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The Efficacy of Acupressure for Symptom Management: A Systematic Review

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Abstract and Figures

Acupressure is a noninvasive strategy used to manage various symptoms. The purpose of this article was to review randomized controlled trials that investigated the efficacy of acupressure for the management of symptoms. A literature search was conducted in the Cumulative Index to Nursing and Allied Health Literature, Medline, and PubMed using the key words acupressure, clinical trial, human, and/or randomized. Randomized clinical trials published between January 1, 2000 and January 31, 2010, which used acupressure as the sole intervention for one group, were included when they were written in English and when there were four or more studies of the efficacy of acupressure for that particular symptom. Forty-three studies were included in this review. Investigators in 16 of 23 studies concluded acupressure was effective, primarily for the management of nausea and vomiting in patients during pregnancy and during chemotherapy. Investigators in nine of 10 studies concluded that acupressure was effective for pain in patients with dysmenorrhea, during labor and after trauma. Investigators of four studies concluded that acupressure was effective in the management of dyspnea and investigators in six studies concluded that acupressure was effective in improving fatigue and reducing insomnia in a variety of populations. However, evaluation of the randomized controlled trial reports indicated a significant likelihood of bias. Acupressure may be a useful strategy for the management of multiple symptoms in a variety of patient populations, but rigorous trials are needed. Inclusion of acupressure as an intervention may improve patient outcomes.
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Review Article
The Efficacy of Acupressure for Symptom
Management: A Systematic Review
Eun Jin Lee, PhD, RN, APRN, and Susan K. Frazier, PhD, RN
Central Baptist Hospital (E.J.L.) and University of Kentucky College of Nursing (S.K.F.), Lexington,
Kentucky, USA
Abstract
Context. Acupressure is a noninvasive strategy used to manage various
symptoms.
Objectives. The purpose of this article was to review randomized controlled
trials that investigated the efficacy of acupressure for the management of
symptoms.
Methods. A literature search was conducted in the Cumulative Index to Nursing
and Allied Health Literature, Medline, and PubMed using the key words
acupressure, clinical trial, human, and/or randomized. Randomized clinical trials
published between January 1, 2000 and January 31, 2010, which used acupressure
as the sole intervention for one group, were included when they were written in
English and when there were four or more studies of the efficacy of acupressure
for that particular symptom.
Results. Forty-three studies were included in this review. Investigators in 16
of 23 studies concluded acupressure was effective, primarily for the
management of nausea and vomiting in patients during pregnancy and during
chemotherapy. Investigators in nine of 10 studies concluded that acupressure
was effective for pain in patients with dysmenorrhea, during labor and after
trauma. Investigators of four studies concluded that acupressure was effective
in the management of dyspnea and investigators in six studies concluded that
acupressure was effective in improving fatigue and reducing insomnia in
a variety of populations. However, evaluation of the randomized controlled
trial reports indicated a significant likelihood of bias.
Conclusion. Acupressure may be a useful strategy for the management of
multiple symptoms in a variety of patient populations, but rigorous trials are
needed. Inclusion of acupressure as an intervention may improve patient
outcomes. J Pain Symptom Manage 2011;42:589e603. Ó2011 U.S. Cancer Pain
Relief Committee. Published by Elsevier Inc. All rights reserved.
Key Words
Acupressure, pain, dyspnea, fatigue, nausea, review
Introduction
Symptoms are the subjective sensations
that accompany disease or injury and include
nausea, pain, dyspnea, and fatigue. These
Address correspondence to: Eun Jin Lee, PhD, RN,
APRN, Fayetteville State University, 1200 Murchison
Road, Nursing Building #311, Fayetteville, NC
28301, USA. E-mail: peace-peace@hanmail.net
Accepted for publication: January 4, 2011.
Ó2011 U.S. Cancer Pain Relief Committee
Published by Elsevier Inc. All rights reserved.
0885-3924/$ - see front matter
doi:10.1016/j.jpainsymman.2011.01.007
Vol. 42 No. 4 October 2011 Journal of Pain and Symptom Management 589
experiences are ubiquitous; all individuals en-
counter multiple symptoms during their life-
time. Symptoms may be acute or chronic,
isolated or found in clusters, and they are
the primary reason individuals seek health
care.
1,2
Effective management of symptoms is
needed to improve individual quality of life
and reduce health care costs. For example,
chronic pain occurs in 50 million Americans
annually and has been found to influence
functional status, to reduce quality of life,
and to cost an estimated $150 million each
year.
3
Thus, interventions to effectively man-
age symptoms such as pain are needed. Acu-
pressure may be an effective intervention for
a wide variety of symptoms. This intervention
is noninvasive, relatively inexpensive, and has
been demonstrated to be without adverse
effects.
4
The use of acupressure is based on meridian
theory, which proposes that acupressure stim-
ulates meridians, a network of energy path-
ways throughout the body, to increase the
flow of qi (bioenergy), subsequently altering
the symptom experience.
5
Acupressure is ap-
plied to specific points by the use of finger,
hand, elbow, foot, and/or acupressure band
(Sea-Bands
Ò
, Leicestershire, U.K.), an elastic
band with a protruding plastic button, for
stimulation of these pathways to increase the
flow of qi.
Studies testing the efficacy of acupressure
for symptom management have been a focus
of research, particularly during the last de-
cade. However, no reviews have been pub-
lished reporting the efficacy of acupressure
for the management of multiple common
symptoms. Thus, the purpose of this article
was to review the findings of randomized con-
trolled trials (RCTs) that tested the efficacy of
acupressure for symptom reduction.
Methods
Cumulative Index to Nursing and Allied
Health Literature (CINAHL), Medline, and
PubMed were searched for articles published
between January 1, 2000 and January 31,
2010, using the key words acupressure, clini-
cal trial, human, and/or randomized. Studies
from this decade were included, as standards
for reporting clinical trials were in place and
this would provide a synthesis of the most
recent findings of rigorous trials related to
acupressure and symptom management.
6
Reference lists of these articles also were
hand searched to find additional pertinent
studies. Articles were included in this review
if they were written in English and reported
RCTs. Studies were included when acupres-
sure was the sole intervention in at least
one of the experimental groups. A review
of studies for individual symptoms was in-
cluded in this review if there were at least
four trials for management of a particular
symptom. This cut-point was selected to en-
sure that there were a minimum number of
clinical trials focused on a given symptom.
Investigations with a sample size of less
than 30 individuals were excluded because
of a presumptive lack of statistical power (if
sample size is 30, alevel 0.05, large effect
size 0.8, power ¼56%). Studies using auricu-
lar or hand acupressure, reflexology, shiatsu,
and electronic or magnetic devices were ex-
cluded because they use a different naming
system for the meridians and a different
technique from body acupressure. Unpub-
lished studies and abstracts also were
excluded.
