The technique, known as auricular point acupressure, or APA, is rooted in auricular therapy, a branch of traditional practice that maps regions of the ear to neurological and somatic pathways involved in pain modulation. In the trial, participants wore tiny vaccaria seeds adhered to predefined auricular points for four weeks and were instructed to press the seeds daily to stimulate the points. The researchers tested two delivery models: a mobile-supported version, called mAPA, in which participants received in-person seed placement and hands-on training reinforced by smartphone instructions and Zoom-based coaching, and a fully virtual version, called vAPA, in which participants learned the technique through standardized instructional videos and remote guidance via a mobile application. Both approaches were designed to be scalable, requiring no ongoing clinical visits once the intervention was underway.

The new report is a prespecified secondary analysis of a three-arm randomized wait-list controlled trial in which 227 adults with moderate or greater CIN were assigned to mAPA, vAPA, or usual care. Because participants in the usual care group were ethically offered APA after their four-week control period, the follow-up phase had no untreated comparison group. The durability analysis therefore focused on the 155 participants who had received one of the two APA variants during the initial randomized phase—80 in the mAPA group and 75 in the vAPA group—and tracked their symptom trajectories at one, two, and three months after the intervention ended. All participants had received neurotoxic chemotherapy and reported pain, numbness, or tingling of at least four on an eleven-point scale at study entry.

The primary outcome was symptom severity measured with an individualized composite outcome, or ICO, derived from the Modified Brief Pain Inventory–Chemotherapy-Induced Neuropathy instrument. For each participant, the ICO captured the single worst symptom-location combination at baseline, providing a personalized anchor for tracking change. The secondary outcome was CIN interference, which measures how much neuropathy disrupts daily activities, mood, walking, work, relationships, sleep, and enjoyment of life. Both scales run from zero to ten, which makes the magnitude of change clinically interpretable: a one- to three-point reduction on such scales is generally considered meaningful for patients.

The results were striking in their consistency. In the mAPA group, ICO scores fell by 3.10 points at one month, 3.36 points at two months, and 3.61 points at three months relative to baseline, with all comparisons reaching statistical significance at p less than 0.001. The vAPA group showed nearly parallel improvements, with reductions of 2.88, 2.90, and 3.21 points at the same time points. Interference scores followed the same pattern, dropping by roughly 1.2 to 1.6 points across follow-up in both groups. Crucially, there was no evidence of symptom worsening at any point after treatment ended, and numerical improvements actually continued to accrue over time, particularly among participants receiving the mobile-supported version. Sensitivity analyses using complete-case data without imputation confirmed the same patterns.

Statistically, the team used generalized estimating equations to account for the correlation among repeated measurements within individuals, and addressed missing data with multilevel multiple imputation that incorporated baseline characteristics and outcome variables. This matters because attrition was substantial, especially in the virtual arm: follow-up completion at one, two, and three months was 62.5, 51.3, and 48.8 percent for mAPA but only 34.7, 30.7, and 25.3 percent for vAPA. Participants with missing data had similar baseline symptom severity to those retained, which offers some reassurance, but the authors are candid that the heavy reliance on imputed values warrants cautious interpretation of the precision of the estimates.

The durability question is scientifically important for a specific reason. In nonpharmacologic and behavioral interventions, improvements measured immediately after treatment can partly reflect expectancy effects, attention, or the novelty of engagement rather than a genuine therapeutic signal. By showing that symptom reductions were maintained—and even deepened—months after the seeds came off and the coaching stopped, the study provides evidence that the benefit was not merely a transient placebo response. The findings also align with a growing literature: a separate randomized trial of APA for chronic low back pain in older adults found benefits maintained up to six months, and auricular acupressure studies in diabetic peripheral neuropathy, a condition sharing many symptoms with CIN, have reported persistent reductions in neuropathic pain and improvements in quality of life.

The clinical context makes these results especially compelling. Current guidelines identify duloxetine as the only pharmacologic therapy with sufficient evidence for painful CIN, and even its benefits are modest, leaving many patients with residual symptoms. Recent systematic reviews conclude that evidence supporting most other pharmacologic and nonpharmacologic interventions remains limited or inconsistent. Against that backdrop, APA stands out as a low-risk, noninvasive, and inexpensive option that patients can administer themselves at home. The fact that both the in-person-supported and the fully virtual formats produced sustained improvements suggests the therapy could be scaled to reach survivors who lack access to specialty supportive care, an increasingly relevant consideration as digital health expands across cancer survivorship.

