Smoking Cessation and Traditional Complementary Medicine Interventions, including Acupuncture and Aromatherapy

By Dr. Soobin Jang

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Smoking is the main cause of preventable deaths worldwide, and 6 million deaths a year are related to tobacco use.1 Smoking is associated with nearly every cancer and many types of chronic diseases, such as coronary artery disease, stroke and asthma.2 Tobacco-related deaths are expected to increase by 8 million by 2030 if effective smoking cessation policies are not implemented.1

Recently, traditional and complementary medicine (T&CM) methods, especially acupuncture, have gained attention in many countries as therapeutic interventions for smoking cessation. In an American trial,3 40% of smokers who had been treated with acupuncture successfully ceased smoking. In a Norwegian trial,4 the experimental group received acupuncture treatment at the ‘Shenmen’, ‘Mouth’ and ‘Liver’ acupoints of the ear, and treating points LU6 (Kongzui) and LU7 (Leique) led to significant changes in the taste of cigarettes and desire to smoke compared with the control group, who had been treated at different acupoints.

This clinical trial aims to verify the effectiveness of acupuncture and aromatherapy in combination with nicotine replacement therapy (NRT) and counselling, which are standard regimens applied for smoking cessation. The intervention of this trial is referred to as the ‘T&CM tobacco control programme’, which involves a combination of ear and body acupuncture, aromatherapy, NRT and counselling. NRT and counselling have been widely used in conventional Western medicine in addition to such drugs as varenicline and bupropion.5 In this T&CM tobacco control programme, ear acupuncture, body acupuncture and aromatherapy will be applied instead of Western interventions for smoking cessation. The primary objective of this trial is to evaluate whether the smoking cessation success rate increases with the application of the T&CM tobacco control programme. The secondary objective is to evaluate the satisfaction of the participants in the T&CM tobacco control programme. This study represents the second research result of our STOP (Stop Tobacco Programme using traditional Korean medicine) study series.

The intervention group will receive acupuncture treatment on body acupoints and ear acupoints. The intervention group will be treated seven times during the treatment period on both sides of the HT7 (Shenmen), LI4 (Hegu), ST36 (Zusanli), LU7 (Lieque) and LU6 (Kongzui) acupoints. Acupoints may be added depending on each participant at the doctor’s discretion. Acupoints will be needled after disinfection. Stimulation will be performed for 20 min by a qualified Korean medical doctor with 6 years of training in Korean medicine and more than 5 years of clinical experience. Sterile needles (Dongbang, South Korea), 0.20×30 mm in size, will be used for treatment. The intervention group will receive ear acupuncture treatment a total of seven times at the ‘Shenmen’, ‘Lung’, ‘Pharynx’, ‘Trachea’ and ‘Endocrine’ acupoints. Needle stimulation will alternate between the right and left sides. The ear acupuncture sites will be patched until the next visit. In the event that a visit is delayed for more than 3 days, the participant will be instructed to remove the intradermal ear acupuncture himself/herself. Participants will be instructed to self-stimulate the acupoints three to six times a day to reduce the desire to smoke. Intradermal needles (Dongbang), 0.2×1.5 mm in size, will be used for the treatment.

Participants in the intervention group will be provided with bottles containing 20 mL of mixed oil to aid control of their tobacco use. The composition of the blended oil will be four drops each of lavender, peppermint and rosemary (Tisserand, UK) in 15 mL of jojoba oil (Tisserand). Participants will be instructed to frequently self-massage one to two drops of the blended aroma oil behind their ears.

Nicotine dependence is recognised as a disease, and smoking behaviour falls under the category of ‘mental and behavioural disorders due to psychoactive substance use’ according to the International Classification of Diseases 10th revision.13 It is necessary to access to smoking cessation in terms of medical treatment. The US Preventive Services Task Force strongly recommends that doctors should intervene to help patients cease smoking by prescribing treatments approved by the Food and Drug Administration, such as NRT and bupropion, if needed.14

This study will investigate the effectiveness of T&CM for smoking cessation. The study is designed to be a pragmatic, randomised controlled trial because excessively controlling other conditions does not reflect real clinical conditions.15 The control group will be provided conventional treatments, including NRT and counselling, because not treating the control group would cause ethical issues and increase the dropout rate. As it is difficult to cease smoking successfully with a single intervention, multiple interventions will be administered to the participants.16 This will help increase the effects of the interventions as well as promote participant compliance. As successful smoking cessation typically does not last long, we will evaluate success rates by performing five follow-up assessments.

The main intervention of this trial is acupuncture.17 Frequently used body acupoints for cessation treatment in the literature include HT7 (Shenmen),18–20 LI4 (Hegu),3 21 ST36 (Zusanli),21–23 LU7 (Lieque)4 21 and LU6 (Kongzui).24 According to the guidelines on acupuncture treatment and counselling for smoking cessation, the ‘Shenmun’, ‘Lung’, ‘Endocrine’, ‘Pharynx’, ‘Trachea’, ‘Mouth’ and ‘Inner-nose’ ear acupoints are recommended for cessation treatment.25 In addition, some clinical trials have demonstrated the effects of auricular acupuncture treatment for smoking cessation.26–28 Aromatherapy can also play a role in relieving withdrawal symptoms. Lavender oil29 30 and rosemary oil30 31 help reduce anxiety after cessation, and peppermint oil31 can relieve symptoms of respiratory discomfort, such as phlegm and cough. NRT and counselling will be applied to both the intervention and control groups as conventional treatments. This trial is designed such that the T&CM tobacco control programme, including acupuncture, aromatherapy, NRT and counselling, will be provided to the intervention group to raise the cessation rate.