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Electrical Stimulation of PC 6 to Control Chemotherapy-Induced Nausea and Vomiting in Patients with Cancer: A Systematic Review and Meta-Analysis
Abstract
Objective: A complementary treatment for managing chemotherapy-induced nausea and vomiting (CINV) with promising results is electrostimulation of Pericardium 6 (PC 6; Neiguan). This review was conducted to evaluate the effects of electrostimulation therapy at PC 6 to control CINV in patients with cancer. The review was registered on PROSPERO (CRD42018087753). Methods: This systematic review and meta-analysis of clinical trials was accomplished according to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Studies written in English, Portuguese, or Spanish that met the eligibility criteria organized according to the PICO [Patient, Problem or Population; Intervention; Comparison, Control, or comparator; Outcome(s)] anagram were included. Descriptors used to search the databases were identified and selected according to the Medical Subject Headings of the National Library of Medicine. The primary outcomes evaluated were the frequency and severity of nausea, vomiting, and general emesis after the experimental protocol. The secondary outcomes evaluated were the numbers of antiemetic pills taken and the patients' quality of life. Results: Fourteen articles were included. There was a reduction in the mean number of episodes of acute nausea (mean difference [MD] = -2.08; 95% confidence interval [95%CI] = -2.76, -1.39) and acute vomiting (MD = -0.91; 95% CI = -1.39, -0.42) or delayed (MD = -0.85; 95%CI = -1.47, -0.23) in patients given the treatment. The other analyses of nausea, vomiting and emesis showed no differences. Conclusions: Electrostimulation at PC6 has an effect on controlling general emesis, and acute nausea and vomiting in different phases of recovery from chemotherapy in patients with cancer.
... It has the advantages of being simple to use and non-invasive. In recent years, TEAS has been more and more widely used in the clinic, such as in oncology, gynecology and obstetrics, gastrointestinal surgery, cardiac surgery, and other surgical fields [6][7][8]. At present, it has been proven that the application of acupoint stimulation in the perioperative period has good effects on reducing anxiety, sedation and analgesia, organ protection, reduces stress response, reduces postoperative nausea and vomiting. ...
Background:
Postoperative nausea and vomiting (PONV) is one of the most common complications after general anesthesia. The traditional comprehensive management of PONV usually uses one or two drugs, but this regimen fails to meet the requirements of the latest version of PONV guidelines. The purpose of this study was to evaluate the effect of transcutaneous electrical acupoint stimulation (TEAS) on high-risk PONV patients who are undergoing laparoscopic gynecological surgery.
Methods:
In total, 162 high-risk PONV patients were randomly divided into an experimental group (n = 81) and a control group (n = 81). Both groups were injected with 4 mg of dexamethasone and 0.25 mg of palonosetron. In the experimental group, Nei-guan (PC6) and He-gu (LI4) were stimulated by a transcutaneous acupoint electrical stimulation instrument (HANS200E) 30 min before the surgery. The control group also received electrodes but no stimulation. Variance analysis and rank sum test were used to compare the differences between the two groups.
Results:
The results of the incidence of postoperative nausea, vomiting, NRS score, degree of abdominal distension, and time to first flatus in the experimental group were lower than those in the control group. Nursing satisfaction of the experimental group was higher than that of the control group.
Conclusions:
The study demonstrates that TEAS combined with dexamethasone and palonosetron can effectively prevent PONV, reduce postoperative abdominal distension and postoperative pain, and shorten the first postoperative flatus time in high-risk patients with PONV. At the same time, it can improve nursing satisfaction.
... Electroceuticals are used also in cancer patients for the reduction of chemotherapyinduced nausea and vomiting [134]. Recently, its use in more directed cancer treatment was proposed [135,136]. ...
Research on the neurobiology of cancer, which lies at the border of neuroscience and oncology, has elucidated the mechanisms and pathways that enable the nervous system to modulate processes associated with cancer initiation and progression. This research has also shown that several drugs which modulate interactions between the nervous system and the tumor micro- and macroenvironments significantly reduced the progression of cancer in animal models. Encouraging results were also provided by prospective clinical trials investigating the effect of drugs that reduce adrenergic signaling on the course of cancer in oncological patients. Moreover, it has been shown that reducing adrenergic signaling might also reduce the incidence of cancer in animal models, as well as in humans. However, even if many experimental and clinical findings have confirmed the preventive and therapeutic potential of drugs that reduce the stimulatory effect of the nervous system on processes related to cancer initiation and progression, several questions remain unanswered. Therefore, the aim of this review is to critically evaluate the efficiency of these drugs and to discuss questions that need to be answered before their introduction into conventional cancer treatment and prevention.
