Is auriculotherapy effective and safe for the treatment of anxiety disorders? – A systematic review and meta-analysis

Auriculotherapy (AA) could support standard treatment for anxiety disorders (AD), but its effectiveness and safety remain undetermined. The aim of this systematic review was to determine whether AA was effective and safe for treating people with AD. Searches were conducted on eight databases for randomized controlled trials (RCT) evaluating the effectiveness and safety of AA compared with placebo, waiting list treatment, routine care, or alternative treatment. Searches were run from inception until the 30th of June 2021. Methodological quality of included studies was assessed using the Cochrane risk of bias assessment tool and quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation tool. Meta-analyses were conducted using statistical software RevMan V5.4. The protocol was published and registered PROSPERO ID: CRD42021254503. Thirteen trials met the inclusion criteria for quality and of these nine were included in the meta-analysis. AA (n=386) reduced anxiety levels compared with placebo (n=382) standardized mean difference (SMD): -0.44 95% of Confidence Intervals (CI) [-0.60, -0.28], 9 studies, for AA compared with a waiting list (n=360), 8 studies SMD (-0.55; 95% CI [-0.70, -0.41]). Certainty was graded as moderate and with unlikely publication bias. There was moderate certainty of evidence for an AA (n=130) intervention for pre-operatory anxiety levels when compared with placebo (n=129) SMD -1.40 95% CI [-2.54, -0.26], 3 studies and when compared with a waiting list group (n=98) Mean difference (MD) -5.02 95% CI [-8.15, -1.90], 2 studies. Few studies reported adverse events and other important secondary outcomes such as salivary cortisol and vital signs. AA may be effective as a complementary treatment for situational anxiety. There is still an evidence gap regarding its safety and efficacy. The type and frequency of AA used for anxiety treatment requires further exploration.