The easiest way to understand asymmetrical distribution is of course to study musculoskeletal pain, for which we may observe different pattern combinations:
1. The most frequent is a consistent ipsilaterality as regards post-traumatic and postoperative pain, or arthritic pain disorders in single joints.
2. Secondly there is the possibility that a bilateral pain of the same area of the spine is represented asymmetrically on the auricles as in Figure 9.8. In these cases vertebral manipulation often reduces the number of tender points at PPT.
3. A third option is that bilateral pain can be recognized only on one side. Besides the possibility of a crossed action of the auricular points, as assumed by Nogier himself, there may be other reasons for explaining this phenomenon. For example, in
some cases a stress reaction or a somatization disorder could contribute to a prevalent unilateral activation of the auricle (see next section). 4. Last but not least, a symptom could be represented on the contralateral side in specific disorders such as trigeminal neuralgia or other forms of neuropathic pain.
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