Background
It is important to investigate beliefs in acupuncture in professionals because professionals’ expectations may affect treatment outcomes.
Aim
To document the type, number, and education of professionals practicing acupuncture. Further, to compare beliefs about the effectiveness of acupuncture for common cancer related symptoms in the different types of professionals.
Methods
This cross-sectional study employed a questionnaire on practice and beliefs regarding acupuncture effects for symptoms that commonly occur in patients treated within oncology care settings. The respondents (n = 555) consisted of oncology professionals that is, physicians (n = 133), nurses (n = 172), and physiotherapists (n = 117). Additional respondents consisted of acupuncturists (n = 133), working outside approved health care.
Results
Of the respondents, acupuncture was practiced by 4% of the physicians, 6% of the nurses, 58% of the physiotherapists, and 90% of the acupuncturists. The professionals believed acupuncture to be effective for pain (of the physicians, nurses, physiotherapists, and acupuncturists, 94%, 98%, 89%, and 99% respectively believed in the effectiveness), chemotherapy-induced nausea (corresponding figures: 74%, 89%, 89%, and 93%), and vasomotor symptoms (corresponding figures: 71%, 81%, 80%, and 97%). The physicians believed acupuncture to be effective in a mean of 5 symptoms, nurses in 6 symptoms, physiotherapists in 6 symptoms, and acupuncturists in 10 symptoms ( P < .001).
Conclusions
Since the professionals varied substantially regarding practice, education and beliefs in acupuncture, oncology clinics may consider delivering patient preferred acupuncture according to evidence-informed guidelines rather than on varying preferences among the professionals, since professionals’ treatment expectations may modify treatment outcomes.
Objectives
Since pre-existing expectations, that is, beliefs, in a treatment may modify outcomes, and acupuncture studies often fail to measure expectations, we wanted to investigate the use of acupuncture, interest, and belief in acupuncture effects among patients undergoing cancer therapy.
Method
A cross-sectional design, where the participants answered a study-specific questionnaire with questions regarding their use of, interest and belief in acupuncture treatment.
Results
A total of 457 patients with cancer (48% men, mean age 65 years) answered the questionnaire. Acupuncture was used by 4 (1%) patients during their cancer therapy, and 368 (83%) expressed an interest in receiving acupuncture. Of the 457 patients, 289 (63%) believed acupuncture to be effective for at least 1 of 17 requested symptoms, most commonly pain (56% of the patients) and muscle tension (40%). They believed acupuncture to be effective for a mean value 3 of the 17 requested symptoms. Women ( P < .001), and patients 41 to 65 years ( P < .001), expressed a stronger belief in acupuncture effects than others.
Conclusions
Men and older patients expressed weaker beliefs in acupuncture effects than other patients, indicating the importance of collecting expectancy data in future randomized sham-controlled acupuncture studies to be able to treat expectancy as an effect-modifier. The high interest and beliefs in acupuncture effects found also indicate that acupuncture should be available for patients with cancer, for side effects where acupuncture has shown to be effective. In a clinical setting, older men might need more encouragement regarding positive expected outcomes of the acupuncture treatment than younger women.
Background
Previous studies have shown that acupuncture is beneficial for the alleviation of chemotherapy-induced nausea and vomiting. However, there is a lack of clinical evidence concerning the effects of acupoint-matching on chemotherapy-induced nausea and vomiting.
Methods/design
This is a parallel randomized controlled trial to evaluate the occurrence of nausea and vomiting after chemotherapy (the incidence of nausea and vomiting, frequency, VAS score, RINVR rating) as the main outcome for cancer. Quality of life, anxiety and depression scores are the secondary outcomes. Quality of life, anxiety and depression scores are the secondary phase. Use of remedy drugs, routine blood examination, and blood biochemical tests are the safety evaluation. We also compare the different effects of ST36 (single acupoint), CV12 (single acupoint), and ST36-CV12 matching groups.
Discussion
The results of this trial are expected to explore the effects of matching different acupoints and to offer biologic plausibility for the use of acupuncture in the treatment of chemotherapy-induced nausea and vomiting (CINV).
Trial registration
This trial is registered with clinicaltrials.gov NCT02195921, The date of registration was 17 July 2014.
Electronic supplementary material
The online version of this article (doi:10.1186/s13063-017-2186-y) contains supplementary material, which is available to authorized users.
