Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)

Abstract

Work related illness (WRI) is physical or mental illness caused by or aggravated by work. WRI affects individuals, their families,
employers, the health system, the economy and the community. The two largest categories of WRI are musculoskeletal disorders
(MSD) and stress, anxiety and depression (SAD). Health Service Executive (HSE) statistics indicate over a million workers are injured
or made ill by their workplace in the United Kingdom each year. In 2016/17 the total cost of workplace self-reported injuries and ill
health was £15 billion with ill health being the biggest proportion of total costs at 65% (£9.7 billion) and workplace injury resulting
in around 35% (£5.2 billion). The Complementary and Alternative Medicine (CAM) treatment modality of Auricular Acupuncture
(AA) has been used for over 2500 years, to treat illness and provides a cost effective treatment modality for WRI including MSD and
SAD.

Full text

ACTA SCIENTIFIC MEDICAL SCIENCES (ISSN: 2582-0931)
Volume 3 Issue 12 December 2019
Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal
Disorders (MSD) and Stress, Anxiety and Depression (SAD)
Carina Harkin*
Independent Researcher, Carahealth, Ireland
*Corresponding Author: Carina Harkin BHSc.Nat.BHSc.Hom.BHSc.Acu. Cert IV TAE. MPH (pend), Independent Researcher, Carahealth
Galway Ireland, MPH student UCC, College Rd, University College, Cork, Ireland. E-mail: info@carahealth.com
Review Article
Received: November 06, 2019; Published: November 22, 2019
Abstract
Keywords: Auricular Acupuncture (AA); Musculoskeletal Disorders (MSD); Stress, Anxiety and Depression (SAD); Work Related
Illness (WRI); Complementary and Alternative Medicine (CAM)
Introduction
WRI is physical or mental illness caused by or aggravated by
work. WRI affects individuals, their families, employers, the health
system, the economy and the community [1]. The Health Service
Executive (HSE) statistics indicate over a million workers are in-
jured or made ill by their workplace in the United Kingdom each
year. In 2016/17 the total cost of workplace self-reported injuries
and ill health was £15 billion pounds sterling with Ill health be-
ing the biggest proportion of total costs at 65% (£9.7 billion) and
workplace injury resulting in around 35% (£5.2 billion) [2]. The
two largest categories of self reported WRI are musculoskeletal
disorders (MSD) and stress, anxiety and depression (SAD) [1, 3, 4].
Work related illness (WRI) is physical or mental illness caused by or aggravated by work. WRI affects individuals, their families,
employers, the health system, the economy and the community. The two largest categories of WRI are musculoskeletal disorders
(MSD) and stress, anxiety and depression (SAD). Health Service Executive (HSE) statistics indicate over a million workers are injured
or made ill by their workplace in the United Kingdom each year. In 2016/17 the total cost of workplace self-reported injuries and ill
health was £15 billion with ill health being the biggest proportion of total costs at 65% (£9.7 billion) and work place injury resulting
in around 35% (£5.2 billion). The Complementary and Alternative Medicine (CAM) treatment modality of Auricular Acupuncture
(AA) has been used for over 2500 years, to treat illness and provides a cost effective treatment modality for WRI including MSD and
SAD.
Incidence in Ireland
In 2013, 55,000 workers suffered from a WRI with over 790,000
workdays lost. Between 2002-2013, MSD and SAD accounted for
MSD SAD
50 per cent % of all WRI 18 per cent % of all WRI
Table 1: Incidence of MSD and SAD in Irish workplaces [5].
Work Related Ill Health 2017/18 UK [6]
• 1.4 million workers suffering from WRI (new or long-
standing).
• 541,000 workers suffering from a new case of WRI.
• 26.8 million working days lost due to WRI .
• 13,000 deaths each year estimated to be linked to past
chemical/dust exposure at work.
68% of all WRI. In the EU28 MSD and SAD accounted for 75% of
WRI.
Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.

Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)
160
New and long-standing cases of WRI by type and working days
lost by type of ill health 2017/18 [7]
Figure 1
Figure 2
Work days lost UK self-reported estimates in 2017/18
30.7 million working days are lost due to work-related ill health
and non-fatal workplace injuries with SAD and MSD accounting for
the majority of days lost due to WRI, 15.4 million and 6.6 million
respectively. On average, each person took around 16.5 days off
work. This can be broken down as follows;
• 7.1 days for injuries.
• 19.8 days for ill health cases.
• 25.8 days for stress, anxiety or depression.
• 14.0 days for musculoskeletal disorders [8].
Figure 3
SAD by cause averaged 2009/10 - 2011/12 [6]
Figure 4
• 595,000 workers suffering from work related SAD (new or
long-standing) in 2017/18.
• 15.4 million working days lost due to work related SADin
2017/18.
• 507,000 workers suffering from work-related MSD (new or
long-standing) 2016/17.
• 8.9 million working days lost due to work-related MSD in
2016/17.
Costs in UK 2016/17 (no cost evaluation exists in Ireland)
• £ 15.0 billion annual costs of work related injury and new
cases of ill health (excluding long latency illness such as
cancer).
• £ 9.7 billion annual costs of new cases of work-related ill
health (excluding long latency illness such as cancer).
• £ 5.2billion annual costs of workplace injury [6].
MSD by affected area 2016/17 [6]
Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.

