Grand Rounds April 24, 2026: Key Insights from the UG3: Personalized Auricular Point Acupressure for Chronic Pain Self-Management in Rural Populations Trial, and Path Forward for the UH3 (Jennifer Kawi, PhD, MSN, FNP-BC, CNE, FAAN; Hulin Wu, PhD, MS; Jane Bolin, PhD, JD, RN)

Posted on by terren.green@duke.edu

Speakers

Jennifer Kawi, PhD, MSN, FNP-BC, CNE, FAAN
Maria C. and Christopher J. Pappas Family Distinguished Chair in Nursing
Lee and Joseph Jamail Distinguished Professor
Department of Research
Cizik School of Nursing at UTHealth Houston

Hulin Wu, PhD, MS
The Betty Wheless Trotter Professor & Chair
Department of Biostatistics & Data Science
School of Public Health at UTHealth Houston

Jane Bolin, PhD, JD, RN
Senior Research Professor
College of Nursing, UNT Health Science Center at Fort Worth
Regents Professor Emeritus
Texas A&M School of Nursing

Keywords

Auricular Point Acupressure, Chronic pain, Pain management, Rural communities.

Key Points

  • Auricular Point Acupressure (APA) uses small seeds embedded into tape and placed on areas of the ear that correspond to areas of the body that are in pain. Placement decisions come from the literature on (APA) locations. APA has been shown to stimulate the central nervous system in fMRI studies, decreased pro-inflammatory substances (IL-ꞵ, TNFα), and increased anti-inflammatory substances (IL-4, IL-10).
  • To scale APA care, our self-managed approach for the Personalized Auricular Point Acupressure for Chronic Pain Self-management in Rural Populations UG3 study used an electronic application that was created to provide participants with tutorial videos, answers to frequently asked questions, and a pain tracking system. A previous study using this self-managed approach in urban areas showed improved physical function and lessoned pain intensity.
  • The current study focused on APA in rural communities that experience challenges with access to pain care, transportation, staff shortages, and technology and internet access. Building trust with rural communities was very important.
  • After the APA intervention, participants felt a regained control over pain and were satisfied with improved comfort. Challenges presented with difficulty reaching points on the back of the ear and discomfort while sleeping.
  • A full UH3 Pragmatic Randomized Clinical Trial is now being organized to expand the reach of the study. This 3-arm trial will randomize 693 participants to a control, APA in-person, or APA remote group. This study aims to determine the effectiveness of APA in chronic musculoskeletal pain, assess the cost-effectiveness, and identify predictive factors for APA treatment response.

Discussion Themes

Supporting rural communities in research requires leveraging existing partners while building new relationships, listening to the needs of the community and adjusting study procedures to meet these needs, and working with community advisory boards to disseminate findings.

The control group for this study was a pain education intervention group. Creating a sham control group for this type of study is difficult because there are many APA points in the ear. Attempting to create a sham control group that targets other points in the ear may inadvertently be influencing other APA points.

 

Read more about the Personalized Auricular Point Acupressure for Chronic Pain Self-management in Rural Populations study.