Meta-analysis was not used in the evalua-
tion of efficacy as the populations and inter-
ventions studied were very diverse and not
suitable for this technique. Effect size
(Hedges’s g) for each trial was calculated us-
ing the mean values of the acupressure and
control groups when provided.
7
Pre-post
mean for the acupressure group was used
alone when the post-mean of the control
group was not available.
Each experimental study was evaluated for
quality using the risk of bias tool by the Co-
chrane group.
6
This instrument consists of
six domains: sequence generation; allocation
concealment; blinding of participants, person-
nel, and outcomes; incomplete outcome data;
selective outcome reporting; and other sources
of bias. Articles were evaluated for the pres-
ence of each domain and one point was as-
signed for each domain present. Scores
ranged from 0 to 6 and a higher value indi-
cated higher quality and less risk for bias
(Table 1). All trials were evaluated by the two
authors and the agreement between them
was 100%.
590 Vol. 42 No. 4 October 2011Lee and Frazier
Table 1
Effect Size and Risk of Bias Evaluation for Studies in the Review
First Author (Year) Measure
Quality of
Study
Acupressure Control/Placebo/Post
Effect Size CI PMean SD nMean SD n
Norheim (2001)
18
Duration of nausea 2 2.74 0.85 0.33e3.45 <0.05
Werntoft (2001)
38
Severity of nausea (0e10) 6 4.2 2.6 20 6.5 2.2 20 0.96 0.28e1.59 0.01
Habek (2004)
12
Success rate of treatment on nausea 4 0.64 0.14 11 0.13 0.12 8 0.59 0.37e1.49 <0.001
Heazell (2006)
32
Number of patients required second
and third antiemetics (%)
4 0.73 0.07 40 0.7 0.07 40 0.43 0.02 to 0.87 NS
Shin (2007)
41
Rhodes Index of Nausea and Vomiting
(6e30)
5 17.6 1.06 23 21.6 1.06 22 3.79 2.76e4.69 <0.05
Jamigorn (2007)
33
RINVR (8e40) 4 14.3 Pre 3.3 33 33 3.3 <0.001
Roscoe (2003)
34
Severity of nausea (1e7) 2 2.6 233 3 232 <0.05
Molassiotis (2007)
55
Incidence of nausea (%) 5 0.66 1.6 17 2.16 2.4 19 0.73 0.04e1.39 <0.05
Dibble (2000)
19
Rhodes Index of Nausea (age <55 yr) 4 6.5 3.3 <0.001
Roscoe (2009)
30
Severity of nausea (pre-post mean
difference)
5 0.7 0.23 59 0.1 0.27 29 2.4 1.87e3.01 <0.001
Harmon (2000)
22
Incidence of nausea and vomiting (%) 4 0.36 0.07 47 0.66 0.07 47 4.3 3.52e4.98 0.007
Agarwal (2000)
45
Incidence of nausea (%) 4 0.18 0.03 100 0.2 0.03 100 0.67 0.38e0.95 NS
Alkaissi (2002)
47
Incidence of nausea and vomiting (%) 5 0.33 0.04 135 0.46 0.04 136 3.25 2.88e3.6 <0.05
Ming (2002)
20
RINVR (finger) 2 1.28 3.4 50 6.96 5.96 50 1.2 0.74e1.59 <0.01
RINVR (wristband) 4.34 6.63 50 6.96 5.96 50 0.41 0.01e0.81 <0.05
Agarwal (2002)
46
Incidence of nausea (%) 4 0.06 0.01 50 0.24 0.06 50 4.18 3.46e4.85 <0.05
Schultz (2003)
39
Moderate to severe nausea (%) 5 0.64 0.1 22 0.63 0.1 24 0.1 0.48 to 0.68 NS
Samad (2003)
29
Incidence of nausea (%) 3 0. 36 0.1 25 0.40 0.1 25 0.4 0.95 to 0.17 NS
Klein (2004)
42
Incidence of nausea (%) 4 0.33 0.05 75 0.36 0.06 77 0.5 0.22e0.86 NS
Ho (2006)
40
Incidence of nausea (%) 5 0.64 0.06 55 0.71 0.06 55 1.2 0.75e1.56 NS
Turgut (2007)
28
Incidence of nausea (%) 4 0.32 0.07 50 0.64 0.07 50 4.57 3.29e5.28 <0.05
Sadighha (2008)
43
Severity of nausea (0e10) 2 0.14 0.05 51 0 0 52 3.98 3.29e4.61 <0.001
Dent (2003)
27
Incidence of nausea and vomiting 4 0.18 0.04 95 0.43 0.05 108 5.48 4.86e6.06 <0.05
Alkaissi (2005)
48
Mean time to moderate nausea (second) 3 352 93 20 280 119 20 0.66 0.02e1.03 NS
Taylor (2002)
26
Pain score (0e10) 4 3.9 1.5 28 7.3 1.4 26 2.34 1.62e3<0.001
Pouresmail (2002)
49
Severity of dysmenorrhea (score 0) 1 0.50 0.06 72 0.18 0.05 72 5.79 5.02e6.5 <0.001
Chen (2004)
13
VAS for pain (0e10) 4 3.9 1.8 35 4.8 1.8 34 0.5 0.01e0.97 <0.05
Chung (2003)
35
VAS for pain (0e10) 4 0.17 1.32 43 0.81 1.23 42 0.5 0.07e0.93 <0.05
Lee (2004)
21
Pain score 4 6.4 1.8 36 7.6 1.9 39 0.6 5.65e6.49 0.012
Hsieh (2004)
53
Pain score 5 9.29 2.6 69 5.05 5.11 77 1.0 0.68e1.37 0.0002
Hsieh (2006)
52
Roland and Morris Disability
Questionnaire
5 5.4 5.0 64 9.2 5.8 65 0.7 6.37e8.24 <0.01
Lang (2007)
51
VAS for pain (0e100) 6 36.6 22.2 15 56 13.3 16 1.07 0.29e1.79 <0.001
Sakurai (2003)
54
VAS for pain (0e100) 5 29.5 13.5 23 40 18 30 0.65 0.08e1.19 NS
Kober (2002)
50
VAS for pain (0e100) pre-post 5 61.8 11.8 19 34 16.9 19 1.9 1.11e2.63 <0.01
Maa (2003)
44
Saint George Respiratory
Questionnaire (%)
1 0.76 0.1 17 0.38 0.13 13 3.3 0.98e44 <0.05
Wu (2004)
14
Pulmonary Function Status, Dyspnea
Questionnaire
2 0.98 1.41 22 0.41 0.43 22 0.55 0.01 to 1.14 <0.05
(Continued)
Vol. 42 No. 4 October 2011 591Acupressure: A Review
Results
Thirty-three articles were retrieved from
CINAHL, 60 from Medline, 103 from PubMed,
and none from hand searching, for a total of
196 articles initially retrieved. Eighty-eight arti-
cles were duplicates, which left 108 articles for
screening. Four articles were excluded because
of duplicate data.
