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Effect of acupressure on nausea and vomiting during pregnancy: A randomized, placebo-controlled, pilot study
Abstract
To compare the antiemetic effect of acupressure at the Neiguan point (P6) in a group of healthy women with normal pregnancy and nausea and vomiting during pregnancy (NVP) with a similar group receiving acupressure at a placebo point and another, similar group not receiving any treatment.
A randomized, placebo-controlled, pilot study involving 60 women.
It is possible to reduce NVP significantly with acupressure at P6 as compared to acupressure at a placebo point or no treatment at all in healthy women with normal pregnancies. Relief from nausea appeared one day after starting treatment in both the P6 and placebo groups but lasted for only six days in the placebo group. The P6 group, however, experienced significantly less nausea after 14 days as compared to the other two groups.
This study involved 60 healthy women with normal pregnancy and suffering from NVP. According to the results, in healthy women with normal pregnancy it is possible to reduce NVP significantly at P6 as compared to acupressure at a placebo point and to no treatment.
... When assessing the final sample of articles included, it is observed that the five countries that most published on the subject were Iran (n = 9) (13,(23)(24)(25)(26)(27)(28)(29)(30) , Thailand (n = 4) (6,15,31,32) , United States of America (n = 4) (33)(34)(35)(36) , Australia (n = 4) (37)(38)(39)(40) and Canada (n = 4) (41)(42)(43)(44) . An article was not published in English (25) , and the studies were published between 1988 and 2020. ...
... The studies analyzed used random allocation. However, most studies (n = 21) (13,15,23,(25)(26)(27)(28)(29)(30)33,34,(39)(40)(41)(42)(43)45,(48)(49)(50)(51) partially reported the mode of execution of allocation (e.g., software), and did not describe how it was concealed (n = 18) (13,(24)(25)(26)(27)(28)(29)32,33,35,38,39,41,45,(47)(48)(49)51) (e.g., opaque envelope). It is also added that six studies detailed some form of masking (13,(23)(24)(25)33,41) . ...
... It is also added that six studies detailed some form of masking (13,(23)(24)(25)33,41) . Most clinical trials (n = 19) reported some form of blinding (6,15,23,25,(27)(28)(29)(30)(34)(35)(36)(37)(38)(39)41,43,46,47,49) , either from intervention applicators or evaluators. ...
Objective
to synthesize the evidence available in the literature on the effects of integrative and complementary practices in nausea and vomiting treatment in pregnant women.
Method
a systematic review, reported according to PRISMA and registered in PROSPERO. The search for studies was carried out in 11 databases. To assess risk of bias in randomized clinical trials, the Cochrane Collaboration Risk of Bias Tool (RoB 2) was used.
Results
the final sample consisted of 31 articles, divided into three categories: aromatherapy, phytotherapy and acupuncture. It was observed that aromatherapy with lemon essential oil, ginger capsules, pericardial 6 point acupressure were the interventions that proved to be effective. Less than half of studies reported adverse effects, with mild and transient symptoms predominating. Most articles were classified as “some concern” in risk of bias assessment.
Conclusion
the three most effective interventions to control gestational nausea and vomiting were aromatherapy, herbal medicine and acupuncture, with significant results in the assessment of individual studies.
DESCRIPTORS
Pregnancy; Nausea; Vomiting; Complementary Therapies; Systematic Review
... Ao avaliar a amostra final de artigos incluídos, observa-se que os cinco países que mais publicaram a respeito do tema foram Irã (n = 9) (13,(23)(24)(25)(26)(27)(28)(29)(30) , Tailândia (n = 4) (6,15,31,32) , Estados Unidos da América (n = 4) (33)(34)(35)(36) , Austrália (n = 4) (37)(38)(39)(40) e Canadá (n = 4) (41)(42)(43)(44) . Um artigo não foi publicado no idioma inglês (25) , e os estudos foram publicados entre 1988 e 2020. ...
... Os estudos analisados utilizaram a alocação aleatória. No entanto, a maior parte dos estudos (n = 21) (13,15,23,(25)(26)(27)(28)(29)(30)33,34,(39)(40)(41)(42)(43)45,(48)(49)(50)(51) relatou parcialmente o modo de execução da alocação (e.g., software), e não descreveu o modo como esta foi ocultada (n = 18) (13,(24)(25)(26)(27)(28)(29)32,33,35,38,39,41,45,(47)(48)(49)51) (e.g., envelope opaco). Acrescenta-se, ainda, que seis estudos detalharam alguma forma de realização do mascaramento (13,(23)(24)(25)33,41) . ...
