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    • Acupuncture for nausea
      • What is Acupuncture?
      • How well does Acupuncture work?
      • Is Acupuncture safe?
      • Acupuncture conclusions
    • TCM for pancreatic cancer
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How well does Acupuncture work?

Systemic efficacy (acupuncture compared to no treatment or other treatments)

Acupuncture:
Acupuncture of P6 has been compared to no treatment in two clinical trials (ref 1, 2). In one trial 39 rheumatologic patients given cyclophosphamide were treated with ondansetron to reduce nausea and vomiting (ref 1). In a design where patients acted repeatedly as their own controls, they were also treated with acupuncture during some of their chemotherapy sessions. The results show that both the severity of nausea and the number of bouts of vomiting were significantly lower when acupuncture was given in addition to ondansetron. Seventy-two hours after the cyclophosphamide infusion, 20% of the patients still had severe vomiting and 10% experienced 10 to 25 bouts of vomiting per day when not given acupuncture, while only 8% had severe vomiting and none experienced 10 to 25 bouts of vomiting when they also were given acupuncture. The other trial consisted of 104 "high-risk" breast cancer patients undergoing standard chemotherapy (ref 2). They were randomised to three treatment arms: low-frequency electroacupuncture, minimum needling at control points, and no adjunct needling. The results showed that the electroacupuncture group experienced significantly fewer five-day emesis episodes (5 versus 15) when compared to the no needling group.

Accupressure:
Acupressure of P6 has been compared to no treatment, or other treatment, in four trials (ref 3-6). Two trials included less than ten patients in every treatment group, and were not evaluated further (ref 5, 6). One large trial included 739 patients with mainly breast and haematological cancers undergoing chemotherapy (ref 3). Patients randomised to an acupressure wristband experienced significantly less severe nausea on the first day of treatment compared to the no treatment group (2,6 versus 3,0 on a scale from 1 to 7), but no difference was seen on the subsequent days. The fourth trial included stomach cancer patients (n=40) undergoing chemotherapy and treated with standard anti-emetic treatment (ref 4). The intervention group applied self-acupressure manually, while the controls received no therapy. The intervention group did significantly better during the five-day follow up. On the 5th day they experienced less severe nausea and vomiting (6.05 versus 9.55 on a scale from 0 to 10), shorter duration of nausea and vomiting (1.70 versus 4.25 hours), and less frequent nausea and vomiting (0.3 versus 0.9 times).

Component efficacy (acupuncture compared to placebo treatment)

Acupuncture:
Acupuncture of P6 has been compared to placebo treatment in two trials (ref 2, 7). The first trial consisted of 104 "high-risk" breast cancer patients undergoing standard chemotherapy (ref 2). They were randomised to three treatment arms: low-frequency electroacupuncture, minimum needling at control points, and no adjunct needling. The results showed that the electroacupuncture group experienced significantly fewer five-day emesis episodes (10 versus 15) when compared to the minimum needling group. The other trial included 80 cancer patients treated with high-dose chemotherapy and autologous peripheral stem cell transplantation treated with ondansetron to reduce nausea and vomiting (ref 7). In a single-blind placebo-controlled design the patients were randomised either to verum or placebo (telescopic needle) acupuncture. The results show no difference in the severity of nausea and the number of bouts of vomiting when acupuncture was given in addition to ondansetron. One additional study (ref 8) was not included in the evaluation because they had added up three sub-trials (among them the pilot study) into one combined trial.

Acupressure:
Acupressure of P6 has been compared to placebo treatment in two trials (ref 6, 9). One of these included less than ten patients in each treatment group, and was not evaluated further (ref 6). The other trial included 49 cancer patients with a variety of diagnoses undergoing standard chemotherapy. The intervention group wore an acupressure wristband, while the control group wore an identical-looking inactive wristband. The intervention group did significantly better during the five-day follow up on severity of nausea and vomiting (1.54 versus 3.1 on a scale from 0 to 10), and retching episodes (1.4 versus 3.6).