8e11
After application of the
exclusion criteria, 43 studies remained for in-
clusion in this review (Fig. 1). Studies were cat-
egorized by the symptoms managed, which
included nausea and vomiting, pain, dyspnea,
and fatigue/insomnia. Fatigue and insomnia
were grouped together as these investigations
typically studied both simultaneously. The
characteristics of these studies are summarized
in Table 2.
Quality of Studies
The average risk of bias score was 3.8 for
RCTs focused on nausea/vomiting, 4.8 for
studies investigating pain management, 2.3
for studies of efficacy for dyspnea, and 2.5
for those studying the reduction of fatigue/
insomnia. Thus, the risk for bias of these stud-
ies was moderate to high and only two studies
(5%) earned scores of 6, indicating the lowest
risk of bias and highest quality RCT. Of 43
RCTs, the randomization strategy was unclear
in 14 studies,
12e25
16 studies did not use
Table 1
Continued
First Author (Year) Measure
Quality of
Study
Acupressure Control/Placebo/Post
Effect Size CI PMean SD nMean SD n
Tsay (2005)
15
VAS for dyspnea (0e100) pre-post 3 69.4 12.0 26 62.7 12.03 26 0.56 0.01 to 1.10 <0.05
Maa (2007)
36
St. George’s Respiratory Questionnaire
activity
3 14.8 13.2 11 28.4 24.8 13 0.7 1.47 to 0.18 0.01
Tsay (2003)
25
Pittsburgh Sleep Quality Index 3 7.1 4.15 35 10.3 4.25 31 0.76 0.26e1.26 <0.05
Tsay (2004)
16
Piper Fatigue Scale 1 4.66 1.77 35 5.71 1.82 36 0.58 0.1e1.05 <0.05
Cho (2004)
24
Piper Fatigue Scale 2 3.4 1.5 28 4.7 1.7 30 0.8 0.26e1.3 <0.05
Harris (2005)
37
Stanford Sleeping Scale 2 0.57 21 1.13 18 <0.001
Molassiotis (2007)
55
Multidimensional Fatigue Inventory (%) 3 0.19 0.1 16 0.01 0.06 16 2.23 <0.001
Nordio (2008)
17
Pittsburgh Sleep Quality Index 4 4.8 2.75 18 1.3 2.9 15 1.27 0.49e1.99 <0.05
RINVR ¼Rhodes Index of Nausea, Vomiting, and Retching; SD ¼standard deviation; VAS ¼visual analogue scale.
Key words: acupressure,
clinical trial, human, and
randomized
Total 108
(103 from PubMed,
60 from Medline,
33 from CINAHL,
0 from hand searching)
84 articles
48 articles
Not body acupressure (n = 23)
Not sole intervention (n = 1)
Less than 30 patients (n = 6)
Not RCT (n = 7)
Less than 5 articles for a
symptom (n = 21)
Duplicated data (n = 4)
Fig. 1. Flow diagram of study inclusion and
exclusion.
592 Vol. 42 No. 4 October 2011Lee and Frazier
Table 2
Acupressure Studies in the Review
First Author (Year) Sample n
Acupressure
Point Tool Time per Day Day Measures
Nausea
Norheim (2001)
18
Pregnancy 97 PC6 Sea-Band 24 hours Four days VAS, nausea intensity, duration, nature of
symptom
Werntoft (2001)
38
Pregnancy 60 PC6 Wristband 24 hours 14 days VAS for nausea
Habek (2004)
12
Pregnancy 36 PC6 Acupressure 30 minutes Seven days Incidence of nausea, vomiting, antiemetic
Heazell (2006)
32
Pregnancy 80 PC6 Sea-Band Eight hours Three days Length of stay, amount of medication and
fluid
Shin (2007)
41
Pregnancy 66 PC6 Acupressure 10 minutes Four days Rhodes Index of Nausea, Vomiting, and
Retching, ketonuria
Jamigorn (2007)
33
Pregnancy 60 PC6 Sea-Band 24 hours Five days Rhodes Index of Nausea and Vomiting
Roscoe (2003)
34
Chemotherapy 739 PC6 Sea-Band 24 hours Five days Severity, frequency of nausea and vomiting,
expected efficacy of the wristbands
Molassiotis (2007)
55
Chemotherapy 36 PC6 Sea-Band 24 hours Five days Rhodes Index of Nausea, Vomiting, and
Retching
Dibble (2000)
19
Chemotherapy 160 PC6 Acupressure Nine minutes 21 days Rhodes Index of Nausea, NRS, State-Trait
Anxiety Inventory
Roscoe (2009)
30
Radiation 88 PC6 Sea-Band 24 hours Five days Likert scale for severity of nausea, number of
vomiting
Harmon (2000)
22
Surgery 94 PC6 Sea-Band Six hours Once Incidence or vomiting, VAS for nausea,
antiemetic
Agarwal (2000)
45
Surgery 200 PC6 Sea-Band Six hours Once Incidence of Nausea, vomiting
Alkaissi (2002)
47
Surgery 410 PC6 Sea-Band 24 hours One day Seven-point scale for nausea, vomiting, pain
Ming (2002)
20
Surgery 150 PC6, HT7 Acupressure
wristband
20 minutes,
24 hours
Once,
one day
Rhodes Index of Nausea, Vomiting, and
Retching, State-Trait Anxiety Inventory
Agarwal (2002)
46
Surgery 150 PC6 Sea-Band Six hours Once Incidence of nausea, vomiting
Schultz (2003)
39
Surgery 103 PC6 Sea-Band 24 hours Three days Four-point scale for nausea, incidence of
vomiting, retching
Samad (2003)
29
Surgery 50 PC6 Sea-Band Six hours Once Incidence of nausea, vomiting, antiemetic
Klein (2004)
42
Surgery 152 PC6 Sea-Band 24 hours One day Incidence of nausea, vomiting, antiemetic
Ho (2006)
40
Surgery 110 PC6 Sea-Band 104 minutes Once Incidence of nausea and vomiting
Turgut (2007)
28
Surgery 100 PC6 Sea-Band 24 hours One day Likert scale for nausea and vomiting
Sadighha (2008)
43
Surgery 156 PC6 Wristband 24 hours One day Likert scale for nausea and vomiting
Dent (2003)
27
Acute MI 301 PC6 Wristband 24 hours One day Incidence and severity of nausea and
vomiting, doses of antiemetic medication
Alkaissi (2005)
48
Motion sickness 60 PC6 Sea-Band Likert-type scale for nausea
Pain
Taylor (2002)
26
Dysmenorrhea 58 Multipoint Acupressure pad 24 hours Three days Descriptive Numeric Rating Scale of pain
intensity, Dysmenorrhea Symptom
Intensity and Distress Inventory
Pouresmail (2002)
49
Dysmenorrhea 216 Multipoint Acupressure Two minutes VAS for pain, multidimensional scoring
system for the severity of dysmenorrhea
(Continued)
Vol. 42 No. 4 October 2011 593Acupressure: A Review
Table 2
Continued
First Author (Year) Sample n
Acupressure
Point Tool Time per Day Day Measures
Chen (2004)
13
Dysmenorrhea 69 SP6 Acupressure 20 minutes Two days VAS for pain and anxiety, Menstrual Distress
Questionnaire, Short-form McGill Pain
Questionnaire
Chung (2003)