... Acrescenta-se, ainda, que seis estudos detalharam alguma forma de realização do mascaramento (13,(23)(24)(25)33,41) . A maior parte dos ensaios clínicos (n = 19) informou alguma forma de cegamento (6,15,23,25,(27)(28)(29)(30)(34)(35)(36)(37)(38)(39)41,43,46,47,49) , seja dos aplicadores da intervenção ou dos avaliadores. ...
Objective
to synthesize the evidence available in the literature on the effects of integrative and complementary practices in nausea and vomiting treatment in pregnant women.
Method
a systematic review, reported according to PRISMA and registered in PROSPERO. The search for studies was carried out in 11 databases. To assess risk of bias in randomized clinical trials, the Cochrane Collaboration Risk of Bias Tool (RoB 2) was used.
Results
the final sample consisted of 31 articles, divided into three categories: aromatherapy, phytotherapy and acupuncture. It was observed that aromatherapy with lemon essential oil, ginger capsules, pericardial 6 point acupressure were the interventions that proved to be effective. Less than half of studies reported adverse effects, with mild and transient symptoms predominating. Most articles were classified as “some concern” in risk of bias assessment.
Conclusion
the three most effective interventions to control gestational nausea and vomiting were aromatherapy, herbal medicine and acupuncture, with significant results in the assessment of individual studies.
DESCRIPTORS
Pregnancy; Nausea; Vomiting; Complementary Therapies; Systematic Review
... Nausea and vomiting in pregnancy caused adverse psychosocial effects, including concerns about economics and employment, depression, anxiety, fear about future pregnancies and relationships with family and partners [7] . Nausea and vomit of physiological condition with multiple consequences, together with the threat of miscarriage, vertebrate and deathrate throughout, congenital disorder, system abnormalities, low birth weight baby, premature delivery is associated with malnutrition and weight loss [8] . ...
... The majority of the study and the control group had the family history of medical diseases with about 41 % in the study group and 61.5 % in the control group suffered from hypertension and the remaining percentage had DM and others, without any significant difference between both groups (p-value >0.05). 8 Table (3) shows obstetric history of the studied groups. The mean of the current pregnancy duration per week were (8.56 ±2.32 weeks) in the study group and (9.18 ± 1.72 weeks) in the control group. ...
... One way to counteract CINV is the use of nonpharmacological methods such as acupressure, which has been shown to be a safe and effective complement to pharmacological CINV treatment (18)(19)(20). Acupressure is also frequently used to effectively treat pregnancy sickness and motion sickness (21,22). ...
Background/aim:
The role of single nucleotide polymorphisms (SNPs) in the frequency and intensity of chemotherapy-induced nausea and vomiting (CINV) in women with breast cancer (BC) is unclear. The primary purpose of this study was to compare/evaluate the effect of SNP-guided antiemetic treatment versus standard CINV treatment.
Patients and methods:
A randomised, factorial, phase II multicentre study design was used. Women planned for neoadjuvant or adjuvant chemotherapy with epirubicin, cyclophosphamide and fluorouracil (FEC /EC, with or without fluorouracil) for BC were randomised to SNP-guided antiemetic treatment (based on the results of SNP analyses) versus standard CINV treatment. Blood samples were taken before the treatment was initiated. Patient-reported data on CINV (during 10 days from onset of cancer treatment) and health-related quality of life (HRQoL), were collected before and after the first cancer treatment.
Results:
A total of 188 women were included. Overall, nausea was reported by 86% (n=129) of the patients during the ten-day period from the start of cancer treatment. The SNP genotype studied varied. In FAS-CD95, the genotypes AG and GG were overrepresented; in RB1-LPAR6, GG was overrepresented, and in CCL2, both AA and GG were overrepresented. We found no statistically significant difference in CINV between SNP-guided antiemetic treatment versus standard CINV treatment.
Conclusion:
SNP-guided antiemetic treatment could be as effective as standard treatment. SNP-guided antiemetic treatment of CINV is possibly useful in detecting patients with a higher or lower risk for CINV and thus may help in avoiding over-treatment with toxic components. CINV negatively affects the HRQL.
... The effectiveness of P6 acupressure on nausea and vomiting has been demonstrated in numerous conditions. It has been applied for pain and vomiting control postcraniotomy [18,19], for its antiemesis effect in postgynecological surgery [20], and for improvement of nausea and vomiting in pregnant women [21][22][23]. However, to date, there are no data comparing the antiemetic effect of P6 acupressure with conventional antiemetic drugs. ...
