***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES The aim of this study was to evaluate the effects of auricular acupressure on relieving menstrual symptoms and decreasing nitric oxide ( NO ) for women with primary dysmenorrhea . DESIGN This was a r and omized clinical trial comparing the effects of auricular acupressure by seed-pressure method and placebo adhesive patch . SETTING Setting s included colleges in northern and central Taiwan . SUBJECTS Serum CA-125 testing was used as a screening test for primary dysmenorrhea ( < 35 mg/dL ) . The study included 36 college females r and omized to acupressure group , 35 to control group . INTERVENTIONS The acupressure group received auricular acupressure by seed-pressure method on liver ( CO12 ) , kidney ( CO10 ) , and endocrine ( CO18 ) acupoints . The control group had a plain adhesive patch placed on the same acupoints with no seed attached . Acupressure protocol included massaging 15 times on each acupoint , 3 times a day , for a total of 20 days . OUTCOME MEASURES Primary : Short-form Menstrual Distress Question naire ( MDQs ) . Secondary : blood sample of NO . Assessment s of MDQs and NO were performed at baseline and within the first 2 days of their next menses ( after completion of 20 days of acupressure ) . RESULTS In the acupressure group , the overall menstrual symptoms ( 95 % confidence interval [ CI ] = -49.8 to -6.5 , effect size [ ES ] = 0.43 , p = 0.01 ) and two subscales , menstrual pain ( 95 % CI = -16.4 -to -2.2 , ES = 0.45 , p = 0.01 ) and negative affects ( 95 % CI = -11.9 - 2.0 , ES = 0.38 , p = 0.04 ) , revealed that menstrual symptoms decreased significantly after auricular acupressure by the seed-pressure method . The ES for the MDQs were in favor of the auricular acupressure by seed-pressure method . NO level increased in the acupressure group , although this difference did not achieve statistical significance ( p > 0.05 ) . CONCLUSIONS This study supports the effects of auricular acupressure by seed-pressure method in improving menstrual symptoms , and offers a noninvasive complementary therapy for women with primary dysmenorrhea Background . Auricular point acupressure ( APA ) is a promising treatment for pain management . Few studies have investigated the physiological mechanisms of APA analgesics . Method . In this pilot r and omized clinical trial ( RCT ) , a 4-week APA treatment was used to manage chronic low back pain ( CLBP ) . Sixty-one participants were r and omized into a real APA  group ( n = 32 ) or a sham APA group ( n = 29 ) . Blood sample s , pain intensity , and physical function were collected at baseline and after 4 weeks of treatment . Results . Subjects in the real APA group reported a 56 % reduction of pain intensity and a 26 % improvement in physical function . Serum blood sample s showed ( 1 ) a decrease in IL-1β , IL-2 , IL-6 , and calcitonin gene-related peptide [ CGRP ] and ( 2 ) an increase in IL-4 . In contrast , subjects in the sham APA group ( 1 ) reported a 9 % reduction in pain and a 2 % improvement in physical function and ( 2 ) exhibited minimal changes of inflammatory cytokines and neuropeptides . Statistically significant differences in IL-4 and CGRP expression between the real and sham APA groups were verified . Conclusion . These findings suggest that APA treatment affects pain intensity through modulation of the immune system , as reflected by APA-induced changes in serum inflammatory cytokine and neuropeptide levels Background Evidence supports the use of exercise for chronic low back pain ( CLBP ) ; however , adherence is often poor due to ongoing pain . Auricular acupuncture is a form of pain relief involving the stimulation of points on the outer ear corresponding with specific body parts . It may be a useful adjunct to exercise in managing CLBP ; however , there is only limited evidence to support its use with this patient group . Methods / Design This study was design ed to test the feasibility of an assessor-blind r and omised controlled trial which assess the effects on clinical outcomes and exercise adherence of adding manual auricular acupuncture to a personalised and supervised exercise programme ( PEP ) for CLBP . No sample size calculation has been carried out as this study aims to identify CLBP referral rates within the catchment area of the study site . The research ers aim to recruit four cohorts of n = 20 participants to facilitate a power analysis for a future r and omised