35
Labor 127 LI4, UB67 Acupressure 20 minutes Once VAS for pain, external fetal monitor, time of
first stage of labor
Lee (2004)
21
Labor 75 SP6 Acupressure 30 minutes Once VAS for labor pain, duration of labor to
delivery
Hsieh (2004)
53
Back pain 146 Acupressure 15 minutes 120 days Short-Form Pain Questionnaire
Hsieh (2006)
52
Back pain 129 Acupressure 30 days Roland and Morris Disability Questionnaire,
Oswestry Disability Questionnaire, quality
of life
Lang (2007)
51
Radial fracture 70 GV20, LI4 Acupressure Six minutes Once VAS for pain and anxiety
Sakurai (2003)
54
Surgery 53 Multipoint Sphere VAS for pain, opioid use
Kober (2002)
50
Trauma 60 Multipoint Acupressure Three minutes Once VAS for pain, anxiety
Dyspnea
Maa (2003)
44
Asthma 41 Multipoint Acupressure 2.5e10 minutes 56 days VAS for dyspnea, Borg Scale, St. George’s
Respiratory Questionnaire, Bronchitis
Emphysema Symptom Checklist
Wu (2004)
14
COPD 44 Multipoint Acupressure 16 minutes 28 days Pulmonary Functional Status, Dyspnea
Questionnaire modified, 6-min walk
distance
Tsay (2005)
15
COPD 52 LI4, PC6, HT7 Acupressure 12 minutes 10 days Respiratory rate, heart rate, VAS for anxiety
and dyspnea
Maa (2007)
36
Bronchiectasis 35 Multipoint Acupressure 2.5e10 minutes 56 days Daily sputum amount, 6-min walk distance,
VAS for dyspnea, Saint George Respiratory
Questionnaire
Fatigue
Tsay (2003)
25
ERSD 98 HT7, KD11 Acupressure Nine minutes 12 days Pittsburgh Sleep Quality Index, sleep log
Tsay (2004)
16
ESRD 106 Multipoint Acupressure 12 minutes 12 days Piper Fatigue Scale, VAS for fatigue,
Pittsburgh Sleep Quality Index
Cho (2004)
24
ESRD 58 ST36, K1 SP6,
K13
Acupressure 12 minutes 12 days Piper Fatigue Scale, Beck Depression
Inventory
Harris (2005)
37
Students 39 Multipoint Acupressure 15 minutes Three days Stanford Sleeping Scale
Molassiotis (2007)
55
Chemotherapy 47 LI4, SP6, ST36 Acupressure Three minutes 12 days Multidimensional Fatigue Inventory
Nordio (2008)
17
Insomnia 40 HT7 Acupressure band 10 hours 20 days Pittsburgh Sleep Quality Index, urinary
melatonin
MI ¼myocardial infarction; COPD ¼chronic obstructive pulmonary disease; ESRD ¼end-stage renal disease; VAS ¼visual analogue scale; NRS ¼numeric rating scale.
Acupressure point: conception vessel (CV), governing vessel (GV), heart (HT), pericardium (PC), lung (LU), spleen (SP), liver (LV/LR), kidney (KD/KI), small intestine (SI), triple heater (TH/TE), large
intestine (LI), stomach (ST), gallbladder (GB), and urinary bladder (UB/BL).
594 Vol. 42 No. 4 October 2011Lee and Frazier
double blinding,
13,14,16,24,26e37
and four of 27
studies that used double blinding
17,38e40
did
not describe the method used. Nine studies
did not report the attrition rate and reasons
for attrition.
12,14,15,29,37,40e43
Another particular issue related to quality
was the lack of fidelity evaluation in the 40%
(n¼17) of studies that used acupressure ad-
ministered by the participants. Also, only four
of these reported the length of time participants
performed acupressure.
26,30,34,39
Fidelity to the
intervention is an important confounding fac-
tor that may have added bias to these studies.
Outcome Measures
To measure the efficacy of acupressure on
nausea and vomiting, outcome measures in-
cluded a visual analogue scale (VAS) for nausea
and vomiting;
18
the incidence and severity of
nausea and vomiting;
12
hospital length of stay;
dose of medication required; and the Rhodes
Index of Nausea, Vomiting, and Retching.
41
To measure the efficacy of acupressure for
pain, a VAS for pain
35
and the Short-Form
McGill Pain Questionnaire
13
were primarily
used. To measure the efficacy of acupressure
for dyspnea, the Saint George Respiratory Ques-
tionnaire,
44
six-minute walk distance,
14
aVAS
for dyspnea,
44
and the Pulmonary Functional
Status and Dyspnea Questionnaire
14
were used
to evaluate outcomes. To measure the efficacy
of acupressure for fatigue and sleep, the
Pittsburgh Statistical Quality Index,
8
the Piper
Fatigue Scale,
16
the Stanford Sleeping Scale,
37
and a VAS for fatigue
16
were used.
Description of Studies
Acupressure for Nausea and Vomiting
Nausea and Vomiting Associated with Pregnancy.
Six RCTs examined the efficacy of acupressure
at PC6 in the prevention or management of
nausea and vomiting associated with preg-
nancy.
12,18,32,33,38,41
Investigators used nausea
self-report and objective measurement of eme-
sis, total dose of antiemetic medications, and
hospital length of stay as indicators of efficacy.
Habek et al.
12
reported that acupressure for 30
minutes daily for seven days significantly im-
proved nausea and vomiting compared with
placebo acupressure in patients with hyperem-
esis gravidarum (n¼36). In women with gesta-
tional age 8e12 weeks, investigators tested
four days of acupressure using Sea-Bands and
compared the duration and intensity of nausea
and vomiting with a control group who wore
wristbands with a felt patch for the same time
period.
18
These investigators found that acu-
pressure significantly reduced the duration of
nausea and vomiting early in pregnancy, but
did not reduce the intensity of nausea when
compared with a placebo group. Sixty-three per-
cent of participants in the acupressure group
and 90% in the placebo group experienced
pain, numbness, soreness, and hand swelling
from using wristbands. Werntoft and Dykes
38
found that acupressure using Sea-Bands daily
for two weeks (removed only when showering)
significantly reduced nausea in healthy preg-
nant women compared with both control (no
antiemetic) and placebo (Sea-Bands at non-
meridian) groups (n¼60).
Because prolonged nausea and vomiting
produces ketonuria, Shin et al.