Yet the study’s limitations temper enthusiasm. Without an untreated concurrent control group during follow-up, the maintained improvements cannot be definitively attributed to APA rather than natural recovery, regression to the mean, or expectancy effects. Adherence to the technique after the intervention was not systematically monitored, so some participants may have continued practicing or adopted other strategies. The three-month follow-up window leaves open whether benefits persist longer or whether booster treatments would be needed. Outcomes were primarily patient-reported, so the study cannot confirm whether subjective improvements corresponded to measurable neurological changes, although the parent trial collected objective sensory testing that may inform future analyses. Attrition was also higher in the virtual arm, and the authors suggest that hybrid models combining remote delivery with brief human support may better sustain engagement.

Even with those caveats, the study represents a meaningful step toward addressing one of oncology’s most persistent unmet needs. Roughly a third of colorectal cancer survivors treated with oxaliplatin still experience neuropathy five years after treatment, with minimal spontaneous improvement, underscoring how desperately durable solutions are needed. A four-week course of ear seeds, pressed daily by the patient’s own fingers, that keeps working for at least three months afterward is an appealing proposition precisely because it is so simple. Larger trials with longer follow-up, untreated comparison groups, and objective outcome measures are now required to confirm the effect and define APA’s place in survivorship care. But if the findings hold, a technique that costs pennies and requires no prescription could become a genuine tool for the millions of survivors living with chemotherapy’s longest shadow.

Subject of Research: Sustained effects of auricular point acupressure on chemotherapy-induced peripheral neuropathy in cancer survivors

Article Title: Sustained effects of auricular point acupressure on chemotherapy-induced neuropathy: a randomized controlled trial follow-up study

Article References: Lukkahatai, N., Jiang, Y., Zhang, J., Kawi, J., Wu, H., Wang, H., Campbell, C. M., Thrul, J., Abdi, S., Hacker, E. D., Johnson, C. M., & Smith, T. J. (2026). Sustained effects of auricular point acupressure on chemotherapy-induced neuropathy: a randomized controlled trial follow-up study. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-026-02104-3

Image Credits: AI Generated

DOI: 10.1007/s11764-026-02104-3

Keywords: chemotherapy-induced neuropathy, auricular point acupressure, acupressure, auriculotherapy, randomized controlled trial, cancer survivorship, neuropathic pain, nonpharmacologic intervention, self-management, digital health, ear seeds, symptom management

Preoperative anxiety in children is far more than a momentary bout of nerves. Decades of pediatric anesthesia research, including classic work by Vernon and colleagues in the 1960s and the influential studies of Zeev Kain, have documented that anxious children are harder to anesthetize, may require more sedative medication, and are at increased risk of negative behavioral changes after hospitalization, including nightmares, separation difficulties, and new-onset bedtime fears. Estimates suggest that well over half of children undergoing elective surgery experience clinically significant anxiety in the preoperative holding area. Because pharmacologic sedation carries its own risks and costs, nonpharmacologic approaches, from parental presence during anesthesia induction to therapeutic medical play and virtual reality distraction, have become a major focus of pediatric perioperative care research.

The research team, led by Jun-Qing Chen and Wei-Fang Zhang, designed their intervention around what children themselves say they want to know. In an earlier qualitative study of Chinese school-age children awaiting elective surgery, the same group found that children consistently reported gaps in their understanding of what would happen to them: why they needed the operation, what the operating room would look like, whether the surgery would hurt, and when they would see their parents again. Rather than delivering that information through a lecture or a pamphlet, which children often ignore or misinterpret, the researchers embedded it in a card game, allowing children to absorb procedural knowledge through play, repetition, and social interaction with trained facilitators.

The trial enrolled children scheduled for elective surgery and randomly assigned them to either the card game intervention or a usual-care control group. Anxiety was assessed with validated instruments, including the modified Yale Preoperative Anxiety Scale, an observational tool that scores behaviors such as vocalizations, emotional expressivity, state of apparent arousal, and use of parents as a source of comfort, together with self-report measures including Chinese versions of the State-Trait Anxiety Inventory. The researchers report that children in the intervention arm displayed significantly lower anxiety scores than controls in the preoperative period, indicating that the game-based preparation translated into measurably calmer behavior at the point where anxiety typically peaks, immediately before transport to the operating room.