161
Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)
MSD SAD
1995/96 UK annual cost estimated
at £5.7 billion (equivalent to £10
billion in 2016)
Estimated annual cost
ranged between £7 - £13
billion.
Table 2: Financial Cost work related MSD and SAD [4].
WRI in the corporate sector?
          
  

-

         
other industry.
Work related
Ill Health Rate
(per 100,000)
Industry Section
Workplace
Injury Rates
(per 100,000)
4740 Agriculture, forestry and

3690
4500 Human health/social work 1730
4310 Public admin/defence 2190
4260 Utility supply
3840 Education 1630
3570 Construction 2620
3430 Other service activities 900
3180 Transport/storage 2200
3140 Water supply/waste man-
agement
2560
2940 Real estate activities
2930 Financial insurance activi-
ties
2780 Arts/entertainment/recre-
ation
1880
2670 Manufacturing 2180
2630 Administrative and support
service activities
1420
2450 Wholesale/retail trade 2200
2300 
technical activities
860
2200 Information and communi-
cation
480
2180 Accommodation/food
services
2320
Mining and quarrying
3180 All industries 1780
Statistically

higher

lower
No statistical
-
ference
Table 3: WRI by industry [6].
Psychosocial risk factors for WRI
As the Whitehall study highlighted, poverty is not the only cause
of workplace illness [9]. Psychosocial risks factors include exces-

antisocial work hours, poor work relationships, inability to partici-

inability to progress up the career ladder and poor work-life bal-
ance [10].
Complementary and alternative medicine (CAM) in Ireland
In 2002, 27% of people used a form of CAM [11]. A conference
for GPs in Ireland entitled, “Emerging medicine strategies for in-
      
awareness of the increasing popularity of CAM [12]. As health
promoters, CAM practitioners can be an additional health resource
to address the global burden of chronic disease [13]. EUCAM and
the National Working Group on the Regulation of Complementary
Therapists in Ireland [14] are looking at the contribution of CAM
to sustainable healthcare. The World Health Assembly has urged
Member States to integrate CAM within national healthcare sys-
tems [15]. Using CAM in the workplace can help satisfy the re-
quirements of the Luxembourg Declaration on Workplace Health
Promotion [16].
The preventative medicine network acknowledges that CAM is
involved in primary, secondary and tertiary prevention of disease
and is synergistic with health promotion [17]. Level 8 (EQF/AQF
NFQ/Level 6 Ofqual science degrees holders in CAM prevent dis-
ease, encourage screening and manage long term chronic disease.
It is also acknowledged that public health promoters aiming to em-
power individuals and encourage community action support CAM
involvement [18]. The EUCAM and the National Working Group on
the Regulation of Complementary Therapists in Ireland [19] are
looking at the contribution of CAM to a sustainable healthcare sys-
tem for its role in health promotion. The World Health Assembly
has urged Member States to integrate CAM within national health-
care systems [14]. Auricular Acupuncture (AA) is a modality of CAM
that has been employed for over 2500 years, to treat illness [20]. A
randomised controlled trial (RCT) looking at CAM in the treatment
of chronic pain and insomnia in military personnel reported AA as
being the most popular CAM treatment modality and concluded
that is a cost effective treatment for pain and insomnia and that AA
may provide a part solution towards the opioid crisis in the US [21].
Pros of auricular acupuncture (AA)
AA can be offered in a community setting
Community acupuncture offers health work in a community set-
ting that is sociable and empowering [22]. Similarly to community

Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.