41
used ketonu-
ria as an additional outcome variable. These
investigators found that a four-day, daily, 10-
minute acupressure treatment significantly
reduced nausea, vomiting, and ketonuria in
women with hyperemesis gravidarum when
compared with placebo (acupressure at inap-
propriate location) and control groups
(standard care) (n¼66). Jamigorn and Phu-
pong
33
also found that acupressure using
Sea-Bands for 24 hours a day for five days re-
duced nausea and vomiting in 60 pregnant
women compared with vitamin B6 and placebo
wristbands. Only one patient reported adverse
effects from the Sea-Bands. In contrast, Hea-
zell et al.
32
found that the use of acupressure
bands (Sea-Bands) for an eight-hour period
did not affect the length of hospital stay,
amount of antiemetic medication required,
and the volume of fluid administered to pa-
tients who experienced nausea and vomiting
in early pregnancy when compared with a pla-
cebo group (Sea-Bands placed in a nonmeri-
dian location) (n¼80).
Nausea and Vomiting Associated with Chemotherapy
and Radiation. Four RCTs examined the effi-
cacy of acupressure at PC6 for nausea and
vomiting in cancer patients who were under-
going chemotherapy or radiation.
19,30,31,34
Roscoe et al.
34
found that acupressure using
Sea-Bands continuously for five days signifi-
cantly reduced nausea and vomiting on the
Vol. 42 No. 4 October 2011 595Acupressure: A Review
first day of chemotherapy compared with the
control group, which received standard care
(n¼739). However, there was no significant
difference on the second to fifth day of chemo-
therapy. In another study by Roscoe et al.,
30
they found that Sea-Bands were effective in re-
ducing nausea and vomiting associated with
radiation therapy compared with standard
care (n¼94). Molassiotis et al.
31
found that
acupressure using Sea-Bands continuously for
five days significantly reduced nausea, vomit-
ing, and retching in patients with breast cancer
receiving chemotherapy when compared with
a control group receiving standard care
(n¼36). However, Dibble et al.
19
found that
a daily nine-minute acupressure treatment
given prior to chemotherapy administration
on the day of treatment initiation and continu-
ing for 21 days did not reduce acute nausea
and vomiting on the day of chemotherapy,
but did decrease nausea and vomiting from
Day 2 to Day 11 when compared with the con-
trol (standard care) and placebo groups (acu-
pressure in inappropriate locations) (n¼160).
Nausea and Vomiting Associated with Surgical
Intervention. Eleven studies examined the
efficacy of acupressure at PC6/HT7 for nausea
and vomiting in a variety of postoperative
patients.
20,22,28,29,39,40,42,43,45e47
The majority
of these investigations focused on patients fol-
lowing abdominal surgery, particularly obstetric
and gynecological surgery or cholecystectomy.
Alkaissi et al.
47
reported that acupressure us-
ing Sea-Bands for 24 hours significantly im-
proved nausea and vomiting in patients after
gynecological surgery compared with standard
care (n¼410). These investigators found that
Sea-Bands were reported to be uncomfortable
and were associated with red indentations, itch-
ing, headache and dizziness, pain, swelling,
and blistering at the site of the acupressure
button. In another investigation, six hours
of acupressure significantly reduced nausea
and vomiting following Caesarean section com-
pared with placebo bands (n¼94)
22
and 24
hours of acupressure significantly improved
nausea and vomiting after other gynecological
surgery compared with placebo bands
(n¼100).
28
However, Ho et al.
40
found that
acupressure after Caesarean section did not re-
duce the incidence of nausea and vomiting
when compared with a control group (placebo
wristbands) (n¼110). Schultz et al.
39
also
found that acupressure with placebo drugs ad-
ministered 24 hours a day for three days did
not reduce nausea and vomiting in patients af-
ter gynecologic surgery compared with placebo
drugs with placebo bands (n¼103).
Agarwal et al.
46
found that acupressure us-
ing Sea-Bands for six hours was as effective as
administration of ondansetron in improving
nausea and vomiting in patients after cholecys-
tectomy when compared with placebo wrist-
bands (n¼150), but did not improve nausea
and vomiting in patients after urological endo-
scopic surgery compared with placebo wrist-
bands (n¼200).
45
In addition, acupressure
using Sea-Bands for six hours did not improve
nausea and vomiting compared with the pla-
cebo wristbands in patients after cholecystec-
tomy (n¼50).
29
In contrast, Sadighha and
Nurai
43
reported that the use of an acupres-
sure wristband for one day relieved nausea
and vomiting in patients after laparoscopic
cholecystectomy compared with placebo band
and antiemetic groups (n¼156).
Acupressure also has been studied as a man-
agement strategy following other surgical
procedures. Following functional endoscopic
sinus surgery, Ming et al.
20
found that one 20-
minute acupressure treatment or Sea-Bands
for 24 hours were both effective in reducing
nausea and vomiting when compared with
a control group (standard care) (n¼150).
Of the two acupressure strategies used with
the sinus surgery patients, acupressure using
fingers for 20 minutes was more effective
than Sea-Bands. In contrast, Klein et al.
42
found that acupressure using Sea-Bands for
24 hours did not improve nausea and vomit-
ing compared with the placebo wristband
group in patients following cardiac surgery
(n¼152). Thus, overall findings for the post-
operative population are equivocal.
Nausea and Vomiting Associated with Acute Myo-
cardial Infarction (AMI). Dent et al.
27
reported
that acupressure for 24 hours using Sea-Bands
at PC6 was not effective in reducing the inci-
dence and severity of nausea and vomiting
after AMI (n¼301). Sea-Bands were supposed
to be applied when patients were admitted.
However, 15% of patients did not receive these
until at least two hours after admission. The
investigators concluded that failure to apply
596 Vol. 42 No. 4 October 2011Lee and Frazier
Sea-Bands during the early onset of AMI might
have reduced the effect of the treatment.
Nausea and Vomiting Associated with Motion Sick-
ness. Alkaissi et al.
48
studied women with a his-
tory of motion sickness and reported that
acupressure using Sea-Bands at PC6 was not ef-
fective in reducing nausea related to motion
sickness compared with the placebo group
(n¼60). The intervention group received
acupressure using Sea-Bands, but the time of
application and the length of treatment were
not described. The placebo group wore Sea-
Bands in an inappropriate location, also for
an unknown period of time, and the control
group received no therapy. Rotation chairs
with 60/sspeedwereusedtoinducemotion
sickness. When participants reported moder-
ate nausea, rotation chairs were stopped. Nau-
sea was measured immediately and 30 minutes
later using a seven-point Likert scale and mo-
tion sickness was not improved by acupressure
in this experiment.
Acupressure for Pain
Dysmenorrhea. Three studies examined the ef-
ficacy of acupressure for menstrual
pain.
13,26,49
Chen and Chen
13
studied adoles-
cents with menstrual pain (n¼69) and found
that 20 minutes of acupressure at SP6 on the
first day of menstruation was effective in re-
ducing dysmenorrhea compared with a control
group that received a rest period in the school
health center. Taylor et al.
