How does auriculotherapy - auricular neuromodulation - auricular acupuncture work?

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The mechanism of auriculotherapy is based on the triad of sensitization - reflex loop - somatotopy

Auriculotherapy is based on three clinical observations that anyone can replicate.

Firstly, bodily pain ('somatic') is associated with hypersensitivity in a delimited area ('circumscribed') of the auricle or concha. This hypersensitivity is called 'allodynia' in medical language. The circumscribed area on the ear is referred to as a 'point' in auriculotherapy and auricular acupuncture, or a 'zone' in auricular neuromodulation.
Secondly, stimulation of the sensitized area generates a therapeutic effect. This observation is evident in the case of acute pain and is not specific to the ear. Healers were already familiar with this practice and, under the pretext of 'putting a nerve back in place,' applied painful stimulation to a sensitized area. Today's osteopaths no longer put nerves back in place but apply techniques known as 'cutaneous' or 'neurocutaneous,' with the most well-known being kneading. It's the same on the ear!
Thirdly: the distribution of these hypersensitive zones follows a particular topographical organization, like a map. This organization is called 'somatotopy.' Thus, certain areas of the body will manifest on specific areas of the ear. Everyone has the image of the 'inverted fetus' in mind, but this representation is deceptive and leads to false reasoning. The reality is a bit more complex.

Stimulation of the ear causes a parasympathetic response

Stimulation of certain areas of the ear generates a parasympathetic response. Among these areas, the most studied has been the upper concha, which is 100% innervated by the vagus nerve (Peuker et al., 2002; Butt et al., 2019). More surprisingly, but observed only in animals, auricular stimulation also induces a sympathetic response (Strack et al., 1990). Using functional MRI, we know that stimulation of different areas on the ear generates different responses (Yakunina et al., 2017). A noteworthy fact is that all information first passes through two relays: the nucleus of the solitary tract and the locus coeruleus. Then, there is observed activation or inhibition of certain brain areas (nuclei or regions of interest). Thus, stimulation of the auricular pavilion induces modulation of certain neuronal networks, hence the term 'auricular neuromodulation.' Unfortunately, very few stimulation areas have been studied, and the stimulation paradigm imposed by functional MRI does not quite correspond to common practice.
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