Auricular point acupressure self-management for chronic musculoskeletal pain in rural communities

A Pragmatic, Randomized Controlled Trial of a Auricular Point Acupressure - Self-Management (APA-SM) Program for Chronic Musculoskeletal Pain Among Rural Populations.

This program will test whether a 4-week auricular point acupressure self-management approach (delivered via a smartphone app with remote training or with in-person training) helps adults in rural areas reduce chronic musculoskeletal pain and improve activity.

Quick facts

• Phase: NA
• Study type: Interventional
• Enrollment: 693 (estimated)
• Ages: 18 Years to 85 Years
• Sex: All
• Sponsor: The University of Texas Health Science Center, Houston (other)
• Locations: 3 sites (Columbia, South Carolina and 2 other locations)
• Trial ID: NCT07179016 on ClinicalTrials.gov

What this trial studies

This randomized trial will enroll 693 rural adults with chronic musculoskeletal pain and assign them to one of three arms: APA-SM self-guided with remote training, APA-SM with in-person training, or an education control. Participants will learn to self-administer auricular point acupressure and use a smartphone app with ecological momentary assessment to track symptoms and adherence. Primary outcomes are pain intensity, pain interference, and activity measured immediately after the 4-week intervention, with secondary endpoints at 1, 3, and 6 months including HEAL Clinical Pain Core measures and analgesic use. The study will also evaluate implementation outcomes and cost-effectiveness to support scalability in rural primary and specialty care.

Who should consider this trial

Good fit: Adults living in rural areas with chronic musculoskeletal pain rated ≥4/10 for at least 3 months (or pain on at least half the days in the past 6 months) who are receiving any form of pain management and can use a smartphone or attend in-person training are ideal candidates.

Not a fit: People with severe ear skin disorders or severe allergies to tape, those whose hearing aids prevent seed placement, those unwilling or unable to provide informed consent, or those not living in rural areas are unlikely to benefit from this program.

Why it matters

Potential benefit: If successful, the program could give rural patients an accessible, low-cost self-management tool to reduce pain and improve daily function without relying on specialty care.

How similar studies have performed: Small trials and pilot studies of auricular acupressure have reported short-term pain relief, but large randomized and digitally delivered self-management trials remain limited.

Eligibility criteria

Inclusion Criteria:

* Receive any pain management for CMP (neck, back, shoulder, hands, hips, knees, feet)
* Have CMP ≥ 4 on a scale of 0-10 that has persisted for at least 3 months or has resulted in pain on at least half the days in the past 6 months

Exclusion Criteria:

* Severe ear skin disorder (Diagnosed with conditions e.g., eczema, lupus with skin involvement) which often require medical intervention and severe allergy to tape
* Inability or unwillingness to provide informed consent
* Use of some type of hearing aid where size may obstruct seed placement
* Not living in rural area

Where this trial is running

Columbia, South Carolina and 2 other locations

• University of South Carolina — Columbia, South Carolina, United States (RECRUITING)
• University of North Texas Health Science Center at Fort Worth — Fort Worth, Texas, United States (NOT_YET_RECRUITING)
• The University of Texas Health science Center at Houston — Houston, Texas, United States (NOT_YET_RECRUITING)

Study contacts

• Principal investigator: Jennifer Kawi, PhD, MSN, FNP-BC, CNE, FAAN — The University of Texas Health Science Center, Houston
• Study coordinator: Jennifer Kawi, PhD, MSN, FNP-BC, CNE, FAAN

Conditions: Chronic Pain, Chronic Pain Management, Chronic Knee Pain, Joint Pain, Rural population, Self-management, Chronic musculoskeletal pain, Auricular point acupressure