Effectiveness of acupressure at different ear acupoints on Insomnia: A secondary analysis of a randomized controlled trial

Introduction: Insomnia is highly prevalent among older adults with chronic low back pain (cLBP), contributing to a cycle of heightened pain sensitivity, impaired physical function, and reduced quality of life. Auricular Point Acupressure (APA), a nonpharmacologic intervention for pain, has shown emerging evidence of improving sleep. We compared the effectiveness of targeted APA (T-APA) versus non-targeted APA (NT-APA) on insomnia in older adults with cLBP. Methods: This secondary analysis used data from a parent RCT, including 99 adults aged 60 or older with cLBP and clinical insomnia (Insomnia Severity Index [ISI]>7). Participants received four weeks of T-APA or NT-APA. Sleep outcomes (ISI, PROMIS-29 sleep disturbance) and pain outcomes (intensity, interference) were assessed at baseline and post-intervention, with pain examined as a mediator of sleep change. Results: The T-APA (n = 45) and NT-APA (n = 54) groups had similar baseline characteristics. Both groups showed significant reductions in sleep disturbance, pain interference, and pain intensity (p < 0.05). However, only the NT-APA group demonstrated significant improvement in ISI scores (p < 0.001, d = 0.50). No significant mediation effect of pain on sleep outcomes was found. Conclusions: APA may be an effective nonpharmacologic approach for improving sleep among older adults with cLBP. Unexpectedly, NT-APA showed greater improvements in insomnia compared to T-APA, suggesting mechanisms beyond traditional somatotopic theory. Further research is warranted to confirm these findings and explore the potential of point-specific versus non-specific APA protocols in treating insomnia. Trial ID: NCT03589703 (registration date: May 22, 2018). URL: https://clinicaltrials.gov/ct2/show/record/NCT03589703.

Duke Scholars

Author Constance Margaret Johnson School of Nursing