A new federal grant will enable Cizik School of Nursing at UTHealth Houston Professor Jennifer Kawi to lead large-scale testing of self-managed auricular point acupressure for nonpharmaceutical pain management in rural communities.

Kawi’s project, “Personalized Auricular Point Acupressure for Chronic Pain Self-Management in Rural Populations,” (UG3AT012728) is funded by the National Center for Complementary and Integrative Health (NCCIH) and the National Institute of Neurological Disorders and Stroke (NINDS). The award is part of the Helping to End Addiction Long-term^® (HEAL) Initiative of the National Institutes of Health (NIH). This “U-series” cooperative agreement award provides $817,483 in its first year with multimillion dollar funding in the next four years given successful completion of first-year milestones.

The award will enable Kawi to build on the foundational work of the late Professor Chao Hsing Yeh, a pioneer in the field of auricular point acupressure.

“Dr. Yeh was foundational in moving the science forward on auricular point acupressure,” said Kawi, PhD, MSN, FNP-BC, CNE, FAAN, a Lee and Joseph Jamail Distinguished Professor at Cizik School of Nursing. “We still have a lot of work to do, and I am thankful and honored that we can continue this work in her honor.”

Yeh, PhD, RN, was a leading researcher in the field of auricular medicine, particularly auricular point acupressure, which involves stimulating pressure points on the ear using similar acupuncture points. She joined the school in November 2021 as The Jane and Robert Cizik Distinguished Chair in the Department of Research. Over the course of her career, Yeh received more than $10 million in grants and published more than 110 papers. She passed away in April 2023 as the result of a hiking accident in Taiwan, and later that year, she was posthumously inducted into the Sigma Theta Tau International Honor Society of Nursing’s International Nurse Researcher Hall of Fame.

Associate Dean for Research Constance Johnson, PhD, MS, RN, FAAN, became principal investigator on two of Yeh’s ongoing NIH grants. Kawi, who had served as a multiple primary investigator on some of Yeh’s studies, joined Cizik School of Nursing from The University of Nevada, Las Vegas, in December 2023.

“Auricular point acupressure is typically performed by a practitioner. My key contributions to the field have been to develop a theory-based, self-managed intervention,” Kawi said. “Pain can happen any time, so we need pain management modalities that are easily accessible and not costly. We hope to equip patients to effectively apply auricular point acupressure themselves when and where they need it.”

Kawi began working with Yeh shortly before the pandemic, which proved to be an impetus for exploring pain relief approaches that patients could self-manage and administer themselves. In this effort, she worked with a team to comprehensively redevelop and refine a smartphone app for self-administered auricular point acupressure, which holds promise in addressing pain care inequities. To reach a broad, diverse population, the app incorporates English and Spanish versions, 3D images, captions, motivational messaging, a self-monitoring progress chart based on ecological momentary assessments, performance checks, and many other features.

“The rural pain care population suffers from disparities and often must travel long distances for appointments,” Kawi said. “Sometimes medication has been the easy way to go because patients don’t have the opportunity to try other pain management options.”

The new grant is expected to fund large-scale, real-world testing of the intervention in rural areas of Texas and South Carolina with the goal of expediting implementation of effective, non-opioid alternatives for pain management. During the first year, the team will focus on community-engaged research and pilot testing the English and Spanish versions of the auricular point acupressure app. They will work with stakeholder focus groups and collaboratively engage health care providers, rural health systems, clinic staff, policymakers, and particularly community health workers.

In the second through fifth years, more than 600 participants are expected to be recruited for a pragmatic randomized controlled trial. In addition to a control group, a group using self-guided, self-managed auricular point acupressure will be compared with a group that receives additional in-person training. After the initial four-week program, patients will be followed for up to six months.

Researchers will measure the intervention’s effects on pain intensity, interference with daily activities, and physical function. They will also look at factors such as differences in analgesic use including opioids, implementation outcomes, cost effectiveness, and predictive factors.

Serving as multiple principal investigators on the project are Jane Bolin, PhD, JD, BSN, a professor with appointments at Texas A&M’s Schools of Nursing and Public Health, and Hulin Wu, a professor in the Department of Biostatistics and Data Science at UTHealth Houston School of Public Health. Bolin, associate director of the Southwest Rural Health Research Center, will take the lead in working with Texas stakeholders to recruit patients. Wu is the Betty Wheless Trotter Professor and chair of the Department of Biostatistics & Data Science.

“In Texas, we will recruit patients in areas identified by Dr. Bolin. We hope that the program can be sustainable in those catchment areas and expand out further,” Kawi said.

Subawards will go to the University of South Carolina (USC) and Johns Hopkins University. Additional co-investigators are Peiyin Hung, PhD, associate professor in the Arnold School of Public Health at USC; Johannes Thrul, associate professor at the Johns Hopkins Bloomberg School of Public Health; and Maria Fernandez, PhD, UTHealth Houston’s vice president of population health and implementation science and the Lorne Baine Distinguished Professor of Public Health and Medicine.

Sherri Deatherage Green