controlled trial . A computer generated r and om allocation sequence will be prepared central ly and used to allocate participants by cohort to one of the following interventions : 1 ) six weeks of PEP plus manual auricular acupuncture ; 2 ) six weeks of PEP alone . Both groups will also complete a further six weeks of self-paced exercise with telephone follow-up support . In addition to a baseline and exit question naire at the beginning and end of the study , the following outcomes will be collected at baseline , and after 7 , 13 and 25 weeks : pain frequency and bothersomeness , back-specific function , objective assessment and recall of physical activity , use of analgesia , perceived self-efficacy , fear avoidance beliefs , and beliefs about the consequences of back pain . Since this is a feasibility study , significance tests will not be presented , and treatment effects will be represented by point estimates and confidence intervals . For each outcome variable , analysis of covariance will be performed on the data , conditioning on the baseline value . Discussion The results of this study investigating the adjuvant effects of auricular acupuncture to exercise in managing CLBP will be used to inform the design of a future multi-centre r and omised controlled trial . Trial Registration Current Controlled Trials IS RCT N94142364 PURPOSE To examine the effect of auricular acupressure therapy on primary dysmenorrhea among female high school students in South Korea . DESIGN A r and omized controlled trial was employed . METHODS The study sample consisted of 91 female high school students , with 45 participants in the experimental group and 46 in the control group in two regions of South Korea . The average age of the participants was 16.7 years , and the average age of menarche was 12.2 years .  Auricular acupressure therapy including an auricular acupressure needle on skin paper tape was applied on an ear for 3 days during periods of extreme primary dysmenorrhea . The acupoint names were Jagung , Sinmun , Gyogam , and Naebunbi . For the placebo control group , only the skin paper tape without an auricular acupressure needle was applied on the same acupoints . Measures used were the Menstrual Distress Question naire to assess primary dysmenorrhea , and the visual analog scale to assess abdominal and back pain of participants . FINDINGS There were significant differences on abdominal pain ( t = 24.594 , p < .001 ) , back pain ( t = 22.661 , p < .001 ) , and primary dysmenorrhea ( t = 32.187 , p < .001 ) between the two groups . Auricular acupressure therapy decreased abdominal pain , back pain , and primary dysmenorrhea of female high school students in South Korea . CONCLUSIONS Auricular acupressure therapy was an effective intervention for alleviating abdominal pain , back pain , and primary dysmenorrhea of female high school students in South Korea . For feasibility of the auricular acupressure therapy in practice , it is needed to train and learn the exact positions of acupoints in ear . CLINICAL RELEVANCE Health providers should consider providing auricular acupressure therapy as an alternative method for reducing abdominal and back pain , and primary dysmenorrhea in female high school students in South Korea OBJECTIVES Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport . The purpose of this r and omized , double-blind , sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture . METHODS With the assistance of the Vienna Red Cross , 38 patients with acute hip fracture were enrolled into this study . Patients were r and omized into two study groups : the true intervention group and the sham control group . Subjects in the true intervention group ( n = 18 ) received bilateral auricular acupressure at three auricular acupressure points for hip pain . Patients in the sham group ( n = 20 ) received bilateral auricular acupressure at sham points . Baseline demographic information , anxiety level , pain level , blood pressure , and heart rate were obtained before the administration of the appropriate acupressure intervention . The level of anxiety , level of pain , hemodynamic profiles , and level of satisfaction were reassessed once the patients arrived at the hospital . RESULTS Patients in the true intervention groups had less pain ( F = 28 , p = 0.0001 ) and anxiety ( F = 4.3 , p = 0.018 ) and lower heart rate ( F = 18 , p = 0.0001 ) on arrival at the hospital than did patients in the sham control group . As a result , the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital . CONCLUSIONS The authors encourage physicians , health care providers , and emergency rescuers to learn this easy , noninvasive , and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation This prospect i ve , r and omized clinical trial ( RCT ) pilot study was design ed to ( 1 ) assess the feasibility and tolerability of an easily administered , auricular point acupressure ( APA ) intervention and ( 2 ) provide an initial assessment of effect size as compared to a sham treatment .  