24. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...

25. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.

26. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...

27. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...

28. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...

29. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
-3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.) ou determinados de acordo com a avaliação individualizada(1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
). A localização dos pontos foi mencionada em seis artigos(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...

15. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
-1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
), por meio de localizador(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
), apalpador manual(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
) e algômetro com caneta permanente(1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
). O protocolo de tratamento de auriculoterapia nos grupos experimentais está descrito no Quadro 2.

Quadro 2
– Protocolo de tratamento de auriculoterapia – Belo Horizonte, MG, Brasil, 2019.

Os dispositivos de aplicação foram fixados unilateralmente(1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...

23. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.
-2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
) ou bilateralmente(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...

27. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
). O principal cuidado de manutenção relacionado à semente foi a estimulação manual dos pontos. Assim, orientou-se os participantes a estimular os pontos quatro vezes ao dia(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
), cinco vezes ao dia por um minuto ou até sentir dor ou desconforto(2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
), e três vezes ao dia por 15 vezes(2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
). Em um dos casos, orientou-se a estimulação por três a cinco minutos na presença de ansiedade(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
). Três dos artigos não descreveram os cuidados com as sementes(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.). As agulhas sistêmicas foram introduzidas e mantidas sem a introdução total na pele(2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
), ou com profundidade de dois a três milímetros(2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
). A estimulação manual dessas foi descrita em apenas um experimento(2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
). Os cuidados com as agulhas semipermanentes, por sua vez, não foram descritos.

A remoção dos dispositivos variou, de modo que as agulhas sistêmicas foram retiradas entre 30 e 45 minutos(2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
). E, as agulhas semipermanentes foram mantidas por um dia(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
), dois(1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
) dias, três dias ou retiradas no caso de dor ou vermelhidão(2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
). Ademais, um estudo apontou a remoção com uma semana(1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
) e outros descreveram a troca de pavilhão auricular duas vezes por semana(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
,1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
), não especificando o intervalo de tempo. As sementes tiveram tempo de permanência de dois(2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
), três(2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.), cinco(1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
), sete(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
-22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
) e quinze dias(2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.). Após a remoção dos dispositivos, realizavam-se novas aplicações, alternando-se as orelhas(1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
).

DISCUSSÃO

A auriculoterapia se mostrou efetiva na maioria dos estudos e nas diferentes situações clínicas de estresse, ansiedade e depressão, como, por exemplo, esclerose múltipla, uso abusivo de álcool e drogas, demência, cefaleia associada a traumatismo cranioencefálico, insônia e dor(1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.

24. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
-2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.). Além da efetividade, a técnica demonstrou-se minimamente invasiva, segura, de baixo custo e com demanda de pouco tempo para a aplicação. Esses achados são corroborados por outros estudos(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
,3434. Tan JY, Molassiotis A, Wang T, Suen LKP. Adverse events of auricular therapy: a systematic review. J Evid Based Complement Alternat Med [Internet]. 2014 [cited 2018 July 6];2014:1-20. Available from: https://www.hindawi.com/journals/ecam/2014/506758/
https://www.hindawi.com/journals/ecam/20...
) e reforçam a utilização da prática nos diferentes contextos de saúde.

Os escores de qualidade metodológica, avaliados por meio da Escala de Jadad, demonstram que boa parte dos estudos (n=12; 50%) obteve nota três, indicativa de estarem no limiar para sua recomendação clínica. Dos estudos, quatro apresentaram nota máxima(1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...

17. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
-1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.), um nota quatro(1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.) e sete notas iguais ou inferiores a dois(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
-33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
,1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.).

Ressalta-se que as Práticas Integrativas e Complementares (PICS) estão inseridas nos âmbitos primário, secundário e terciário do SUS, com destaque para a Atenção Básica(3535. Ruela LO, Moura CC, Gradim CVC, Stefanello J, Lunes DH, Prado RR. Implementação, acesso e uso das práticas integrativas e complementares no Sistema Único de Saúde: revisão da literatura. Ciênc Saúde Coletiva [Internet]. 2018 [citado 2018 jul. 6]. Disponível em: http://www.scielo.br/scielo.php?pid=S1413-81232019001104239&script=sci_arttext
http://www.scielo.br/scielo.php?pid=S141...
). No entanto, a presente investigação demonstra que todos os ECR foram realizados em ambientes terciários e secundários, não havendo nenhum estudo na Atenção Básica. Isso reforça a necessidade de estudos de maior evidência científica nesse cenário(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
), a fim de fortalecer o reconhecimento das PICS enquanto estratégia de saúde pública no Brasil.