Hyperemesis gravidarum is characterized by severe nausea and vomiting. This study aims to illustrate the efficacy of acupressure at P6 in treating nausea and vomiting in hyperemesis gravidarum. This parallel randomized controlled trial was conducted from 2016–2017 in a tertiary hospital. Hospitalized women with ≤16 weeks of gestation and moderate to severe nausea and vomiting classified using a modified PUQE score were randomly assigned in a 1:1 ratio to either apply an acupressure wristband at the P6 point three times daily or to receive regular doses of intravenous antiemetics. The primary outcome was differences in modified PUQE scores among the groups. The secondary outcomes were differences in the rate of urine ketone clearance and the frequency of requiring rescue antiemetics. Ninety women were equally randomized into two groups, with no dropout. There was a statistically significant difference in the degrees of nausea and vomiting between the groups at 8, 16, and 24 hours post-admission (p8hours= 0.001, p16hours = 0.006, and p24hours = 0.001). The requirement of antiemetics and the rate of urine ketone clearance between the two groups were also statistically significant, at p = 0.001 and p = 0.02 respectively. There were no side effects in either group. The P6 acupressure was efficacious in alleviating nausea and vomiting among hyperemesis gravidarum women. The trial was retrospectively registered on ClinicalTrials.gov (NCT05175079).
... Many EP systems use the acupuncture meridian points as their foundation (Benor, 2014;Feinstein, 2008) yet usually employ self-applied acupressure, rather than needles. Though the number of well-designed studies is small, randomized, double-blind, placebo-controlled acupressure studies have shown some such protocols to be more effective than sham treatments (Church, Stapleton, Yang, & Gallo, 2018;Lang et al., 2007;Werntoft & Dykes, 2001). Proponents of EP claim that their techniques are faster and just as effective as traditional psychoanalytic techniques (Feinstein, Eden, & Craig, 2005;Feinstein, 2012) and recent research has offered promising findings for conditions such as anxiety, depression, and PTSD (Church, Piña, Reategui, & Brooks, 2012;Church & Brooks, 2014;Church & Feinstein, 2013;Mollon, 2018). ...
Reducing communication apprehension (CA) in university public speaking classes has been traditionally achieved by strategies such as skills training, rehearsal, preparation, and repeated performance. Yet, some highly anxious speakers require more intensive interventions. Recently, Energy Psychology (EP) protocols such as Emotional Freedom Techniques (EFT) and Primordial Energy Activation and Transcendence (PEAT) have significantly reduced CA after brief interventions. Other studies have investigated the therapeutic effects of the various components of selected EP protocols through dismantling studies. This study contributes to existing EP dismantling and CA studies by exploring the efficacy of two modified PEAT protocols. Participants (N = 51) were randomly placed into one of three groups: a modified PEAT acupressure group, a modified PEAT non-acupressure group, and a no-treatment control group. Mixed method analyses did not find a significant difference in CA scores (p < .05) or reported subjective experiences between groups at posttest, and highly anxious speakers benefitted more from the public speaking course than less anxious ones. The authors suggest that dismantling the original PEAT technique may have limited its efficacy and further study on PEAT for CA is required.
Natural products have for long been receiving wide attention for the prevention and treatment of various diseases. Attention is being given to natural products because they are cost-effective, safe and well tolerated. Ginger (Zingiber officinale Roscoe), one of the widely used natural products, has been reported to promote digestion and metabolism in the Ayurvedic and Chinese Medicine. Additionally, it was reported to be effective in acting as a remedy for cough, cold, nausea, vomiting, food poisoning and arthritic pain. The medicinal and nutritional value of ginger has led scientific researchers to explore its anti-microbial, anti-oxidant and anti-cancer properties. The anti-cancer properties of ginger have been attributed mainly to the most active components in ginger, which are 6-gingerol and 6-shogaol. Understanding the mechanisms by which these pungent components control cancer cell proliferation might put ginger in the frontline for cancer treatment. The aim of this review is to cover all the medicinal applications of ginger extract and/or the non-volatile bioactive constituents of ginger (6-gingerol and 6-shogaol) with a focus on both the chemotherapeutic role of ginger and the role it plays as adjuvant therapy in several diseases.
Background
Nausea and vomiting of pregnancy are common complaints that affect the quality of life significantly, even in mild cases. Although pharmacological treatments are available for these ailments, concerns about their effects on fetal health make healthcare providers and recipients prefer non-pharmacological therapies.
Objectives
This study examines the effect of Pericardium 6 (P6) acupressure with Sea-Band on the severity and frequency of nausea and vomiting of pregnancy and compares it with a placebo and a control group.
Design and participants
In this randomized, single-blind, placebo-controlled trial, 75 pregnant women with symptoms of mild to moderate nausea and vomiting of pregnancy with a gestational age of <20 weeks were assigned to three equal groups (n = 25).
Setting
The participants were selected from five healthcare centers in Ardebil, Iran.
Interventions
Pressure was applied to the P6 in the acupressure group using Sea-Band button for three days; in the placebo group, sea-band was applied without pressure on the P6; the control group did not receive any interventions, except for dietary recommendations similar to the other two groups.