The psychology underlying why a simple card game might outperform standard verbal preparation is rooted in several well-established mechanisms. First, play is the natural language of childhood; children process frightening information more readily when it is presented through symbolic, interactive formats rather than abstract explanations. Second, the game provides cognitive control: by turning the surgical journey into a set of cards to be mastered, questions to be answered, and rounds to be won, it converts a passive, threatening experience into an active, comprehensible one. Third, therapeutic play reduces uncertainty, which is a core driver of anxiety. A child who knows what the anesthesia mask feels like, who will be present, and roughly how long everything will take has fewer unknowns to catastrophize about. Finally, the social dimension matters. Playing with a facilitator or peers engages emotion regulation, normalizes the hospital environment, and gives the child a brief, positive relational experience inside an otherwise intimidating setting.

The findings arrive amid a growing evidence base for game-based interventions in pediatric care. A 2022 systematic review and meta-analysis by Suleiman-Martos and colleagues concluded that game-based interventions significantly reduce preoperative pain and anxiety in children, and a 2023 umbrella review by Agüero-Millan and coauthors found moderate evidence supporting nonpharmacologic interventions more broadly. Other trials have tested incentive-based games, group medical play sessions, and immersive virtual reality, with the latter showing striking results for procedures such as venipuncture. What distinguishes the new study is its simplicity and low cost. A deck of cards requires no screens, no software licenses, no charging infrastructure, and no technical support, making it potentially deployable in resource-limited hospitals and rural clinics where virtual reality headsets are out of reach.

The trial was grounded in the emerging discipline of child life services, which the authors have described elsewhere as the heartbeat of healing in pediatric care. Child life specialists use developmentally appropriate preparation, therapeutic play, and coping support to help children navigate medical experiences, a model that is well established in North America but still developing in many parts of Asia. By demonstrating in a rigorous randomized design that a structured play intervention measurably reduces preoperative anxiety, the Hangzhou team provides local evidence that child life principles can be adapted to the Chinese healthcare context using culturally appropriate materials, potentially accelerating the adoption of psychosocial support services in pediatric units across the region.

Methodologically, the study reflects careful attention to ethics and measurement. It was approved by the Ethics Committee of Children’s Hospital, Zhejiang University School of Medicine, and written informed consent was obtained from parents, with written assent from children aged eight and above and verbal assent from younger children. The use of both observer-rated and self-report anxiety instruments strengthens the findings, since children’s self-assessments and clinician observations can diverge, and converging measures reduce the risk that an apparent benefit reflects measurement artifact. The authors note no conflicts of interest, and the study was funded by the Medical Technology and Education program of Zhejiang Province. The datasets generated in the trial are not publicly available because of privacy and ethical restrictions but can be requested from the corresponding authors.

Like all single-center trials, the study has limits that will shape future work. The sample was drawn from one large children’s hospital, and it remains to be seen whether the same card game performs equally well across different age bands, surgical types, and cultural settings. The trial did not, based on the published report, examine downstream outcomes such as anesthesia induction compliance, postoperative analgesic requirements, or emergence delirium, which are the natural next endpoints for testing whether calmer children before surgery translate into safer and smoother operations afterward. Larger multicenter trials and implementation studies will be needed to determine how the intervention integrates into busy preoperative workflows and whether benefits persist across repeated hospital encounters.

Even so, the message for clinicians and parents is strikingly practical. At a moment when hospitals are investing heavily in digital distraction technology, one of the most effective tools against a child’s fear of surgery may be a deck of cards and twenty minutes of guided play. The intervention requires no anesthesia expertise, can be delivered by nurses or trained volunteers, and costs little enough to be sustainable at scale. For the millions of children who undergo elective surgery worldwide each year, a simple game that helps them understand what is coming may do more than win a round: it may quietly reset one of the most stressful experiences in pediatric medicine, replacing fear with familiarity, one card at a time.

Subject of Research: Effectiveness of a card game-based intervention in reducing preoperative anxiety in children

Article Title: Effectiveness of a card game-based intervention in alleviating preoperative anxiety in children: a randomized controlled trial

Article References: Chen, J.-Q., Sun, R.-Y., Wang, Y., Lin, N., Ye, X., Wang, D., Wu, X.-H., Qiu, F., Xu, H.-Z., & Zhang, W.-F. (2026). Effectiveness of a card game-based intervention in alleviating preoperative anxiety in children: a randomized controlled trial. World Journal of Pediatrics. https://doi.org/10.1007/s12519-026-01097-4

Image Credits: AI Generated

DOI: 10.1007/s12519-026-01097-4

Keywords: preoperative anxiety, children, card game intervention, pediatric surgery, randomized controlled trial, therapeutic play, child life services, pediatric anesthesia, nonpharmacologic intervention, World Journal of Pediatrics, modified Yale Preoperative Anxiety Scale, Zhejiang University