A maioria dos profissionais que aplicaram a intervenção nos estudos analisados foram enfermeiros. Esses estão inseridos nos diferentes níveis da Rede de Atenção à Saúde e destacam-se pela proximidade com os usuários, sendo assim, potenciais difusores das PICS. Tal achado demonstra avanços na literatura, em que esse profissional foi uma das categorias profissionais com menor número de terapeutas(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
). Destaca-se ainda que além do amparo legal para a realização da acupuntura e auriculoterapia por enfermeiros(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
), as práticas são reconhecidas como intervenções de enfermagem em classificações que padronizam a linguagem como a Classificação Internacional das Práticas de Enfermagem – CIPE®(88. Bulechek GM, Butcher HK, Dochterman J. Classificação das intervenções de enfermagem (NIC). Rio de Janeiro: Elsevier; 2016.) e a Nursing Interventions Classification – NIC(99. Garcia TR. Classificação Internacional para a prática de enfermagem (CIPE®): versão 2017. Porto Alegre: Artmed; 2018.).

Em relação aos protocolos de intervenção, nos grupos experimentais, os dispositivos mais utilizados para estimulação dos pontos auriculares foram agulhas semipermanentes(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.-1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
-1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
), agulhas sistêmicas(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
) e sementes(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
-22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,1313. Dellovo AG, Souza LMA, Oliveira JS, Amorim KS, Groppo FC. Effects of auriculotherapy and midazolam for anxiety control in patients submitted to third molar extraction. Int J Oral Maxillofac Surg [Internet]. 2018 [cited 2019 Feb 10];1-6. Available from: https://www.ijoms.com/article/S0901-5027(18)30423-5/fulltext
https://www.ijoms.com/article/S0901-5027...
,2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.). Dois estudos testaram agulhas semipermanentes e sementes, a fim de comparar os efeitos desencadeados pelas mesmas(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
). Em ambos, o efeito da agulha semipermanente sobressaiu sobre o da semente. Porém, a semente apresenta vantagens em relação à agulha nas situações em que os indivíduos não toleram estímulos invasivos ou em crianças, e por causar menos dor e risco de infecção(3636. Kurebayashi LFS, Gnatta JR, Borges TP, Belisse G, Coca S, Minami A, et al. The applicability of auriculotherapy with needles or seeds to reduce stress in nursing professionals. Rev Esc Enferm USP [Internet]. 2012 [cited 2018 Aug 1];46(1):89-95. Available from: http://www.scielo.br/scielo.php?pid=s0080-62342012000100012&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=s008...
). Ressalta-se que os resultados das sementes dependem da pressão correta exercida pelos pacientes. No entanto, existem divergências da frequência e cuidados de manutenção das sementes entre os estudos, de modo que não é possível estabelecer recomendações.

Os grupos controles foram formados por indivíduos que não foram submetidos a nenhuma intervenção(11. Kurebayashi LFS, Gnatta JR, Borges TP, Silva MJP. Avaliação diagnóstica da Medicina Tradicional Chinesa dos sintomas de estresse tratados pela auriculoterapia: ensaio clínico. Rev Eletr Enf [Internet]. 2014 [citado 2018 jul. 6];16(1):68-76. Disponível em: https://revistas.ufg.br/fen/article/view/20167/16444
https://revistas.ufg.br/fen/article/view...
,44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.,1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...

15. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
-1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
), que continuaram o tratamento convencional(22. Rivadeneira MOD, Díaz A, Hidalgo TG, Tejeda JMC, Sánchez YG. Efectividad de la auriculoterapia en el tratamiento de la ansiedad en el adulto mayor. Rev Elec Dr Zoilo E Marinello Vidaurreta [Internet]. 2015 [citado 2018 jul. 6];40(6):1-6. Disponible en: https://pt.scribd.com/document/353262880/Efectividad-de-la-auriculoterapia-en-el-tratamiento-de-la-ansiedad-en-el-adulto-mayor
https://pt.scribd.com/document/353262880...
,2525. Rodríguez-Mansilla, J, López-Arza MVG, Varela-Donoso E, Montanero-Fernández J, Sánchez BG, Garrido-Ardila EM. The effects of ear acupressure, massage therapy and no therapy on symptoms of dementia: a randomized controlled trial. Clin Rehabil. 2015; 29(7):683-93.,2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
-2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
), ou com outro tipo de tratamento(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
,2626. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring LV. Auricular acupuncture and cognitive behavioural therapy for insomnia: a randomised controlled study. Sleep Disord [Internet]. 2016 [cited 2018 July 6];2016:1-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4876000/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2929. Bergdahl L, Broman J-E, Berman AH, Haglund K, Knorring L, Markström A. Auricular acupuncture versus cognitive behavioural therapy in the discontinuation of hypnotic drug usage, and treatment effects on anxiety, depression and insomnia symptoms: a randomised controlled study. Eur J Integr Med. 2017;16:15-21. DOI: https://doi.org/10.1016/j.eujim.2017.10.002
https://doi.org/10.1016/j.eujim.2017.10....
). Os resultados alcançados nesses grupos sobressaíram em relação à auriculoterapia em apenas dois estudos, em que se utilizou técnicas de relaxamento(2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
) e tratamento com medicamentos e opções não farmacológicas(2727. Jonas WB, Bellanti DM, Paat CF, Boyd CC, Duncan, A, Price A, et al. A randomized exploratory study to evaluate two acupuncture methods for the treatment of headaches associated with traumatic brain injury. Med Acupunct [Internet]. 2016 [cited 2018 July 6];28(3):113-30. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926228/
https://www.ncbi.nlm.nih.gov/pmc/article...
). Desse modo, os resultados reforçam a utilização de PICS em relação aos tratamentos convencionais e vão ao encontro aos obtidos em outros estudos(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
,3737. Goyatá SLT, Avelino CCV, Santos SVM, Souza JRDI, Gurgel MDSL, Terra FS. Effects from acupuncture in treating anxiety: integrative review. Rev Bras Enferm [Internet]. 2016 [cited 2018 July 6];69(3):564-71. Available from: http://www.scielo.br/pdf/reben/v69n3/en_0034-7167-reben-69-03-0602.pdf
http://www.scielo.br/pdf/reben/v69n3/en_...
).

Já os grupos placebos(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,1111. Vieira A, Hinzmann M, Silva K, Santos MJ, Machado J. Clinical effect of auricular acupuncture in anxiety levels of students prior to the exams: a randomized controlled trial. Eur J Integr Med. 2018;20:188-92.-1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...

19. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
-2020. Iunes DH, Chaves ECL, Moura CC, Corrêa B, Carvalho LC, Silva AM, et al. Role of auriculotherapy in the treatment of temporomandibular disorders with anxiety in university students. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/430143/
https://www.hindawi.com/journals/ecam/20...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
,3030. Valiani M, Mansourian M, Ashtari F. The effect of auriculotherapy on stress, anxiety, and depression in ms patients: a double blind randomized clinical control trial (parallel design). Arch Sicil Med Chir Acta Med Mediterr. 2018;34:561-7.) demonstraram resultados próximos à terapia auricular em duas situações, em que se utilizaram fitas adesivas nos pontos do grupo experimental ou agulhas falsas(1818. Haddad-Rodrigues M, Nakano AMS, Stefanello J, Silveira RCCP. Acupuncture for anxiety in lactating mothers with preterm infants: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013 [cited 2018 July 6];2013:(169184). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3858010/
https://www.ncbi.nlm.nih.gov/pmc/article...
,2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
). O efeito da auriculoterapia foi superior ao do placebo em dois estudos(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
,1919. Gagliardi G, Meneghetti M, Ceccherelli F, Giommi A, Romoli M. Auricular acupuncture for anxiety in health care volunteers: randomized crossover study comparing real and sham needles. Med Acupunct [Internet]. 2014 [cited 2018 July 6];26(3):161-6. Available from: https://www.liebertpub.com/doi/abs/10.1089/acu.2014.1036?journalCode=acu
https://www.liebertpub.com/doi/abs/10.10...
), nos quais se utilizou agulhas sem intenção terapêutica ou que não perfuravam a pele.

