Falsepositive And Falsenegative Auricular Diagnosis

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This is probably the most complex problem that the therapist has to overcome to get the correct information about a patient's health problems.

A false-positive diagnosis in an asymptomatic subject is probably less confounding for the practitioner than a false-negative diagnosis in a patient with various known ailments. In the former the

Fig. 9.4 Tender points of the ear lobe of a 52-year-old female patient with current vertigo attack. One tender point coincides with the scar of piercing.

identified auricular areas may be the representation of parts of the body which have been injured in the past, leaving almost no after-effects. A second possibility is the detection of a tendency to allergy or food intolerance, or a predisposition to diabetes and hypertension, when these disorders are shared by other members of the patient's family. A third possibility is that of indicating hitherto unexpressed stress-related symptoms or somatization disorders in apparently healthy subjects.

A false-negative diagnosis is much more limiting and frustrating for the practitioner when the patient is affected by a series of different diseases. The suspicion arises especially when PPT and ESRT identify points which do not fit at all with the patient's current or past problems. Another possibility is that PPT and ESRT may show a particularly low number of points (average <2) which keep the practitioner from making a sufficient diagnosis. Different reasons can explain this, for example a particularly high pain threshold at PPT or the particularly high electrical skin resistance of the subject.

However, I have long been aware of the possibility that some specific drugs may interfere with auricular diagnosis. Ceccherelli et al6 examined two groups of patients affected by disorders of the upper digestive system, scheduled to undergo endoscopy of the esophagus, stomach and duodenum the following day. The first group was under regular treatment with benzodiazepines; the second was not taking any medication of this type. The author found a fivefold higher number of tender points in the second group. Ceccherelli's conclusions were that in clinical practice we must investigate if a patient is taking benzodiazepines for any reason; in that case auricular diagnosis is not reliable.

The drop of points with PPT was explained by the author by the decrease of reactivity to nocicep-tive afferents shown by this class of drugs on the central nervous system. Despite the great difference in the half-life of drugs such as diazepam, lorazepam, triazolam, etc., administered with both a sedative and a hypnotic objective, the disappearance of tender points still took place.

In several further studies we (Romoli and Van der Windt) tried to control this interference by excluding from the clinical trial patients who had taken antidepressants or benzodiazepines less than 12 hours previously or NSAIDs less than 6-8 hours previously.7 The aim was to avoid a false-negative detection of auricular points in the group to be treated with ear acupuncture, but the temporal range proposed was based only on clinical impressions. It is indeed rather difficult, outside an experimental setting, to calculate the real half-life of a drug in every patient.

For instance, it is interesting to notice how unpredictable the interference of nimesulide is on PPT and ESRT in patients with musculoskeletal pain disorders. Some subjects still show a reduced number of tender points 48 or 72 hours after the intake of 100 mg of nimesulide. The auricular findings in these patients are, however, consistent with their statement that they are able to control pain only with two or three doses a week. Some other drugs can have further unpredictable effects, for example antihypertensive drugs or aspirin, even in low doses (100 mg). In general, every drug may interfere specifically with the auricular diagnosis of areas related to the symptom which the drug is supposed to cure. This aspect has, however, to be checked if we are planning, for example, to combine ear acupuncture with drugs with the intention of reducing the amount of drug needed to maintain the same therapeutic effect, as in the following case.

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