Smoking is a major risk factor for morbidity and mortality. The French High Authority for Health recommends that "All health professionals must advise every smoker to stop smoking, regardless of the form of tobacco used, and offer advice and assistance to quit". The modalities of accompaniment towards quitting and support during the withdrawal period vary according to each smoker, his or her degree of motivation, the intensity of his or her dependence, and any previous attempts.
Nicotine substitutes are the first-line drug treatment, and can be part of a strategy to stop using nicotine right away or to reduce consumption with a view to quitting later. According to the opinion of the High Council of Public Health of 22 February 2016, ZYBAN and CHAMPIX can be prescribed as second-line medications for smoking cessation.
The electronic cigarette is not recommended to date as a smoking cessation aid, but can be a smoking cessation aid.
Hypnosis, cognitive and behavioral therapies, acupuncture are also used for withdrawal.
Auriculotherapy (ART) is based on the observation that treating specific points on the pinna improves some symptoms, relieves pain and anxiety. It is practiced in the context of Pain Assessment and Treatment Centers (PATC) where it is particularly effective on certain stubborn pains, in supportive care and in cancerology. It is also effective in general medicine where it provides an interesting non-drug therapeutic aid. It is also used in smoking cessation.
Auriculotherapy is taught in France within the framework of an inter-university diploma (Strasbourg- Paris XI). The doctors involved in this study have all been trained in this way and regularly use ART by integrating it into their practice within the Foch's PATC.
Cryo-auriculotherapy treatment (injection of nitrous oxide at -89°C) is a simple and powerful treatment since the effect of one session seems to last, depending on the indications, for about 1 to 4 weeks, thus reducing the number of sessions required.
We hypothesized that ART treatment by cryotherapy of specific points of the auricle could help smoking cessation.
This first proof-of-concept project, named StopAuric, is realized to validate our hypothesis on a population of motivated patients who will not use nicotine substitutes in order to measure the impact of cryo-ART alone.
It is a prospective, multicenter, controlled, single-blind, randomized study in 2 parallel groups.
Patients will be randomized into 2 groups :
* Experimental group "True Cryo-auriculotherapy": Patients will be treated with auriculotherapy with N2O (nitrogen) projection on specific smoking cessation points.
* "Sham" control group: the patients will be treated according to the same scheme as the experimental group with a technique without N2O (sham cryotherapy), but with the presence of the propellant gaz.
Responses to the Hospital Anxiety and Depression Scale (HADS), Patient Global Impression of Change questionnaire (PGIC) self-questionnaires, satisfaction VAS, possible weight gain, smoking consumption, and measurement of exhaled Carbon mOnoxide (CO) and urinary cotinine will be collected at one month.
Patients will be able to say whether or not they wish to continue the same treatment.
If this proof-of-concept study is positive regarding the interest of an ART session in smoking cessation, we planned to initiate a larger study (named Auriculo-TABAC) evaluating the value of a complete ART treatment program in smoking cessation.
This largest study will treat patients of the experimental arm with CryoAuriculotherapy over 3 sessions (D0, D30 and D60).
The expected effect of smoking cessation will be evaluated at 3 and 6 months.
