APPA: An auricular acupuncture protocol for the attenuation of pain and anxiety in humanitarian aid environments: a consensus study to determine a theoretically safe and effective beta protocol

By Karen Charlesworth



On the basis of current research, it was hypothesised that a standardised auricular acupuncture (AA) protocol may be a suitable treatment to attenuate pain and anxiety in humanitarian aid environments (HAEs).


Aims and objectives

This study aimed to construct a theoretically safe, effective beta standardised AA protocol, known as the Auricular Protocol for Pain and Anxiety (APPA), suitable for use in HAEs, by consensus.

The main objectives were:

  1. to determine a list of components and a list of AA experts;
  2. to consult expert opinion in a consensus process to refine the list of components;
  3. to thereby determine a beta protocol supported by consensus.



This study used the Internet-Based Iterative Sequential Mixed Methods (IBIS-MM) model, combining quantitative and qualitative data. Data from each round was analysed to determine components with the greatest level of support to progress to successive rounds; repeated-measures ANOVA was used as a surrogate measure of consensus.



Consensus was achieved on a draft protocol, suitable for use in HAEs, that participants rated theoretically highly effective in the attenuation of pain and anxiety. The study made a range of secondary findings, including a level of ‘component instability’ and a level of participant bias that may have affected the quality of the beta protocol.



This study demonstrates that it is possible to use a consensus process to construct a standardised AA protocol that is safe and effective in the attenuation of pain and anxiety, and suitable for use in HAEs.

Note that consensus was gained on theoretical safety and effectiveness. It is recommended that a further research programme is structured to determine actual effectiveness and safety, taking into account the primary and secondary findings of this study.