Chemotherapy-induced nausea (CIN) has a significant negative impact on the quality of life of cancer patients. The use of 5-hydroxytryptamine-3 (5-HT3) receptor antagonists (RAs) has reduced the risk of vomiting, but (except for palonosetron) their effect on nausea, especially delayed nausea, is limited. This article reviews the role of NK1RAs when combined with 5-HT3RA-dexamethasone in CIN prophylaxis. Aprepitant has not shown consistent superiority over a two-drug (ondansetron-dexamethasone) combination in nausea control after cisplatin- or anthracycline-cyclophosphamide (AC)-based highly emetogenic chemotherapy (HEC). Recently, dexamethasone and dexamethasone-metoclopramide were demonstrated to be non-inferior to aprepitant and aprepitant-dexamethasone, respectively, for the control of delayed nausea after HEC (AC/cisplatin), and are now recognized in the guidelines. The potential impact of the new NK1RAs rolapitant and netupitant (oral fixed combination with palonosetron, as NEPA) in CIN prophylaxis is discussed. While the clinical significance of the effect on nausea of the rolapitant-granisetron-dexamethasone combination after cisplatin is not conclusive, rolapitant addition showed no improvement in nausea prophylaxis after AC or moderately emetogenic chemotherapy (MEC). NEPA was superior to palonosetron in the control of nausea after HEC (AC/cisplatin). Moreover, the efficacy of NEPA in nausea control was maintained over multiple cycles of HEC/MEC. Recently, NK1RAs have been challenged by olanzapine, with olanzapine showing superior efficacy in nausea prevention after HEC. Fixed antiemetic combinations (such as NEPA) or new antiemetics with a long half-life that may be given once per chemotherapy cycle (rolapitant or NEPA) may improve patient compliance with antiemetic treatment.
Background
Chemotherapy-induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization (TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation (TEAS) on nausea and vomiting after TACE.
Methods
A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active-acupuncture (n = 72) or placebo-acupuncture (n = 70) groups using a covariate-adaptive randomization at a ratio of 1:1. The acupoints Hegu (LI4), Neiguan (P6), and Zusanli (ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory (MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored.
Results
Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant (all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active-acupuncture group than in the placebo-acupuncture group and continued to decrease over time with treatment (all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active-acupuncture group were slightly lower than those for the placebo-acupuncture group, but the differences were not statistically significant (all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event (P > 0.05).
Conclusion
TEAS appears to be a safe and effective therapy to relieve patients’ gastrointestinal discomfort after chemotherapy.
Trial registration NCT01895010. Registered 21 June 2013
Background
Acupuncture is beneficial for controlling chemotherapy-induced nausea and vomiting (CINV). However, the effect of different acupoint combinations on controlling CINV remains unknown. This study aims to compare the effects of distal-proximal point association and local distribution point association on controlling CINV.
Methods/design
The study is a single-center, randomized controlled trial. A total of 240 participants will be randomly divided into four groups. The control group will receive standard antiemetic only, whereas three acupuncture groups will receive four electro-acupuncture treatments once a day with the standard antiemetic. Acupuncture group I and II will receive distal-proximal point association (“Neiguan (PC6) and Zhongwan (CV12)”, and “Zusanli (ST36) and CV12”, respectively); Acupuncture group III will receive local distribution point association (“Shangwan (CV13) and CV12”). The primary outcome measures are the frequency and distress of nausea and vomiting. The secondary outcome measures are the grade of constipation and diarrhea, electrogastrogram, quality of life, etc. Assessment is scheduled from the day before chemotherapy to the fifth day of chemotherapy. Follow-ups are performed from the sixth day to the twenty-first day of chemotherapy.
Discussion
Results of this trial will help in evaluating the efficacy and safety of electro-acupuncture with different acupoint combinations in the management of CINV.
Trial registration
ClinicalTrials.gov identifier: NCT02478047.
Questions:
In the active phase of the first stage of labour, does transcutaneous electrical nerve stimulation (TENS) relieve pain or change its location? Does TENS delay the request for neuraxial analgesia during labour? Does TENS produce any harmful effects in the mother or the foetus? Are women in labour satisfied with the care provided?
Design:
Randomised trial with concealed allocation, assessor blinding for some outcomes, and intention-to-treat analysis.
Participants:
Forty-six low-risk, primigravida parturients with a gestational age > 37 weeks, cervical dilation of 4cm, and without the use of any medications from hospital admission until randomisation.