A estimulação de qualquer ponto em acupuntura pode produzir efeitos fisiológicos ou relacionados à crença do paciente (placebo)(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,3838. Zhang CS, Yang AW, Zhang AL, May BH, Xue CC. Sham control methods used in ear-acupuncture/ear-acupressure randomized controlled trials: a systematic review. J Altern Complement Med [Internet]. 2014 [cited 2018 Aug 1];20(3):147-61. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3948482/
https://www.ncbi.nlm.nih.gov/pmc/article...
). O efeito terapêutico em grupos placebos é explicado por mecanismos neurológicos e psicológicos(44. Prado JM, Kurebayashi LFS, Silva MJP. Experimental and placebo auriculotherapy for stressed nurses: randomized controlled trial. Rev Esc Enferm USP. 2018;52:e03334. DOI: 10.1590/S1980-220X2017030403334
https://doi.org/10.1590/S1980-220X201703...
,3939. Miller LR, Miller FG. Understanding placebo effects: implications for nursing practice. Nurs Outlook. 2015;63(5):601-6. DOI: https://doi.org/10.1016/j.outlook.2015.03.002
https://doi.org/10.1016/j.outlook.2015.0...
). No primeiro, há liberação de neurotransmissores, como opioides endógenos, dopamina e serotonina(3939. Miller LR, Miller FG. Understanding placebo effects: implications for nursing practice. Nurs Outlook. 2015;63(5):601-6. DOI: https://doi.org/10.1016/j.outlook.2015.03.002
https://doi.org/10.1016/j.outlook.2015.0...
-4040. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009;15(3):213-16. DOI: 10.1089/acm.2008.0356
https://doi.org/10.1089/acm.2008.0356...
) modulando as respostas biológicas do indivíduo. No segundo, estados emocionais como ansiedade e controle pessoal alteram a percepção sobre a condição de saúde(3939. Miller LR, Miller FG. Understanding placebo effects: implications for nursing practice. Nurs Outlook. 2015;63(5):601-6. DOI: https://doi.org/10.1016/j.outlook.2015.03.002
https://doi.org/10.1016/j.outlook.2015.0...
), aumentado a resiliência do indivíduo.

Em uma revisão sistemática para determinar se a acupuntura placebo tinha a mesma efetividade da acupuntura para diferentes indicações clínicas, observou-se que 58% dos estudos não apresentaram diferença estatisticamente significativa entre grupos experimentais e placebos; ademais, nenhum grupo placebo apresentou efeito superior à acupuntura(4040. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009;15(3):213-16. DOI: 10.1089/acm.2008.0356
https://doi.org/10.1089/acm.2008.0356...
).

Os pontos comuns ao estresse, ansiedade e depressão foram Shenmen e Rim. Para o tratamento de estresse, além desses pontos foram utilizados Tronco Cerebral e Yang do Fígado 1 e 2. Os protocolos de ansiedade incluíram o Sistema Nervoso Autônomo ou Simpático. Depressão e ansiedade, por sua vez, tinham o ponto do Coração estimulado. Diante da efetividade e utilização desses pontos em mais de um estudo, recomenda-se a utilização deles em novos estudos.