Main outcome measures
Nausea and vomiting frequency and severity were recorded for six days, twice a day, with the intervention starting on the fourth day. Data were analyzed using the ANOVA, Kruskal-Wallis test, Chi-square test, Fisher’s exact test and Mann-Whitney’s U-test.
Results
There was a significant reduction in the frequency, duration and severity of nausea and also in the frequency of vomiting in the acupressure and placebo groups but not in the control group after three days of the intervention. A significant difference was observed between the acupressure and placebo groups in terms of the frequency and severity of nausea but not its duration or the frequency of vomiting after the intervention.
Conclusion
Acupressure on the P6 applied using a wristband for at least three days appears to be effective in the relief of nausea and vomiting of pregnancy; however, this finding may be due in part to the placebo effect. Acupressure on the P6 with Sea-Band button can be used for the management of nausea and vomiting of pregnancy.
Introduction:
Nausea and vomiting are common problems during pregnancy. Previous studies have shown that stimulation at Neiguan (PC6) acupoint can be effective in controlling pregnancy-induced nausea and vomiting. However, more evidence is required for approving this method on controlling pregnancy-induced nausea and vomiting. The aim of this study was to determine the efficacy of PC6 acupoint pressure stimulation on the severity of nausea, vomiting, and retching in pregnant women.
Method:
This randomized, multi-center clinical trial was conducted on pregnant women referring to Health Centers and Ommolbanin Hospital in Mashhad, Iran, during December 2016 to September 2017. Women with first singleton pregnancy and below 12 weeks were included. Patients were randomly allocated into three groups of (1) PC6 pressure (4 times a day, for 10 min), (2) sham acupressure, and (3) medication with vitamin B6 and metoclopramide. Assessment of severity of nausea, vomiting, and retching was done based on the Rhodes Index on the first and fifth day (before and after the intervention). Pearson chi-square test, one-way ANOVA, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis using SPSS version 18. This clinical trial was registered at the Iranian Registry of Clinical Trials (IRCT) with the code IRCT201512187265N6.
Results:
Ninety patients with a mean age of 26.40 ± 4.73 years were studied in 3 groups of 30. There was no significant difference between the 3 groups in terms of the severity outcomes before the intervention, while, after the intervention, the three groups were significantly different on the fifth day in terms of vomiting frequency, distress from retching, distress from vomiting, duration of nausea, distress from nausea, amount of vomiting, frequency of nausea, and frequency of retching (p < 0.001 for each outcome). According to the linear regression analysis, the correlation between occupation with vomiting frequency (beta coefficient = 0.252) and nausea severity (beta coefficient = -0.213) was statistically significant.
Conclusion:
It seems that PC6 acupoint pressure can reduce the severity of nausea, vomiting, and retching in pregnant women.
23 patients were entered into a double-blind cross-over study to evaluate the use of P6 acupressure versus sham acupressure in the treatment of early morning sickness (EMS). 16 completed the study. P6 acupressure was significantly more effective than the sham acupressure in the relief of nausea as measured by daily visual analogue scales (P = 0.019). Two thirds of the patients preferred acupressure on P6 as compared to the sham point. Sham acupressure was specifically evaluated and shown to be a credible placebo.
A linear analogue for rating pain with 10, 15 and 20 cm lines is significantly less variable than a 5 cm line (mean error of 15 cm line is 0-19%, 95% confidence limits for the group +/- 2% and an inood correlation between repeated ratins of a recalled pain distant in time. The variance of the rating is significantly less than the repeated rating of a random mark. The linear analogue rating of a constant pain stimulus is reproducible and changes in rating are likely to be real changes of opinion. Pethidine 150 mg intramuscularly had no significant effect, tested 30 minutes after the administration, on the accuracy or reproducibility of the analogue rating. A linear analogue seems a suitable method of recording the patient's opion of a severe pain such as that of labour.
Our purpose was to investigate the efficacy of P6 acupressure in reducing or relieving symptoms of nausea with or without vomiting and retching during pregnancy.
Symptomatic pregnant volunteers (n=161) participated in a 7-day community-based clinical trial. All participants were assigned to one of three groups (i.e., P6 acupressure, placebo [acupressure bands inappropriately placed], or control) on the basis of a process of blocked randomization. Data were analyzed by error bar charts and analysis of variance of difference scores.
Of 161 women, 149 (92.5%) completed the protocol. Irrespective of group assignment, participants reported significant decreases in nausea (p<0.0009) and vomiting or retching (p<0.0009). However, there was no differential treatment effect as a result of acupressure.
There was no apparent medical benefit from the use of P6 acupressure. Our findings differ from other recently published studies that did not include a control group.