Intervention:
The principal investigator applied TENS to the experimental group for 30minutes starting at the beginning of the active phase of labour. A second investigator assessed the outcomes in both the control and experimental groups. Both groups received routine perinatal care.
Outcome measures:
The primary outcome was pain severity after the intervention period, which was assessed using the 100-mm visual analogue scale. Secondary outcomes included: pain location, duration of the active phase of labour, time to pharmacological labour analgesia, mode of birth, neonatal outcomes, and the participant's satisfaction with the care provided.
Results:
After the intervention, a significant mean difference in change in pain of 15mm was observed favouring the experimental group (95% CI 2 to 27). The application of TENS did not alter the location or distribution of the pain. The mean time to pharmacological analgesia after the intervention was 5.0hours (95% CI 4.1 to 5.9) longer in the experimental group. The intervention did not significantly impact the other maternal and neonatal outcomes. Participants in both groups were satisfied with the care provided during labour.
Conclusion:
TENS produces a significant decrease in pain during labour and postpones the need for pharmacological analgesia for pain relief.
Trial registration:
NCT01600495. [Santana LS, Gallo RBS, Ferreira CHJ, Duarte G, Quintana SM, Marcolin AC (2016) Transcutaneous electrical nerve stimulation (TENS) reduces pain and postpones the need for pharmacological analgesia during labour: a randomised trial.Journal of Physiotherapyxx: xxx-xxx].
Introdução: Náuseas e vômitos são efeitos colaterais frequentes associados aos tratamentos quimioterápicos antineoplásicos. Evidências científicas apoiam o uso do ponto de acupuntura PC6-Neiguan, com diferentes métodos para o tratamento de náusea e vômito de diversas etiologias. Desta forma, a fisioterapia poderia também ser eficaz no controle dos sintomas eméticos ligados ao tratamento quimioterápico através de recursos como a Estimulação Elétrica Nervosa Transcutânea (TENS) de baixa frequência. Objetivo: Verificar se a aplicação da TENS de baixa frequência no ponto PC6-Neiguan de acupuntura reduz os sintomas antecipatórios e agudos de náuseas e vômitos, associados ao tratamento quimioterápico neoadjuvante e adjuvante de alto e moderado potencial emetogênico. Método: Trata-se de um estudo clínico, prospectivo, randomizado, com abordagem quantitativa e grupo controle. A população da pesquisa foi constituída por pacientes oncológicos, com qualquer tipo de neoplasia, que estivessem sendo submetidos à quimioterapia neoadjuvante ou adjuvante de alto e moderado efeito emetogênico. Resultados: Foram selecionados para a pesquisa 75 sujeitos, sendo 35 correspondentes ao grupo controle que não recebeu a aplicação da TENS e 40 do grupo experimental que recebeu a TENS de baixa frequência no ponto PC6. Os resultados mostraram que houve uma melhora significativa nos sintomas de náuseas e vômitos antecipatórios e agudos decorrentes do tratamento quimioterápico, tanto na sua intensidade quanto na sua frequência, no grupo experimental. Conclusão: Os resultados da pesquisa sugerem que a utilização da TENS de baixa frequência no ponto PC6, pode ser benéfica no controle dos sintomas de náuseas e vômitos provocados pela quimioterapia.
Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement--a reporting guideline published in 1999--there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
There is debate on how the methodological quality of clinical trials should be assessed. We compared trials of physical therapy (PT) judged to be of adequate quality based on summary scores from the Physiotherapy Evidence Database (PEDro) scale with trials judged to be of adequate quality by Cochrane Risk of Bias criteria.
Meta-epidemiological study within Cochrane Database of Systematic Reviews.
Meta-analyses of PT trials were identified in the Cochrane Database of Systematic Reviews. For each trial PeDro and Cochrane assessments were extracted from the PeDro and Cochrane databases. Adequate quality was defined as adequate generation of random sequence, concealment of allocation, and blinding of outcome assessors (Cochrane criteria) or as trials with a PEDro summary score ≥5 or ≥6 points. We combined trials of adequate quality using random-effects meta-analysis.
Forty-one Cochrane reviews and 353 PT trials were included. All meta-analyses included trials with PEDro scores ≥5, 37 (90.2%) included trials with PEDro scores ≥6 and only 22 (53.7%) meta-analyses included trials of adequate quality according to the Cochrane criteria. Agreement between PeDro and Cochrane was poor for PeDro scores of ≥5 points (kappa = 0.12; 95% CI 0.07 to 0.16) and slight for ≥6 points (kappa 0.24; 95% CI 0.16-0.32). When combining effect sizes of trials deemed to be of adequate quality according to PEDro or Cochrane criteria, we found that a substantial difference in the combined effect size (≥0.15) was evident in 9 (22%) out of the 41 meta-analyses for PEDro cutoff ≥5 and 10 (24%) for cutoff ≥6.
