Tobacco smoking is one of the most significant preventable lifestyle risk factors, causing a wide range of diseases and causing harm to millions of people worldwide. Nicotine replacement treatment (NRT) and behavioral counseling have long been used to help people quit smoking. However, because pharmacologic and behavioral therapy only have a 22% to 45% success rate in smoking cessation, a systematic review and meta-analysis was conducted to evaluate ear acupuncture’s usefulness as an adjunct to nicotine replacement therapy and behavioral counseling for smoking cessation.

This systematic review only included randomized controlled trials which involved current smokers aged 19 years or older, and who were in the contemplation stage according to the Transtheoretical Model of Intentional Behavior of Change. The RevMan 5 software was used in the analysis of data. The primary outcome that was measured is the rate of continuous abstinence based on participant/patient report at the end of treatment and secondary outcome of the study was reporting of nicotine withdrawal symptoms.

Of the 1,661 identified records, only 2 studies were included (both RCTs) in the meta- analysis. The studies were rated with low to unclear selection bias and high risk of performance bias. The pooled estimates of effect were statistically significant in favor of ear acupuncture plus counseling (standard therapy), RR= 2.28, 95% CI 1.27, 4.08, p= 0.006, I2= 0%. Nicotine withdrawal symptoms were noted to be less pronounced in those who received the intervention of ear acupuncture even after 3 months post-treatment. The evidence was graded as low quality, indicating that more research is needed and would extremely likely have a significant impact on confidence in the estimate of effect.

The results of this systematic review and meta-analysis suggest that ear acupuncture produces an additive benefit on counseling (standard of care) as a means of smoking cessation. Future research should be conducted using RCTs of a high quality in order to address the substantial risk of bias that was present in the studies that were included and to improve the quality of the evidence.