The efficacy of acupressure for symptom management: a systematic review

Nausea and vomiting in early pregnancy

INTRODUCTION

More than half of pregnant women suffer from nausea and vomiting, which typically begins by the fourth week and disappears by the 16th week of pregnancy. The cause of nausea and vomiting in pregnancy is unknown, but may be due to the rise in human chorionic gonadotrophin concentration. In 1 in 200 women, the condition progresses to hyperemesis gravidarum, which is characterised by prolonged and severe nausea and vomiting, dehydration, and weight loss.

METHODS AND OUTCOMES

We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatment for nausea and vomiting in early pregnancy? What are the effects of treatments for hyperemesis gravidarum? We searched: Medline, Embase, The Cochrane Library, and other important databases up to September 2013 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).

RESULTS

We found 32 studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.

CONCLUSIONS

In this systematic review we present information relating to the effectiveness and safety of the following interventions: acupressure; acupuncture; corticosteroids; ginger; metoclopramide; ondansetron; prochlorperazine; promethazine; and pyridoxine (vitamin B6).

Gastroparesis: from concepts to management

While the symptoms of gastroparesis are common, an accurate diagnosis is based on a combination of those symptoms with a documented delay in gastric emptying. Typical symptoms include nausea, vomiting, early satiety, postprandial fullness, bloating, and abdominal discomfort. Patients with gastroparesis face many diagnostic and therapeutic challenges. The most common origins of gastroparesis are idiopathic causes and diabetes mellitus. The increased use of certain medications in medicine today, including opiates and drugs with anticholinergic properties, can alter gastrointestinal functions and mimic symptoms of gastroparesis. Accordingly, alternative explanations for symptoms and altered gastrointestinal function need to be considered. Numerous clinical sequelae, including weight loss and severe protein-calorie malnutrition, may be seen in advanced stages of gastroparesis. This article provides an overview of gut sensorimotor function to help the reader better understand the clinical presentation of patients with dyspepsia and those who may have accompanying delayed gastric emptying that meets criteria for gastroparesis. Techniques available for diagnosing motor dysfunction and the principles of gastroparesis management are reviewed. Nutrition recommendations and a review of pharmacologic agents, nonpharmacologic techniques, and novel treatment modalities are provided.

The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: a randomized controlled trial

CONTEXT

Both positive and negative results have been reported in the literature from the use of acupressure at the P6 point, providing evidence of highly suggestive but not conclusive results.

OBJECTIVES

To clarify whether acupressure is effective in the management of chemotherapy-related nausea and vomiting.

METHODS

A randomized, three-group, sham-controlled trial was designed. Patients with cancer receiving chemotherapy were randomized to receive standardized antiemetics and acupressure wristbands, sham acupressure wristbands, or antiemetics alone. Primary outcome assessment (nausea) was carried out daily for seven days per chemotherapy cycle over four cycles. Secondary outcomes included vomiting, psychological distress, and quality of life.

RESULTS

Five hundred patients were randomized. Primary outcome analysis (nausea in Cycle 1) revealed no statistically significant differences between the three groups, although nausea levels in the proportion of patients using wristbands (both real and sham) were somewhat lower than those in the proportion of patients using antiemetics-only group. Adjusting for gender, age, and emetic risk of chemotherapy, the odds ratio of lower nausea experience was 1.18 and 1.42 for the acupressure and sham acupressure groups, respectively. A gender interaction effect was evident (P = 0.002). No significant differences were detected in relation to vomiting, anxiety, and quality-of-life measures.

CONCLUSION

No clear recommendations can be made about the use of acupressure wristbands in the management of chemotherapy-related nausea and vomiting as results did not reach statistical significance. However, the study provided evidence of encouraging signals in relation to improved nausea experience and warrants further consideration in both practice and further clinical trials.

TRIAL REGISTRATION

This trial is registered with the ISRCT register, number ISRCTN87604299.