The PeDro and Cochrane approaches lead to different sets of trials of adequate quality, and different combined treatment estimates from meta-analyses of these trials. A consistent approach to assessing RoB in trials of physical therapy should be adopted.
To assess the feasibility of undertaking a high-quality randomised controlled study to determine whether EA gives better control of delayed chemotherapy-induced nausea and vomiting (CINV) than sham EA or standard antiemetic treatment alone.
Patients having their first cycle of moderately or highly emetogenic chemotherapy were randomised to EA, sham EA or standard care. EA was given for 30 min on day 1 at the time of chemotherapy and on day 3 using standard acupuncture points bilaterally. Sham EA was given to points adjacent to true EA points. All patients received usual care, comprising antiemetics, according to hospital guidelines. The primary outcomes related to study feasibility, and the clinical outcome measure was the change in Functional Living Index Emesis (FLIE) score captured on days 1 and 7.
153 participants were screened between April 2009 and May 2011. Eighteen patients did not meet the inclusion criteria, 37 declined to participate and the absence of an acupuncturist or lack of consent from the treating oncologist excluded a further 38 patients; 60 patients were recruited. The FLIE was completed on day 7 by 49 participants; 33 of 40 patients returned on day 3 for treatment. The nausea and vomiting scores were low in all three arms. Adverse events were generally mild and infrequent.
It was feasible to undertake a randomised EA trial on a busy day oncology unit. As few patients experienced nausea with their first cycle of chemotherapy, it was not possible to determine whether EA improves CINV over standard care. An enriched enrolment strategy is indicated for future studies. A simple numerical rating scale may prove a better objective nausea measure than the FLIE.
ACTRN12609001054202.
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The prevention of chemotherapy-induced nausea and vomiting (CINV) has been revolutionized over the past 25 years. Guideline-based treatment means that vomiting can be prevented in the majority, but not in all patients. Therefore, antiemetic research continues with the goal of optimizing CINV control for all patients. This comprehensive review summarizes the research efforts in this field over the past few years. Emerging from this research are two new antiemetic agents, NEPA, the first antiemetic combination agent and rolapitant, a new NK1RA. In addition, studies have evaluated the benefits of olanzapine and ginger, explored optimal combinations of agents for delayed CINV prevention, confirmed that dexamethasone-sparing regimens are effective, and demonstrated the value of NK1RAs in high dose chemotherapy settings as well as with certain moderately emetogenic chemotherapies such as carboplatin. Research has also validated the correlation between antiemetic guideline adherence and improved CINV control. Finally, regulatory authorities have utilized extreme caution in retiring some 5HT3RAs or decreasing their maximum dose.
© The Author 2015. Published by Oxford University Press on behalf of the European Society for Medical Oncology. All rights reserved. For permissions, please email: journals.permissions@oup.com.
Background
Qualitative systematic reviews are increasing in popularity in evidence based health care. Difficulties have been reported in conducting literature searches of qualitative research using the PICO search tool. An alternative search tool, entitled SPIDER, was recently developed for more effective searching of qualitative research, but remained untested beyond its development team.Methods
In this article we tested the `SPIDER¿ search tool in a systematic narrative review of qualitative literature investigating the health care experiences of people with Multiple Sclerosis. Identical search terms were combined into the PICO or SPIDER search tool and compared across Ovid MEDLINE, Ovid EMBASE and EBSCO CINAHL Plus databases. In addition, we added to this method by comparing initial SPIDER and PICO tools to a modified version of PICO with added qualitative search terms (PICOS).ResultsResults showed a greater number of hits from the PICO searches, in comparison to the SPIDER searches, with greater sensitivity. SPIDER searches showed greatest specificity for every database. The modified PICO demonstrated equal or higher sensitivity than SPIDER searches, and equal or lower specificity than SPIDER searches. The modified PICO demonstrated lower sensitivity and greater specificity than PICO searches.Conclusions
The recommendations for practice are therefore to use the PICO tool for a fully comprehensive search but the PICOS tool where time and resources are limited. Based on these limited findings the SPIDER tool would not be recommended due to the risk of not identifying relevant papers, but has potential due to its greater specificity.
