Cizik School of Nursing at UTHealth Houston awarded grant to advance chronic pain management in rural communities through auricular point acupressure

Jennifer Kawi, PhD, MSN (left), professor of research with Cizik School of Nursing, received the grant from the National Center for Complementary and Integrative Health and the National Institute of Neurological Disorders and Stroke.

Large-scale testing of self-managed auricular point acupressure for non-pharmaceutical pain management in rural communities is the focus of a new federal grant awarded to researchers with Cizik School of Nursing at UTHealth Houston.

Jennifer Kawi, PhD, MSN, professor of research with Cizik School of Nursing, received the grant (UG3AT012728) from the National Center for Complementary and Integrative Health and the National Institute of Neurological Disorders and Stroke. The first year grant amount, part of the National Institutes of Health’sHelping to End Addiction Long-term® Initiative, is $817,483.

Auricular point acupressure involves stimulating pressure points on the ear using similar acupuncture points.

“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,” said Kawi, who also holds the title of Lee and Joseph Jamail Distinguished Professor. “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 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, and performance checks.

“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, nonopioid 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 community health workers.

In subsequent years of the grant, 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 up for 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, senior professor of research with the College of Nursing at Texas A&M University, and Hulin Wu, PhD, professor of biostatistics and data science with D. Bradley McWilliams School of Biomedical Informatics at UTHealth Houston School of Public Health. Bolin 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 and Data Science.

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

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 Bloomberg School of Public Health at Johns Hopkins University; and María Fernández, PhD, professor and Lorne Bain Chair in Public Health and Medicine at School of Public Health at UTHealth Houston.

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

“Yeh was foundational in moving the science forward on auricular point acupressure,” said Kawi. “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 joined UTHealth Houston 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.

Constance Johnson, PhD, MS, RN, associate dean for research with Cizik School of Nursing, 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.

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