Thirty-seven subjects were r and omized to receive either the  real or sham APA treatment .  All participants were treated once a week for 4 weeks . Self-report measures were obtained at baseline , weekly during treatment , at end-of-intervention ( EOI ) , and at a 1-month follow-up . A  dropout rate of 26 % in the real APA group and 50 % in the sham group was observed . The reduction in worst pain from baseline to EOI was 41 % for the real and 5 % for the sham group with a Cohen 's effect size of 1.22 ( P < 0.00 ) . Disability scores on the Rol and Morris Disability Question naire ( RMDQ ) decreased in the real group by 29 % and were unchanged in the sham group ( + 3 % ) ( P < 0.00 ) . Given the high dropout rate , results must be interpreted with caution ; nevertheless , our results suggest that APA may provide an inexpensive and effective complementary approach for the management of  back pain in older adults , and further study is warranted Objectives . This prospect i ve , r and omized clinical trial ( RCT ) was design ed to investigate the feasibility and effects of a 4-week auricular point acupressure ( APA ) for chronic low back pain ( CLBP ) . Methods . Participants were r and omized to either true APA ( true acupoints with taped seeds on the design ated ear points for CLBP ) or sham APA ( sham acupoints with taped seeds but on different locations than those design ated for CLBP ) . The duration of treatment was four weeks . Participants were assessed before treatment , weekly during treatment , and 1 month following treatment . Results . Participants in the true APA group who completed the 4-week APA treatment had a 70 % reduction in worst pain intensity , a 75 % reduction in overall pain intensity , and a 42 % improvement in disability due to back pain from baseline assessment . The reductions of worst pain and overall pain intensity in the true APA group were statistically greater than participants in the sham group ( P < 0.01 ) at the completion of a 4-week APA and 1 month followup . Discussion . The preliminary findings of this feasibility study showed a reduction in pain intensity and improvement in physical function suggesting that APA may be a promising treatment for patients with CLBP OBJECTIVE We examined whether auricular acupressure ( AA ) can alleviate postoperative pain and decrease narcotic consumption and its adverse effects for osteoarthritis patients after total knee arthroplasty ( TKA ) . DESIGN A prospect i ve , r and omized , sham control trial comparing AA and a sham control . SETTING Department of Orthopedics , the first Hospital affiliated to Zhejiang University of Traditional Chinese Medicine , Hangzhou , China . SUBJECTS Ninety patients with degenerative osteoarthritis undergoing TKA . INTERVENTIONS The AA group received true AA by embedding vaccaria seeds at four specific AA points ( knee joint , shenmen , subcortex , sympathesis ) ipsilateral to the surgery site , while the control group received four nonacupuncture points on the auricular helix . OUTCOME MEASURES Visual analog scale ( VAS ) , the consumption of analgesic via patient-controlled analgesia , the incidence of analgesia-related adverse effects , Hospital for Special Surgery scores ( HSS ) , and range of motion ( ROM ) were recorded . RESULTS VAS scores were similar at 12 , 24 , 36 , and 48 h postsurgery ( P > 0.05 ) , but AA group scores were lower than those of the control group at 3 , 4 , 5 , and 7 days ( P < 0.05 ) . Patients in the AA group consumed lower doses of analgesic than those in the control group after surgery ( P <  
    Output:
    
This supports that the use of AA for patients may enhance self‐management for their pain .
Conclusion : The nursing implication s based on this review is that education about AA and complementary or alternative medicine therapies for health care providers may assist them in providing pain control for their patients .