•Transcutaneous electrical nerve stimulation (TENS) is a non-invasive, inexpensive, self-administered technique to relieve pain.•There are few side effects and no potential for overdose so patients can titrate the treatment as required.•TENS techniques include conventional TENS, acupuncture-like TENS and intense TENS. In general, conventional TENS is used in the first instance.•The purpose of conventional TENS is to selectively activate large diameter non-noxious afferents (A-beta) to reduce nociceptor cell activity and sensitization at a segmental level in the central nervous system.•Pain relief with conventional TENS is rapid in onset and offset and is maximal when the patient experiences a strong but non-painful paraesthesia beneath the electrodes. Therefore, patients may need to administer TENS throughout the day.•Clinical experience suggests that TENS may be beneficial as an adjunct to pharmacotherapy for acute pain although systematic reviews are conflicting. Clinical experience and systematic reviews suggest that TENS is beneficial for chronic pain.
This review looked at whether stimulating acupuncture points could reduce nausea and vomiting caused by chemotherapy. Acupuncture points can be stimulated by acupuncture applied with electricity (electroacupuncture), acupuncture without electricity (manual acupuncture), acupressure (pressing on the points usually with fingertip), or electrical stimulation on the skin surface such as wristwatch-like devices. Electroacupuncture reduced first-day vomiting, but manual acupuncture did not. Acupressure reduced first-day nausea, but was not effective on later days. Acupressure showed no benefit for vomiting. Electrical stimulation on the skin showed no benefit. All trials also gave anti-vomiting drugs, but the drugs used in the electroacupuncture trials were not the most modern drugs, so it is not known if electroacupuncture adds anything to modern drugs. Trials of electroacupuncture with modern drugs are needed.
Background:
Olanzapine is an anti-psychotic drug that has been used for preventing and treating Chemotherapy-Induced Nausea and Vomiting (CINV). This study aimed to systematically review and meta-analyze the efficacy and safety of olanzapine for prophylaxis and treatment of CINV.
Methods:
We conducted a systematic literature search of MEDLINE, EMBASE, SCOPUS, and the Cochrane Central Register of Controlled Trials-CENTRAL up to July 15, 2016. All observational and intervention studies were included, but only the intervention studies were pooled for meta-analysis. The efficacy outcome was the proportion of patients achieving complete response (CR) - no emesis and no rescue therapy, in the acute, delayed, and overall phases. The safety outcomes were the adverse events associated with olanzapine according to Common Terminology Criteria for Adverse Events (CTCAE).
Results:
Sixteen studies were eligible: 15 clinical trials and 1 observational study. Nine of the interventional studies were pooled for meta-analysis. The CR of olanzapine was superior to other anti-emetic regimens, in both the delayed and overall phases (RR=1.27, 95% CI 1.07-1.49, RR=1.32, 95% CI 1.08-1.62, respectively). However, olanzapine was not better than standard CINV prophylaxis of the nausea and emesis outcome in the acute phase. Drowsiness and constipation were the most reported adverse events. No grade 3 or 4 adverse events were reported.
Conclusion:
Olanzapine is effective and safe at reducing during the delayed and overall phase of the CINV prevention. Other regimens might be added, in cases of CINV during the acute phase of CINV.
Purpose
To compare the effects of a relief band using transcutaneous electrical nerve stimulation with a wrist band using acupressure on the Nei-Guan acupuncture point to relieve postoperative nausea and vomiting (PONV) in patients who had undergone gynecologic surgery.
Design
A double-blinded randomized controlled trial.
Methods
In total, 54 patients scheduled for gynecologic surgery under general anesthesia were included in this study. Assessments of PONV were performed 0, 2, 6, and 24 hours after discharge from the postanesthesia care unit. The severity of PONV was measured using the Rhodes' Index of Nausea, Vomiting and Retching and by recording the frequency of patient-requested antiemetic administration that is used to treat severe cases of PONV.
Findings
The relief band reduced the severity of PONV and the need for antiemetic administration within the first 24 hours postsurgery.
Conclusions
The results of this study support the use of a relief band when compared with a wrist band and with a control group to reduce PONV in women after gynecologic surgery.
