Management of Chronic Low Back Pain in Older Adults Using Auricular Point Acupressure

Almost one-third (30%) of persons 65 years and older suffer from cLBP and cause a significant
negative impact on individuals and society in the U.S. The goal of managing cLBP is decreased
pain and disability.To accomplish this, cLBP sufferers often use analgesics including opioids
to decrease pain and facilitate activity, but the side effects caused by these medications
are problematic. A better pain management strategy clearly needs to be developed.

The investigators propose to test auricular point acupressure (APA), a non-invasive, easily
administered, patient-controlled, and non-pharmacological strategy, to provide rapid, safe,
and an innovative solution for chronic low back pain (cLBP) in older adults. APA involves an
acupuncture-like stimulation of the ear without needles. With APA, small seeds are taped to
specific ear points. The patient is taught to apply pressure to the seeds, with the thumb and
index finger, three times a day (morning, noon, and evening) for three minutes each session
to achieve pain relief. The investigators have developed a detailed APA protocol to teach
health-care providers without experience in acupuncture and traditional Chinese Medicine that
investigators can learn about APA in brief educational seminars as a treatment including the
systematic identification of ear points (called auricular diagnosis). The investigators teach
methods that enable patients to continue using APA to self-manage participants' pain.

Brain imaging studies in acupuncture indicate that acupuncture can restore normal functional
connectivity related to pain reduction. Studies suggest that stimulation of ear points (1)
excites the somatotopic reflex system in the brain and that pathological brain patterns are
electrically reset to stop the unwanted activation of spinal pain pathways, explaining the
possible immediate pain relief that patients feel after APA and (2) cause a broad spectrum of
systemic effects, such as vasodilation, by releasing endorphin to elicit short-term analgesic
effects or neuropeptide-induced anti-inflammatory cytokines, which may explain long-term
effects.

The Ecological Momentary Assessment (EMA) smartphone app will be used to collect real-time
cLBP outcomes and adherence to APA practice. Treatment and nonspecific psychological placebo
effects will be measured via questionnaires for all participants. Neuro-transmitters is
measured by inflammatory biomarkers. Blood samples will be collected for serum collection and
a multiplex bead-based immunofluorescence assay performed to check for serum levels.
Mini-Mental State Examination will be used to screen for cognitive function, also HRQoL,
satisfaction, treatment beliefs and expectations, sleep, relaxation effects, catastrophizing
and fear/avoidance, and placebo effects will be measured.