Biologic mechanism

Two human studies measuring gastric myoelectric activity and tachyarrhythmia showed conflicting results (ref 10, 11). A recent study on a dog model monitoring gastroduodenal motor activity by four implanted force transducers on the serosal surfaces of the gastric body, antrum, pylorus, and duodenum, showed that stimulation by electroacupuncture of P6 significantly suppressed vasopressin-induced retrograde peristaltic contractions (ref 12). The anti-emetic effect of was abolished by pre-treatment with naloxone but not naloxone methiodide. It is therefore suggested that the anti-emetic effect of acupuncture is mediated via the central opioid pathway.

Meta-analysis of system and component efficacy

The meta-analysis generally agrees with the above-mentioned findings on efficacy (ref 13). It did not, however, differentiate between systemic and component efficacy for acupuncture and acupressure. The summary indicators of effect suggest effect on certain aspects of the nausea and vomiting associated with chemotherapy, but studies with state-of-the-art anti-emetics as well as with a placebo control are needed for determining clinical relevance.

References

1. Josefson A, Kreuter M. Acupuncture to reduce nausea during chemotherapy treatment of rheumatic diseases. Rheumatology 2003;42:1149-54.

2. Shen JN, Wenger N, Glaspy J, Hays RD, Albert PS, Choi C et al. Electroacupuncture for control of myeloablative chemotherapy-induced emesis - A randomized controlled trial. JAMA 2000;284:2755-61.

3. Roscoe JA, Morrow GR, Hickok JT, Bushunow P, Pierce HI, Flynn PJ et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting - A University of Rochester Cancer Center Community Clinical Oncology Program Multicenter Study. Journal of Pain and Symptom Management 2003;26:731-42.

4. Shin YH, Kim TI, Shin MS, Juan HS. Effect of acupressure on nausea and vomiting during chemotherapy cycle for Korean postoperative stomach cancer patients. Cancer Nursing 2004;27:267-74.

5. Dibble SL, Chapman J, Mack KA, Shih AS. Acupressure for nausea: results of a pilot study. Oncology Nursing.Forum 2000;27:41-7.

6. Roscoe JA, Morrow GR, Bushunow P, Tian L, Matteson S. Acustimulation wristbands for the relief of Chemotherapy-induced nausea. Altern Ther Health Med 2002;8;40-3.

7. Streitberger K, Friedrich-Rust M, Bardenheuer H, Unnebrink K, Windeler J, Goldschmidt H et al. Effect of acupuncture compared with placebo-acupuncture at P6 as additional antiemetic prophylaxis in high-dose chemotherapy and autologous peripheral blood stem cell transplantation: A randomized controlled single-blind trial. Clinical Cancer Research 2003;9:2538-44.

8. Dundee JW, Ghaly RG, Fitzpatrick KT, Abram WP, Lynch GA. Acupuncture prophylaxis of cancer chemotherapy-induced sickness. J.R.Soc.Med. 1989;82:268-71.

9. Treish I, Shord S, Valgus J, Harvey D, Nagy J, Stegal J et al. Randomized double-blind study of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy. Supportive Care in Cancer 2003;11:516-21.

10. Hu S, Stritzel R, Chandler A, Stern RM. P6 acupressure reduces symptoms of vection-induced motion sickness. Aviat.Space.Environ.Med. 1995;66:631-4.

11. Miller KE, Muth ER. Efficacy of acupressure and acustimulation bands for the prevention of motion sickness. Aviat.Space.Environ.Med. 2004;75:227-34.

12. Tatewaki M, Strickland C, Fukuda H, Tsuchida D, Hoshino E, Pappas TN et al. Effects of acupuncture on vasopressin-induced emesis in conscious dogs. American Journal of Physiology-Regulatory Integrative and Comparative Physiology 2005;288:R401-R408.

13. Ezzo J, Vickers A, Richardson MA, Allen C, Dibble SL, Issell B et al. Acupuncture-Point Stimulation for Chemotherapy-Induced Nausea and Vomiting. J Clin Oncol 2005;23:7188-98