The aim of this study was to assess the effect of acupressure, applied at P6 (Neiguan) acupuncture point, on chemotherapy-induced nausea and vomiting in patients with acute myeloblastic leukemia. This was a randomized controlled trial conducted on patients with myeloblastic leukemia. A total of 90 patients, who received the same chemotherapy regimen and antiemetic therapy, were included in the study as 30 patients in the control group, 30 patients in the band group, and 30 patients in the pressure group. Although acupressure was applied by placing wristbands at P6 acupuncture point of both wrists in patients of the band group for totally 4 days, acupressure was applied with the use of finger pressure in patients of the pressure group for totally 4 days. No intervention was made in patients of the control group other than the routine antiemetic therapy. The data of the study were collected by using a questionnaire and nausea-vomiting chart. Severity of nausea-vomiting was assessed by using the visual analog scale on this chart. It was determined that the acupressure band applied to the patients included in the study reduced number and severity of nausea-vomiting (P < .05); however, the acupressure applied with pressure did not affect number and severity of nausea-vomiting (P > .05). It was found that the acupressure band was effective for reducing the chemotherapy-induced nausea and vomiting.
BACKGROUND
Greater than 70% of patients with cancer experience chemotherapy-induced nausea and vomiting. In the current study, the authors examined the effects of electrostimulation of the K1 acupoint located on the sole of the foot because it is believed to have the potential to control chemotherapy-induced nausea and vomiting.METHODS
In this trial, 103 patients diagnosed with primary or metastatic liver cancer were recruited before transcatheter arterial infusion (TAI) of cisplatin or oxaliplatin and randomized to either group A (51 patients who were treated with the antiemetic tropisetron and acustimulation at the K1 acupoint for 20 minutes approximately 1 to 2 hours before TAI on the first day and then daily for the subsequent 5 days) or group B (52 patients who were treated with tropisetron and electrostimulation at a placebo point on the heel). The rate, intensity, and duration of nausea and vomiting were collected at baseline and then daily for 5 days after TAI. Quality of life was assessed daily using the MD Anderson Symptom Inventory and the EuroQoL scale.RESULTSNo differences were found between groups A and B with regard to the incidence and degree of nausea or vomiting on day 1 or the following 5 days. Patients in group A had better EuroQoL scores compared with patients in group B (72.83 in group A vs 65.94 in group B; P =.04) on day 4 but not on the other days. No group differences were noted at any time point for MD Anderson Symptom Inventory scores.CONCLUSIONS
Electrostimulation of K1 combined with antiemetics did not result in initial prevention of cisplatin-induced or oxaliplatin-induced nausea or vomiting. Cancer 2014. © 2014 American Cancer Society.
Objective:
To investigate the electronic anti-nausea instrument (EANI) combined with hydrochloride palonosetron for prevention of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy.
Methods:
Patients who received highly emetogenic chemotherapy were randomly assigned to a treatment group (60 patients) treated with EANI combined with hydrochloride palonosetron, and control group (also 60 patients) given only hydrochloride palonosetron. Chemotherapy related nausea and vomiting were observed and recorded in both groups of patients from the start till the end of chemotherapy.
Results:
Complete control rates of vomiting in treatment and control group were 40%, and 35%, respectively, without any statistical ly significant difference (p> 0.05); however the response rates are 95.0%, 78.3%, respectively, with statistical difference (p< 0.05). Complete control rates of nausea in treatment and control group were 36.7%, 30%, respectively, without statistical difference (p> 0.05); but the response rates are 90.0%, 76.7%, respectively, with statistical difference (p<0.05).
Conclusion:
EANI combined with hydrochloride palonosetron for prevention of nausea and vomiting induced by chemotherapy could be more effective than hydrochloride palonosetron alone, and can be recommended for use in prevention and treatment of chemotherapy-induced nausea and vomiting following highly emetogenic chemotherapy.
To find out whether the combination of transcutaneous electrical nerve stimulation (TENS) and ondansetron had an increased antiemetic effect.
Fourteen testis and 11 bladder cancer patients were scheduled for 4 cycles of bleomycin-etoposide-cisplatin (BEP) or methotrexate-vinblastine-etoposide-cisplatin (MVEC) combination chemotherapy, respectively. At each cycle the whole cisplatin dose was given in 1 day that is 100 mg/m(2)/day in the BEP and 70 mg/m(2)/day in the MVEC protocols. Ondansetron was given at a dose of 12 mg/day and TENS was applied by commercially available 'Relief Band'(Maven Labs, Inc., Citrus Heights, Calif., USA). The first 3 cycles of each case were blindly randomized to one of the following regimens; TENS vs. ondansetron vs. a combination of both. The regimens were applied during the administration of cisplatin and the patients were asked to report their nausea according to a scale between 0 to 10. Also for each regimen the number of emetic attacks experienced during the administration of cisplatin was recorded by the same observer. Then the scores of each regimen were compared.