O ponto Shenmen tem propriedade sedativa, já o rim função energética e revigorante. O Tronco Cerebral tem função calmante, enquanto o Yang do Fígado 1 e 2 contem a subida do Yang do fígado, que é um padrão energético diante do estresse(1010. Moura CC, Carvalho CC, Silva AM, Iunes DH, Carvalho EC, Chaves ECL. Auriculoterapia efeito sobre a ansiedade. Rev Cuba Enferm [Internet]. 2015 [citado 2018 jul. 6];30(2):120-34. Disponível em: http://scielo.sld.cu/pdf/enf/v30n2/enf05214.pdf
http://scielo.sld.cu/pdf/enf/v30n2/enf05...
,1515. Kurebayashi LFS, Silva MJP. Chinese auriculotherapy to improve quality of life of nursing team. Rev Bras Enferm [Internet]. 2015 [cited 2018 July 6];68(1):117-23. Available from: http://www.scielo.br/pdf/reben/v68n1/en_0034-7167-reben-68-01-0117.pdf
http://www.scielo.br/pdf/reben/v68n1/en_...
-1616. Mafetoni RR, Rodrigues MH, Jacob LMS, Shimo AKK. Effectiveness of auriculotherapy on anxiety during labor: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2018 [cited 2019 Feb 10];26:e3030. Available from: http://www.scielo.br/scielo.php?pid=S 0104-11692018000100347&script=sci_arttext&tlng=en
http://www.scielo.br/scielo.php?pid=S 01...
,2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
). O Sistema Nervoso Autônomo regula o funcionamento do sistema nervoso simpático e parassimpático, com efeito considerável sobre a dor e o relaxamento muscular. Já o Ponto do Coração controla a circulação sanguínea e as atividades mentais e emocionais, é sedativo e relaxante(1414. Kurebayashi LFS, Silva MJP. Efficacy of Chinese auriculotherapy for stress in nursing staff: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2014 [cited 2018 July 6];22(3):371-8. Available from: http://www.scielo.br/pdf/rlae/v22n3/0104-1169-rlae-22-03-00371.pdf
http://www.scielo.br/pdf/rlae/v22n3/0104...
).

Dentre os protocolos utilizados, destaca-se que o National Acupuncture Detoxification Association (NADA) foi aplicado em cinco estudos para estresse, ansiedade e depressão(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
,2121. Ahlberg R, Skårberg K, Brus O, Kjellin L. Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services. Subst Abuse Treat Prev Policy [Internet]. 2016 [cited 2018 July 6]; 11(24):11-24. Available from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-016-0068-z
https://substanceabusepolicy.biomedcentr...
,2323. Rodrigues MDF, Rodrigues ML, Bueno KS. Effects of low-power laser auriculotherapy on the physical and emotional aspects in patients with temporomandibular disorders: A blind, randomized, controlled clinical trial. Complement Ther Med. 2019;42:340-6.-2424. Jiao Y, Han Y, Li X, Fang Y, Liu Z, Zhou W, et al. Comparison of body, auricular, and abdominal acupuncture treatments for insomnia differentiated as internal harassment of phlegm-heat syndrome: an orthogonal design. J Evid Based Complement Alternat Med [Internet]. 2015 [cited 2018 July 6];2015:1-9. Available from: https://www.hindawi.com/journals/ecam/2015/578972/
https://www.hindawi.com/journals/ecam/20...
). Por meio dele, estimulam-se os pontos Shenmen, Rim, Sistema Nervoso Autônomo, Fígado e Pulmão, a fim de aliviar sintomas de uso e abuso de drogas e condições severas, como problemas neurológicos, depressão, ansiedade, epilepsia, insônia, dentre outros(33. Széchenyi I, Antal Z, Hegyi G. Tracking and evaluating the immediate stress-reducing effect of ear acupuncture through prolactin levels and meridian diagnostics: a randomized, double-blinded, controlled study. Med Acupunct. 2015;27(1):23-32.,2828. Carter K, Olshan-Perlmutter M, Marx J, Martini JF, Cairns SB. NADA ear acupuncture: an adjunctive therapy to improve and maintain positive outcomes in substance abuse treatment. Behav Sci [Internet]. 2017 [cited 2018 July 6];7(2):37. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5485467/
https://www.ncbi.nlm.nih.gov/pmc/article...
). Ademais, os protocolos são ferramentas importantes para a replicabilidade de pesquisas acerca da auriculoterapia.