26
used specialized
panties that administered acupressure to mul-
tiple points (CV2, CV4, SP12, SP13, ST30,
KD11, KD13, UB23, UB25, UB27, UB28, and
GV4) continuously. These panties were worn
for the first three menstrual days and were
found to be effective in reducing dysmenor-
rhea and the number of doses of pain medica-
tion daily compared with a control group that
received usual care (n¼58). Concurrently,
Pouresmail and Ibrahimzadeh
49
reported
that acupressure was effective in the treatment
of dysmenorrhea in high-school students
when compared with a placebo group that
received sham acupressure (n¼216).
Labor Pain. Two RCTs tested the efficacy of
acupressure for the reduction of labor
pain.
21,35
Chung et al.
35
found that
acupressure at LI4 and UB67 for 20 minutes
during the first stage of labor was effective in
reducing pain when compared with a placebo
group that received effleurage, a light stroking
at both upper outer arms, and a control group
that received usual care (n¼127). In a similar
study, Lee et al.
21
found that acupressure at
SP6 for 30 minutes significantly reduced pain
and decreased labor time required for cervical
dilation from 3 cm to delivery when compared
with a placebo group that received only touch
at SP6 (n¼75).
Pain Related to Trauma.TwoRCTsexamined
the efficacy of acupressure for pain related to
trauma.
50,51
Kober et al.
50
reported that acu-
pressure at LI4, PC6, PC9, BL60, and GV2 for
three minutes in patients being transported
by ambulance following minor trauma re-
duced pain, anxiety, and heart rate compared
with control (standard care) and sham acu-
pressure groups (n¼60). In a similar study,
Lang et al.
51
found that in patients with a radial
fracture, six minutes of acupressure adminis-
tered once at GV20 and LI4 during ambulance
transport to the hospital significantly reduced
pain and anxiety when compared with a pla-
cebo group that received acupressure at an in-
appropriate location (n¼70).
Muscular System. Two RCTs examined the effi-
cacy of acupressure for muscular pain.
52,53
Hsieh et al.
53
found that acupressure treatment
six times over a one-month period was sig-
nificantly more effective in reducing chronic
low back pain compared with a comparison
group that was treated with physical therapy
(n¼146). The efficacy of the acupressure treat-
ments persisted for six months and pain scores
remained significantly lower than the physical
therapy group. In a subsequent study, Hsieh
et al.
52
used the same protocol and found that
acupressure significantly reduced chronic low
back pain when compared with a placebo acu-
pressure group (n¼129). Unfortunately, these
two reports provided inadequate details about
the acupressure treatment, which precludes
replication of the studies.
Pain Related to Surgery. Sakurai et al.
54
com-
pared acupressure with a control condition
(standard care) after open abdominal surgery.
All patients received intravenous morphine
Vol. 42 No. 4 October 2011 597Acupressure: A Review
via patient-controlled analgesia. These investi-
gators found that acupressure at PC6, ST36,
SP4, and SP6 did not reduce pain scores or to-
tal dose of analgesics required when compared
with the control group (n¼53).
Acupressure for Dyspnea
The authors of four investigations reported
that acupressure was effective in reducing
dyspnea.
14,15,36,44
Dyspnea is the sensation of
difficulty breathing or shortness of breath,
which may be acute or chronic. Dyspnea is
often accompanied by other symptoms, such
as anxiety and depression, and signs such as ta-
chypnea and reduced functional ability.
10,14
Dyspnea is the most common and most debili-
tating symptom found in chronic lung disease.
Thus, studies primarily included patients
with some form of chronic lung disease.
Wu et al.
14
found that four weeks of a daily
16-minute acupressure treatment at GV14,
CV22, UB13, UB23, and LU10 was effective
in improving pulmonary function, oxygen sat-
uration, six-minute walk distance, dyspnea,
and state-anxiety when compared with a pla-
cebo group that received acupressure at an
inappropriate location in patients with chronic
obstructive pulmonary disease (COPD)
(n¼44). In another study of patients with
COPD, Tsay et al.
15
found that 12 minutes of
daily acupressure for 10 days at LI4, PC6, and
HT7 improved dyspnea, anxiety, blood pres-
sure, heart rate, and respiratory rate when
compared with a placebo group that received
handholding and massage. Two studies by
Maa et al.
36,44
found that 2.5e10 minutes of
daily acupressure for an eight-week period at
LU1, LU5, LU10, and ST36, ST40 and stan-
dard care significantly improved dyspnea and
respiratory health-related quality of life in pa-
tients with bronchiectasis and asthma when
compared with a standard care group (medica-
tion and chest physiotherapy).
Acupressure for Insomnia and Fatigue
Six RCTs were performed to determine the ef-
ficacy of acupressure on the reduction of fatigue
and improvement of sleep in adults.
8,16,17,24,37,55
Authors of all six studies concluded that acu-
pressure was effective in improving fatigue and
reducing insomnia. The symptom of fatigue is
often associated with poorer sleep quality, so
the efficacy of acupressure for fatigue and sleep
was investigated both separately and simulta-
neously in these studies.
Tsay and Chen
8
found that the application
of nine minutes of acupressure at HT7 and
KD11, three times a week for four weeks,
improved sleep quality in patients with end-
stage renal disease when compared with stan-
dard care (n¼98). However, there was no
statistical difference between the acupressure
treatment and placebo (acupressure at nona-
cupressure points) groups. Melatonin and its
circadian rhythm have been postulated to
have an important role in sleep. In a subse-
quent study of acupressure and sleep, Nordio
and Romanelli
17
studied the efficacy of acu-
pressure on sleep and melatonin changes.
These investigators found that the use of an
acupressure band at HT7 for 10 hours daily
for 20 days significantly improved sleep and
melatonin biorhythm compared with a placebo
group (wristband in different meridian)
(n¼40).
Other investigators studied the use of acu-
pressure to reduce fatigue and increase alert-
ness. Harris et al.
37
investigated the efficacy
of two sequences of acupressure treatment
administered daily for three days using a
crossover design to support relaxation or
stimulation in healthy young adults. These in-
vestigators found that stimulation acupressure
at LI4, ST36, KD1, and UB10 significantly
decreased fatigue and improved alertness
when compared with placebo acupressure
(n¼39). Harris et al.
37
reported that acupres-
sure was also associated with adverse effects
such as muscle cramps, muscle aches, head-
aches, and fatigue when used with healthy
college students. Other investigators studied
the efficacy of acupressure in patients with
a chronic disease. Molassiotis et al.
55
reported
that acupressure for 20 minutes, six times per
week for two weeks, reduced fatigue in cancer
patients when compared with a sham acupres-
sure group (n¼47).