The effect of convalescent meridian acupressure after exercise on stress hormones and lactic acid concentration changes

Meridian acupressure has been used as the one way recovering body conditions. The purpose of this study was to investigate whether meridian acupressure is effective on removing cortisol, norepinephrine, epinephrine, and lactic acid in blood following exercise. The subjects were 12 healthy male college students and data were processed using SPSS 12.0 statistical program and the results were calculated by setting the significance level at P< 0.05. First, there was a significant difference between exercise recovery group except for stability group and acupressure recovery group in convalescent cortisol concentration changes after exercise (P= 0.001). And acupressure recovery group showed a significant difference compared with two groups (P= 0.001). Second, exercise recovery group showed nonsignificant difference in convalescent norepinephrine concentration changes but meridian acupressure recovery group showed a significant difference (P= 0.001). There was a significance difference in the groups rather than exercise recovery group and rest recovery group (P= 0.001). Third, exercise recovery group and acupressure recovery group showed a significant difference in convalescent epinephrine concentration changes after exercise (P= 0.001). However, rest recovery group showed nonsignificant difference. In addition, three groups showed nonsignificant difference in the groups. However, it showed in order of acupressure= exercise> rest recovery. Fourth, three groups showed a significant difference in convalescent lactic acid concentration changes after exercise (P = 0.001). And it showed in order of acupressure= exercise> rest recovery after recovery treatment in the groups (P= 0.001).

Management of hyperemesis gravidarum

Nausea and vomiting in pregnancy are common complaints and vary considerably in duration and severity. Hyperemesis gravidarum represents the extreme end of the spectrum associated with dehydration and weight loss. As embryonic organogenesis occurs during the first trimester, pharmacological intervention for any condition during this period poses a significant clinical dilemma requiring careful assessment of risks and benefits. In the UK, there are no formal national guidelines for the management of hyperemesis gravidarum. In addition, no high-quality evidence exists for i.v. fluid and electrolyte replacement in hyperemesis gravidarum, and a Cochrane review on interventions for the treatment of nausea and vomiting in pregnancy specifically excluded studies on hyperemesis gravidarum. In this article, we review the evidence for the efficacy and safety of different management options for hyperemesis gravidarum.

"Until the trial is complete you can't really say whether it helped you or not, can you?": exploring cancer patients' perceptions of taking part in a trial of acupressure wristbands

BACKGROUND

Nested qualitative studies within clinical trials provide data on patients' experiences of receiving trial interventions and can inform and improve trial designs. The present study explored patients' experiences of participating in a randomised controlled trial of acupressure wristbands for chemotherapy related nausea.

METHODS

A randomised three-group sham-controlled trial was carried out to evaluate the effectiveness of acupressure wristbands in the management of chemotherapy-related nausea. A convenience sample of 26 patients volunteered to participate in a qualitative study to explore their experiences of using acupressure wristbands, and taking part in the clinical trial. Participants were recruited from each of the three UK geographical sites from which the trial was conducted: Manchester, Liverpool and Plymouth. In-depth semi-structured interviews were conducted with the participants in their own homes or other location convenient for participating patients. Interviews were audio-taped, transcribed verbatim and analysed using Framework methodology.

RESULTS

The main motivational factors influencing participants to take part in the trial were a desire to 'give something back' and limit their own experience of nausea. Participants were largely satisfied with the organisation and running of the acupressure wristband trial. Many participants experienced positive outcomes as a result of taking part in the trial. Lapses in memory, or poor health as a result of their chemotherapy treatment, led to some participants failing to complete trial paperwork on designated days. Two sham wristband participants reported wearing the bands inappropriately resulting in pressure being applied to the acupoint. Almost all of the participants interviewed had only experienced mild nausea or vomiting during the trial. Participants were pragmatic on the extent to which the wristbands were responsible for this lack of nausea and vomiting during the trial. However, many participants, including some patients receiving sham acupressure, believed the wristbands to have had a positive impact on their nausea and vomiting; there was a perception that the wristbands were, at least in part, responsible for the lack of nausea and vomiting they had experienced.

CONCLUSIONS

Participants perceive acupressure wristbands as reducing the level of nausea and vomiting experienced during chemotherapy treatment. Reports that some participants wore wristbands inappropriately, and/or delayed completion of trial paperwork could represent confounding variables and have implications for the trial results, and the design of clinical trials within the field of cancer.