Observou-se que os eventos adversos (EA) relacionados à auriculoterapia são ausentes(1717. Ndubisi C, Danvers A, Gold MA, Morrow L, Westhoff CL.Auricular acupuncture as an adjunct for pain management during first trimester abortion: a randomized, double-blinded, three arm trial. Contraception [Internet]. 2018 [cited 2019 Feb 10];1-5. Available from: https://www.contraceptionjournal.org/article/S0010-7824(18)30516-X/fulltext
https://www.contraceptionjournal.org/art...
) ou pouco comuns. Apenas dor de cabeça, sangramento no local da aplicação da agulha(1212. Klausenitz C, Hacker H, Hesse T, Kohlmann T, Endlich K, Hahnenkamp K, et al. Auricular acupuncture for exam anxiety in medical students: a randomized crossover investigation. PLoS Med [Internet]. 2016 [cited 2018 July 6];1-9. Available from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168338
https://journals.plos.org/plosone/articl...
) e dor local(2222. Kurebayashi LFS, Turrini RNT, Souza TPB, Marques CF, Rodrigues RTF, Charlesworth K. Auriculotherapy to reduce anxiety and pain in nursing professionals: a randomized clinical trial. Rev Latino Am Enfermagem [Internet]. 2017 [cited 2018 July 6];25:e2843. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-11692017000100320
http://www.scielo.br/scielo.php?script=s...
) foram apontados nos estudos. Uma revisão acerca dos EA da terapia auricular reafirma o achado(3434. Tan JY, Molassiotis A, Wang T, Suen LKP. Adverse events of auricular therapy: a systematic review. J Evid Based Complement Alternat Med [Internet]. 2014 [cited 2018 July 6];2014:1-20. Available from: https://www.hindawi.com/journals/ecam/2014/506758/
https://www.hindawi.com/journals/ecam/20...
). Além disso, demonstra que quando os EA ocorrem, eles são transitórios, toleráveis e se manifestam como desconforto e sensibilidade no local da aplicação dos dispositivos, irritação da pele, tontura e vermelhidão(3434. Tan JY, Molassiotis A, Wang T, Suen LKP. Adverse events of auricular therapy: a systematic review. J Evid Based Complement Alternat Med [Internet]. 2014 [cited 2018 July 6];2014:1-20. Available from: https://www.hindawi.com/journals/ecam/2014/506758/
https://www.hindawi.com/journals/ecam/20...
).

Não existe consenso quanto ao número de sessões, de modo que essas variaram de uma a 24 sessões, com média de 11 sessões, com resultados efetivos. Diante disso, não é possível determinar o número de sessões para o protocolo e frequência do tratamento. Para avaliação do desfecho, instrumentos como a Lista de Sintoma de Estresse (LSS), o Inventário de Ansiedade Traço-Estado (IDATE) e a Escala de Depressão de Hamilton, associados a parâmetros fisiológicos podem ser utilizados nas avaliações.

A principal limitação do estudo foi a exclusão de artigos no idioma chinês, uma vez que a China é o centro cultural das terapias como a auriculoterapia. Acredita-se que a filosofia e a experiência acumulada naquele país acerca da técnica podem contribuir para o fortalecimento em âmbito mundial.

CONCLUSÃO

As evidências disponíveis na literatura acerca dos efeitos da auriculoterapia no tratamento do estresse, da ansiedade e da depressão comprovam a efetividade da técnica em indivíduos adultos e idosos. No entanto, os ECR apresentaram fragilidades quanto à qualidade metodológica. Assim, sugere-se a realização de estudos clínicos com alto nível de evidência para a avaliação do efeito da auriculoterapia para o estresse, a ansiedade e a depressão.

Embora os protocolos identificados sejam diferentes, existem pontos frequentes, dentre os quais estão Shenmen, Rim, Sistema Nervoso Autônomo, Coração, Tronco Cerebral e Fígado 1 e 2 que podem ser utilizados em novos estudos, uma vez que foram eficazes para essas condições que têm características energéticas e sintomáticas semelhantes entre si. O número de sessões e frequência do tratamento não são uniformizados e, por isso, não foi possível determiná-los.

A auriculoterapia é, portanto, uma prática milenar, aplicada a partir de um raciocínio diagnóstico embasado filosoficamente e que vai ao encontro dos preceitos de assistência humanizada e integral que fundamenta a prática da enfermagem. Tendo em vista a atuação dos enfermeiros em todos os níveis de atenção à saúde, a utilização da prática pode ser difundida e diante da sua efetividade, melhorar a saúde da população.

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  • Apoio financeiro: Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG. Processo APQ 01681-18. Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Código de Financiamento 001.

Datas de Publicação

  • Publicação nesta coleção
    26 Out 2020
  • Data do Fascículo
    2020

Histórico

  • Recebido
    13 Mar 2019
  • Aceito
    07 Nov 2019
Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br