Because fatigue and insomnia are often ac-
companied by depressive symptoms, Tsay
16
in-
cluded depressive symptoms as an outcome
and found that the application of 12 minutes
of acupressure at SP6, GB34, ST36, and KD1
three times a week for four weeks significantly
reduced fatigue and depression, and improved
598 Vol. 42 No. 4 October 2011Lee and Frazier
sleep quality in patients with end-stage renal
disease when compared with standard care
(n¼106).
Discussion
Forty-three studies examined the efficacy of
acupressure for symptom management. A ma-
jority of these investigators (84%) concluded
that acupressure was effective for symptom
management in adults with a variety of disor-
ders and conditions. Unfortunately, the quality
ratings using the Cochrane bias instrument
did not find that these trials were of sufficient
rigor to provide adequate evidence for efficacy
of acupressure. Most of these investigators re-
ported that acupressure did not have adverse
effects.
56
However, in two studies, acupressure
was associated with headache and dizziness,
and skin reactions.
33,37
Symptom management strategies include
pharmacological therapy, nutritional ther-
apy,
57
exercise,
58
cognitive behavioral therapy,
relaxation, complementary and alternative
therapies,
59
meditation,
60
music therapy, and
guided imagery.
61
There are currently few
studies that compare the efficacy of acupres-
sure with other symptom management strate-
gies. Thus, there is a dearth of evidence to
support the use of acupressure over other
management strategies or as an adjunct to
other strategies.
The daily dose of acupressure in this review
varied from 2.5 minutes to 24 hours. The total
intervention time for acupressure varied from
20 minutes to 56 days. The numbers of acupres-
sure points varied from one to 12. There were
no studies that compared equivalent doses of
acupressure. Thus, well-designed, rigorous
studies are needed to compare equivalent daily
doses, intervention times, and number of acu-
pressure points.
It is vital that investigators include appropri-
ate measures of outcome for acupressure trials.
Nearly one-fourth of the reviewed studies in-
cluded both subjective measures of symptoms
and objective markers of symptom improve-
ment. These included physiological measures
such as urinalysis for ketonuria, and clinical
indicators, such as total daily dose of medica-
tion for symptom management. Although
symptoms are an individual experience, and
as such, self-report is the gold standard mea-
sure,
62
the addition of these types of objective
indicators provides additional evidence for ef-
ficacy and utility.
Acupressure may be administered using
several techniques. Only two of the studies re-
viewed compared different methods of admin-
istration of acupressure.
20,34
Ming et al.
20
reported that manual acupressure and Sea-
Bands were equally effective for management
of nausea. Other studies used techniques as
varied as traditional finger pressure and
specialized panties that applied pressure to
multiple acupressure sites. Thus, different ad-
ministration strategies, in addition to variation
in the meridians treated, makes comparisons
across studies impossible. Consistency in tech-
niques and acupressure sites under study
would facilitate comparison of results and pro-
vide more rigorous examination of the efficacy
of acupressure for symptom management.
In addition to consistency, patient-provider
interaction during acupressure therapy may
confound outcomes. Most of these studies
did not describe patient-practitioner interac-
tion. Only one study by Ming et al.
20
reported
that practitioners stayed with patients in the
control group for 20 minutes. The lack of in-
formation about the practitioner-patient inter-
action in both intervention and control groups
could introduce a serious confounding vari-
able that has not been considered in these
studies.
Patient and health care provider attitudes
toward acupressure may be a factor related to
its efficacy and use. Roscoe et al.
34
found that
patients who expected acupressure to be effec-
tive demonstrated more positive effects than
those who thought that acupressure was un-
likely to be effective. However, Rosenberg
et al.
63
found that although more than half
of their chronic pain patients used some
form of complementary or alternative therapy
in addition to their traditional treatment,
when given the choice between traditional
treatment and alternative therapy, the tradi-
tional treatment strategy was preferred. Other
factors such as the degree of individual per-
ceived control and level of depression also
might influence the use of acupressure and
require investigation.
The effective use of both traditional and
complementary and alternative therapies is an
Vol. 42 No. 4 October 2011 599Acupressure: A Review
attractive strategy for symptom management. A
variety of patient populations, including those
with chronic diseases and those requiring palli-
ative care, could benefit from a noninvasive,
easily performed intervention with few
adverse effects. Unfortunately, there are con-
siderable knowledge deficits about acupres-
sure, in spite of a generally positive attitude
about its inclusion in a plan of care.
64
Because
of this, curriculum development and continu-
ing education focused on the inclusion of alter-
native and complementary strategies is clearly
needed should rigorous RCTs demonstrate
the efficacy of acupressure for symptom
management.
Limitations
Statistical techniques such as meta-analysis
for definitive evidence of efficacy were not
possible because of the wide variability in
participants and the interventions, including
fundamental differences in treatment site,
treatment frequency, treatment length and
number of days of treatment, and the
method of application of acupressure. The
limitations of this review also include the ex-
clusion criteria, such as sample size, publica-
tion years, and language. Excluded studies
might have been well designed, but the
lack of well-designed studies in those in-
cluded suggests that this would not be the
case and studies performed prior to 2000
could have offered more rigorous evidence
of efficacy. There is always the possibility
that some appropriate studies were missed
with our search strategy. However, multiple
key words were used and reference lists
were hand searched to ensure that all studies
that met criteria were included.
Conclusion
Acupressure is commonly used in some
cultures and countries to manage symptoms.
This technique is noninvasive and may prove
to be a useful adjunct in the care of a wide
variety of individuals with symptoms. Our re-
view of clinical trials from the past decade
did not provide rigorous support for the effi-
cacy of acupressure for symptom manage-
ment. Well-designed, randomized controlled
studies are needed to determine the utility
and efficacy of acupressure to manage a vari-
ety of symptoms in a number of patient
populations.
Disclosures and Acknowledgments
This work was supported in part by a grant
to the University of Kentucky, College of
Nursing from the National Institutes of
Health’s National Institute of Nursing Re-
search (1P20NR010679). The content is
solely the responsibility of the authors and
does not necessarily represent the official
viewsoftheNationalInstituteofNursing
Research or the National Institutes of
Health. The authors declare no conflicts of
interest.
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Vol. 42 No. 4 October 2011 603Acupressure: A Review
... Today, using complementary medicine as a non-pharmacological approach in conjunction with nursing care and common treatments as clinical expertise and competence are emphasized (Cherryand Jacob.,2013) ( (28) . Acupressure is a therapy used to manage various symptoms (Lee and Frazier, 2011) (17) . Acupressure is rooted in acupuncture, and the hands or elbows are used to apply physical pressure to acupoints for treatment (Lee and Frazier, 2011) ( (35) . ...