The mean nausea scores for regimens TENS, ondansetron and TENS + ondansetron were found to be 5.12 +/- 2.54, 3.0 +/- 1.71 and 0.8 +/- 0.96, respectively. Ondansetron was better than TENS in preventing nausea (p = 0.000). However the combination of TENS and ondansetron resulted in a significant decrease in nausea scores when compared to TENS alone (p = 0.000) or ondansetron alone (p = 0.000). The mean number of emetic attacks for the TENS, ondansetron and TENS + ondansetron regimens were 3.16 +/- 1.84, 1.64 +/- 1.44 and 0.56 +/- 0.82, respectively. A statistically significant difference was present between the number of emetic attacks observed with the TENS + ondansetron combination and TENS alone (p = 0.000) or ondansetron alone (p = 0.001). Ondansetron was again better than TENS in preventing emetic attacks (p = 0.001).
The use of TENS as an adjunct to ondansetron therapy has provided significant benefit in preventing nausea and emetic attacks caused by cisplatin.
Substantial evidence suggests that acupuncture-point stimulation may be effective in controlling side effects of chemotherapy.
To examine the efficacy of an acustimulation wristband for the relief of chemotherapy-induced nausea.
Randomized clinical trial using a 3-level crossover design.
Three outpatient oncology clinics in the northeastern United States.
Twenty-five women and 2 men who experienced moderate or more severe nausea following their first chemotherapy treatment.
We compared active acustimulation of the Pericardium 6 (PC-6) point on the ventral surface of the wrist with sham acustimulation (a corresponding point on the posterior surface of the wrist). A control group received no acustimulation.
Severity of nausea and quantity of antiemetic medication used.
No statistically significant differences in average severity of nausea were observed between the 3 interventions. However, the data showed a difference close to statistical significance in the severity of delayed nausea reported during active acustimulation compared to no acustimulation (P <.06). In addition, patients took fewer antinausea pills during the active-acustimulation cycle of this experiment compared to the no-acustimulation phase (P < .05).
Findings on the efficacy of an acustimulation band for the control of chemotherapy-induced nausea are positive but not conclusive. These findings provide ample justification for further study of acustimulation in clinical oncology.
As an adjunct to standard antiemetics for the relief of chemotherapy-induced nausea and vomiting (NV), 739 patients were randomly assigned to either: 1) acupressure bands, 2) an acustimulation band, or 3) a no band control condition. Patients in the acupressure condition experienced less nausea on the day of treatment compared to controls (P<0.05). There were no significant differences in delayed nausea or vomiting among the three treatment conditions. Additional analyses revealed pronounced gender differences. Men in the acustimulation condition, but not the acupressure condition, had less NV compared to controls (P<0.05). No significant differences among the three treatment conditions were observed in women, although the reduction in nausea on the day of treatment in the acupressure, compared to the no band condition, closely approached statistical significance (P=0.052). Expected efficacy of the bands was related to outcomes for the acupressure but not the acustimulation conditions.
Chemotherapy-induced nausea and vomiting (CINV) are major adverse effects of cancer chemotherapy. We compared the impact of acute (during the first 24 hours postchemotherapy) and delayed (days 2 through 5 postchemotherapy) CINV on patients' quality of life (QoL) after highly or moderately emetogenic chemotherapy (HEC and MEC, respectively).
This prospective, multicenter, multinational study was conducted in 14 medical practices on cancer patients undergoing either HEC or MEC treatment. Patients recorded episodes of nausea and vomiting in a diary. Patients completed the Functional Living Index-Emesis (FLIE) questionnaire at baseline and on day 6.
A total of 298 patients were assessable (67 HEC patients, 231 MEC patients). Emesis was reported by 36.4% of patients (13.2% acute, 32.5% delayed) and nausea by 59.7% (36.2% acute, 54.3% delayed). HEC patients reported significantly lower mean FLIE total score than MEC patients (95.5 v 107.8 respectively; P = .0049). Among all patients, the nausea score was significantly lower than the vomiting score (50.0 and 55.3, respectively; P = .0097). Of the 173 patients who experienced neither vomiting nor nausea during the first 24 hours postchemotherapy, 22.9% reported an impact of CINV on daily life caused by delayed CINV.
CINV continues to adversely affect patients' QoL despite antiemetic therapy even after treatment with only moderately emetogenic chemotherapy regimens, and even in the subgroup of patients who do not experience nausea and vomiting during the first 24 hours. On the basis of the FLIE results in this study, nausea had a stronger negative impact on patients' daily lives than vomiting.