162
Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)
either on yoga mats or recliner lounges and is described as a socio-
behavioural wellness model [23].
AA is cost effective and practical
The main barrier to the utilisation of CAM is seen as cost, how-
ever when used in a community setting and fees are charged on a
sliding scale service according to ability to pay, community acu-
puncture becomes cost effective it has been found that low-income
communities will use CAM [24]. Community acupuncture has been
shown to offer substantial savings even as an alternative to knee
surgery in patients with osteoarthritis of the knee who would oth-
erwise have been referred to an orthopaedic surgeon [25]. AA as a

predetermined points on the external ear only has even greater
cost effectiveness and has minimal side effects [26]. Having mini-
 et al. for a
realistic and pragmatic settings based approach that moves away
from being overly reliant on individualistic methods to promote
health [27] and being offered in a community setting, can also help
address the psychosocial risk factors for WRI.
AA reduces inflammation, is analgesic and anxiolytic
The use of CAM to alleviate WRI pro-actively promotes health
by supporting the body’s homeostatic mechanisms [19]. Acupunc-
ture in general, increases the activity of the endogenous opioid
peptides enkephalin, beta-endorphin, endomorphin and dynor-
phin [28], monoamines neurotransmitters serotonin, noradrena-
lin, dopamine, acetylcholine (Ach), inhibitory amino acids such as

also attenuating noradrenalin and excitatory amino acids includ-
ing glutamate and aspartic acid activity [29,30]. In addition acu-

        
[31]
  
activated B-cell and T-cell proliferation and regulates humoral and
adaptive immunity [32].
AA for SAD
A RCT has shown that true ear acupuncture was more effective
than placebo to reduce stress in student nurses [33]. According to
a State-Trait Anxiety Inventory (STAI) AA can reduce stress, anxi-
ety and pain in HCWs and may improve work engagement [34-36].
AA for MSD
AA is good for any type of pain, in particular post operative pain
[37]. A systematic review and meta-analysis reported numerous
RCTs showing that acupuncture is effective for pain relief [38]. AA
is effective in alleviating lower back pain [39]. A recent systematic
review and meta-analysis investigating RCTs on the action of AA for
chronic back pain in adults concluded AA is a promising method
to treat chronic back pain in adults [40]. AA has been shown to
relieve muscle and joint pain in temporomandibular joint disorder
(TJM) [41].
What to expect
-
       
protocol typically used to treat drug and alcohol withdrawal; they
are proven to relieve anxiety and pain of withdrawal [42]. Addi-
tional points are often chosen according to the diagnoses Pattern
of Disharmony in Traditional Chinese Medicine. The NADA proto-


ear and left in for 20 minutes. Treatment takes half an hour in total.
Short term evaluation
Routine observations including heart rate (HR), blood pressure
(BP), and respiratory rate (RR), pain score as indicated by a Visual
Analogue Scale (VAS) and anxiety score as indicated by the State-
Trait Anxiety Inventory (STAI) can be taken pre and post treatment.
Evaluation can also incorporate a talking circle which in itself has
been shown to help deal with work related stress [43]. The health
        
to the psychosocial and physical causes of MSD and SAD and in-
creasing the capacity of workers by providing emotional support.
The health circle can also facilitate heath surveillance reports and
employee surveys [44].
Conclusion
AA as a CAM treatment modality has been shown to be both a
highly effective and cost effective method to treat WRI including
MSD and SAD. Not only is AA a cost effective treatment for WRI,
AA may provide a part solution towards the global opioid crisis. In
light of the current global crisis of overspending in the health care
system, the cost effectiveness of AA can no longer be overlooked. It

      
Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.

163
Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)
Chinese Medicine. For purpose of a corporate role out, an RTC
         
andplacebo AA (non stimulated press seeds on non points) also
using(HR, BP, RR, VAS, STAI) along with key performance indica-
tors (KPI) such as absenteeism and overall labour effectiveness
(OLE) in the workplace as a measure of effectiveness is needed
[45].
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Abbreviations
Acetylcholine (Ach), Auricular Acupuncture (AA) Blood pres-
sure (BP), Complementary and Alternative Medicine (CAM), C-re-
  
Executive (HSE), Heart rate (HR), Interleukin (IL) IL-1, IL-6 and Key
performance indicators (KPI), Musculoskeletal disorders(MSD),
 
labour effectiveness (OLE), Respiratory rate (RR), Randomised
controlled trial (RCT), State-Trait Anxiety Inventory (STAI), Stress,
anxiety and depression (SAD), Work Related Illness (WRI), Visual
Analogue Scale (VAS)
Declarations
• Ethics approval and consent to participate Not appli-
cable
• Consent for publication Not applicable
• Competing interests None declared
• Funding None declared
• Authors’ contributions Carina Harkin wrote read and
a
• Acknowledgements Not applicable
• Availability of data and materials Not applicable
Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.

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Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and Depression (SAD)
Volume 3 Issue 12 December 2019
© All rights are reserved by Carina Harkin.
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Citation: Carina Harkin. “Auricular Acupuncture (AA) for Work Related Illness (WRI); Musculoskeletal Disorders (MSD) and Stress, Anxiety and
Depression (SAD)". 3.12 (2019): 159-164.