Auricular Point Acupressure for Pain

hronic musculoskeletal pain is common among older people living with HIV and can negatively affect mobility, independence, sleep, and quality of life. Although medications are commonly used to manage chronic pain, older adults living with HIV may already take multiple medications for HIV and other health conditions, increasing concerns about medication burden, side effects, and drug interactions. Accessible, low-cost, non-drug approaches to pain management are therefore needed for this population.

This pilot randomized controlled trial will evaluate auricular point acupressure (APA) as a non-invasive approach for managing chronic musculoskeletal pain among adults age 50 years and older who are living with HIV. APA involves placing small seeds on specific points of the outer ear using adhesive tape. Participants apply pressure to these seeds themselves. Unlike acupuncture, APA does not involve needles and can be largely self-administered.

The study will enroll 30 participants with chronic musculoskeletal pain and randomly assign them to one of two groups. One group will receive true APA, with seeds placed on ear points designated for chronic musculoskeletal pain. The other group will receive sham APA, with seeds placed on ear points not associated with the painful areas. Both groups will follow the same treatment schedule for four weeks.

During the four-week intervention, participants will attend weekly visits for placement of the ear seeds. They will be instructed to press the seeds for three minutes, three times each day. The seeds will remain on the ears for five days, followed by two days without the seeds before the next weekly placement. Participants will also complete daily electronic surveys about their pain and pain medication use and use an under-mattress sleep sensor to measure sleep. Study assessments will be conducted at baseline and at the end of the four-week intervention.

The study will examine whether APA shows preliminary benefits for reducing pain and improving sleep and health-related quality of life. It will also evaluate whether APA is feasible, acceptable, and safe for older people living with HIV. Feasibility will be assessed through measures such as recruitment, adherence to the study protocol, and adverse events. At the end of the intervention, participants will complete an individual interview to share their experiences and perceptions of APA.

Because this is a small pilot study, its purpose is to provide preliminary information rather than definitive evidence about the effectiveness of APA. The findings will help determine the feasibility of conducting a larger clinical trial and provide preliminary information about APA's potential as an accessible, non-drug approach to chronic pain management for older people living with HIV.

• Auricular Point Acupressure (Other): Participants will receive auricular point acupressure (APA) using Vaccaria seeds secured with adhesive tape to designated ear acupoints for chronic musculoskeletal pain. Both ears will be treated. Participants will be instructed to press the seeds for 3 minutes, 3 times daily. Treatment will continue for 4 weeks, with each weekly cycle consisting of 5 days of wearing the seeds followed by 2 days without the seeds. Seeds will be replaced weekly by trained study personnel.
• Sham Auricular Point Acupressure (Other): Participants will receive sham auricular point acupressure using the same materials, treatment schedule, and procedures as the APA group. However, Vaccaria seeds will be placed on non-specific ear points unrelated to chronic musculoskeletal pain. Participants will press the seeds for 3 minutes, 3 times daily for 4 weeks, following the same weekly treatment cycle as the APA group.

Primary outcomes

• Change in Pain Intensity Assessed by the Numeric Pain Rating Scale (NRS) [Baseline and 4 weeks]: Pain intensity will be assessed using the Numeric Pain Rating Scale (NRS), on which participants rate their pain from 0 (no pain) to 10 (worst possible pain). Higher scores indicate greater pain intensity. Change in pain intensity from baseline to the end of the 4-week intervention will be compared between the true APA and sham APA groups.

Secondary outcomes

• Change in Health-Related Quality of Life Assessed by the EQ-5D [Baseline and 4 weeks]: Health-related quality of life will be assessed using the EuroQol 5-Dimension (EQ-5D) questionnaire. The EQ-5D assesses five dimensions of health: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The EQ Visual Analogue Scale (EQ-VAS) records participants' self-rated overall health on a scale from 0 to 100, with higher scores indicating better perceived health. Change from baseline to the end of the 4-week intervention will be compared between the true APA and sham APA groups.
• Change in Sleep Quality Assessed by the Withings Sleep Analyzer [Baseline through 4 weeks]: Sleep will be objectively assessed using the Withings Sleep Analyzer, an under-mattress sleep sensor. The device will continuously track night-to-night sleep measures during the study, including sleep timing, sleep efficiency, and wake after sleep onset. Changes in sleep measures during the 4-week intervention will be evaluated between the true APA and sham APA groups.

Sex: All, ages: 50 Years to any

Inclusion Criteria:

* Age 50 years or older
* Living with HIV
* Chronic musculoskeletal pain affecting the muscles, joints, or bones for at least 3 months
* Average chronic musculoskeletal pain intensity of ≥4 on a 0-10 Numeric Pain Rating Scale during the past week

Exclusion Criteria:

* Recent trauma as the primary cause of pain
* Concurrent use of other adjunctive pain therapies, including physical therapy, chiropractic treatment, or acupuncture
* Allergy to latex due to the use of latex-containing tape on the ear points Presence of acute pain