Acupressure and ginger to relieve nausea and vomiting in pregnancy: a randomized study

BACKGROUND

Nausea and vomiting of pregnancy (NVP) is the most common medical condition of pregnancy, affecting up to 85% of expecting mothers. NVP can have serious adverse effects on the quality of a woman's life, social, and domestic functioning, and her general well-being. Therefore, it is very important to treat this condition.

OBJECTIVES

The effectiveness of ginger and acupressure in the treatment of NVP was compared in the present study.

PATIENTS AND METHODS

159 eligible pregnant women with symptoms of mild to moderate nausea and/or vomiting before 16 weeks gestational age participated in a 7-day clinical trial. They were divided randomly into three groups: the acupressure, ginger, and control. Participants did not receive any intervention for three days and interventions were performed for the women in acupressure and ginger groups for four days. No intervention was performed for the control group. Data was collected by self-recorded symptoms according to the Rhodes index. Data was analyzed by ANOVA, Kruskal-Wallis, Chi-square, and Fisher exact tests for quantitative and qualitative variables.

RESULTS

There were no statistical differences in the baseline demographics between the three groups. ANOVA test showed that there were significantly differences in mean difference Rhodes index scores (vomiting, nausea, retching and total score) in the three groups (P < 0.001).

CONCLUSIONS

Ginger is more effective than acupressure to relieve mild to moderate nausea and vomiting in symptomatic pregnant women in less than 16 weeks of gestational age.

Acupressure at the Meridian Acupoint Xiyangguan (GB33) Influences Near-Infrared Spectroscopic Parameters (Regional Oxygen Saturation) in Deeper Tissue of the Knee in Healthy Volunteers

Up to now, it is still unknown whether microcirculation of deeper peripheral tissue (knee) can be modulated by acupuncture or acupressure on a meridian acupoint. The goal of this pilot study was to investigate possible effects of acupressure at the Xiyangguan acupoint (GB33) on the regional oxygen saturation of the deeper knee tissues by near-infrared spectroscopy (NIRS). Twelve healthy volunteers with a mean age of 23.8 ± 1.6 years were investigated. Acupressure stimulation was performed for 5 minutes at the Xiyangguan acupoint. The results of the controlled study showed a significant increase of the values of regional oxygen saturation on the stimulated side of the knee (P = 0.033), whereas the opposite side on the same knee showed insignificant changes. These results may serve as a valuable basis for monitoring a possible therapeutic effect (e.g., after Khalifa therapy) in patients with knee problems.

Assessing EMS scope of practice for utility and risk: the New Mexico EMS Interventions Assessment Project, Phase One results

INTRODUCTION

Few emergency medical services (EMS) interventions in New Mexico have been assessed for efficacy, potential harm, or potential benefit. There is concern that many interventions added over the years may be outdated, harmful, or ineffective in the EMS setting. A formal process for reviewing the state EMS scope of practice using literature review and expert consensus is discussed. In Phase One of the project, interventions in the New Mexico EMS scope of practice were prioritized for further review by surveying a national cadre of EMS experts to evaluate EMS interventions using a utilitarian harm/benefit metric.

METHODS

An electronic survey based on the 2010 New Mexico EMS Scope of Practice statute was administered from March through June, 2011. A national cadre of 104 respondents was identified. Respondents were either State EMS medical directors or EMS fellowship directors. Respondents were asked to rate the potential harm and the potential benefit of specific EMS interventions on a 5-point ordinal scale. Median harm and benefit scores were calculated.

RESULTS

A total of 88 completed surveys were received following 208 emailed invitations to 104 respondents (43% response rate). Twenty-two (22) highest-priority interventions (those with a harm/benefit median score ratio of >1) were identified. Seven additional second-priority interventions were also identified. These interventions will be advanced for formal literature review and expert consensus.

CONCLUSIONS

The New Mexico EMS Interventions Project offers a novel model for assessing a prehospital scope of practice.