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background: Acupressure is helpful and powerful technique used to reduce postoperative pain and anxiety through stimulation of the blood circulation and secretion of neurotransmitters. That providing comfort post mastectomy treatment for women with breast cancer. This study aimed to assess the effect of acupressure in reduction of pain and anxiety among women with modified radical mastectomy. Setting at Zagazig University Hospitals. Material and Method: a quasi-experimental (pre and posttest design). A purposive sample of total 134 study participants, 67 in experimental and 67 in control group based on inclusion and exclusion criteria. Data collection questionnaire were prepared with extensive review of previous literatures. Data collection through three tools includes, interviewing questionnaire sheet, postoperative anxiety assessment scale, postoperative pain assessment scale. Result: a highly statistical difference was indicated between both study and control groups regarding the level of pain and anxiety. Conclusion: Acupressure reduces level of pain and anxiety among women with modified radical mastectomy.
... Complementary and alternative therapies are harmless therapies that do not seem to have negative consequences [12]. Acupressure is based on the theory of meridians and believes that vital energy (qi) is distributed throughout the body by meridians and the imbalance of vital energy flow leads to disease or pain [13]. In traditional Chinese medicine, PCOS combines amenorrhea, irregular menstruation, and infertility. ...
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The present study was conducted to determine the effect of acupressure on health-related quality of life in patients with polycystic ovary syndrome. This study was a double-blind, randomized clinical trial with a control group. Ninety-six patients with polycystic ovary syndrome from Mofateh gynecological clinic in Yasuj in Iran were enrolled according to the inclusion criteria. Patients were randomly assigned to intervention and control groups. In the intervention group, pressure on the points, Ren3, Ren4, Liv3, Sp6, and Sp10 and in the control group, pressure on sham points were performed for 6 weeks (2 sessions per week). The primary outcome was health-related quality of life, measured by the modified polycystic ovary syndrome health-related quality of life questionnaire (MPCOSQ). The secondary outcomes were total testosterone levels and clinical symptoms in patients with polycystic ovary syndrome. The outcome variables were measured before the intervention at week 0 (baseline) and after the intervention at week 18 (12 weeks after the end of intervention). The results indicated that at week 18, the score of clinical symptoms and the total testosterone level of the intervention group were lower than those of the control group. The health-related quality of life score in the intervention group was higher than that in the control group, which was statistically significant (P<0/05). Therefore, acupressure in these points is recommended as a practical and effective method of treating polycystic ovarian syndrome.
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A dismenorreia, ou dor menstrual, é problema comumente apresentado pelas mulheres durante o período reprodutivo. De acordo com a segunda edição da Classificação Internacional de Atenção Primária (ciap 2), no componente “queixas e sintomas”, a dismenorreia é classificada no código “X02” (X: de aparelho genital feminino; X02: dores menstruais). A classificação ciap 2 foi elaborada pelo Comitê Internacional de Classificação da Organização Mundial de Médicos de Família (World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians - wonca) e traduzida para o português pela Sociedade Brasileira de Medicina de Família e Comunidade (sbmfc) e pelo Ministério da Saúde (comitê internacional de classificação da organização mundial de associações nacionais, academias e associações acadêmicas de clínicos gerais/médicos de família, 2009). A dismenorreia é uma das queixas ginecológicas mais frequentes em todo o mundo e afeta a qualidade de vida de muitas mulheres (bmj best practice, 2015). Entre 50% e 90% delas informam já terem sentido dor no período menstrual. A maioria é jovem e tem dismenorreia primária (klein; litt, 1981; andersch; milsom, 1982; johnson, 1988; wilson; keye jr., 1989; campbell; mcgrath, 1997; hillen et al., 1999; burnett et al., 2005; ortiz et al., 2009; polat et al., 2009; ortiz, 2010). Quando intensa, a dismenorreia está ligada à morbidade significante, podendo interferir no desempenho de atividades de vida diárias (avd) e levar ao absenteísmo escolar, do trabalho e de outros desempenhos (dipiro; talbert; yee, 2011; smith; kaunitz, 2017). Os principais fatores que têm relação positiva com a dismenorreia são: idade até 30 anos, nuliparidade, tabagismo (ativo e passivo), menarca antes dos 12 anos ou sangramento menstrual intenso (lasco; catalano; benvenga, 2012; krinsky et al., 2014; bmj best practice, 2015). Contudo, a dismenorreia também foi associada à maior duração do ciclo ou do sangramento, ao fluxo menstrual irregular, à ocorrência de sintomas pré-menstruais, à suspeita clínica de doença inflamatória pélvica, à este21rilização, à história de agressão sexual, ao índice de massa corporal (imc) < 20 kg/m2 e à obesidade (latthe et al., 2006). Em contraste, o uso de contraceptivos orais, a ingestão de peixe, o exercício físico, o casamento ou a relação estável e maior paridade foram associados ao risco reduzido de dismenorreia (hornsby; wilcox; weinberg, 1998; latthe et al., 2006; brown, j.; brown, s., 2010).
Thesis
Les Interventions Non-Médicamenteuses (INM), et autres procédures qui peuvent leur être associées (Médecine Traditionnelle, Médecines Complémentaires et Alternatives), sont aujourd’hui d’une prépondérance à ne pas sous-estimer dans l’optique d’une santé intégrative. Une évaluation scientifique robuste est nécessaire afin de trier les pratiques néfastes ou inefficaces, de celles attestant de réels bénéfices. Dans ce domaine, les essais randomisés contrôlés (ERC) font loi, à un titre discutable du fait de leurs limites intrinsèques. Par le biais d’une revue systématique de littérature centrée sur les pratiques de manipulation corporelles comme soins de support proposés en oncologie, nous confirmons la difficulté qu’ont les ERCs de tirer des conclusions fermes et bien appuyées. Nous présentons alors une méthode interventionnelle différente et peu enseignée, les protocoles expérimentaux à cas unique, et proposons leur illustration à travers quatre études. Celles-ci portent sur l’évaluation de différentes interventions dans des contextes de maladies chroniques ou de problèmes de santé variables : 1) Jeu vidéo thérapeutique dans le cadre de la réadaptation physique de la maladie de Parkinson, 2) Intervention musicale en Soins Palliatifs, 3) Hypnose face aux restrictions hydriques de patients sous hémodialyse et 4) Séances de shiatsu face à la dysménorrhée primaire. Ces études rendent compte de résultats intéressants, et permettent de discuter des forces et faiblesses de cette méthode. Nous plaidons alors en sa faveur du fait de ses principes expérimentaux légitimes ainsi que son adéquation avec la pratique fondée sur la preuve. Nous profitons enfin de la faible qualité des études que nous avons menées pour dresser une liste de recommandations et d’écueils à considérer afin de les employer de façon optimale.
Article
Background: Acupressure is known to be a nursing intervention used to prevent chemotherapy-induced nausea and vomiting in children. Methods: This study was conducted to evaluate and compare the effectiveness of manual and wristband acupressure in the prevention of chemotherapy-induced nausea and vomiting in children. This double-blinded and placebo-controlled study was conducted with 44 children aged between 5 and 18 years receiving chemotherapy in a university hospital's pediatric oncology clinic. Children were randomized into groups using a 2 × 2 factorial design: (a) The child who was given manual acupressure before the first chemotherapy was given placebo manual acupressure before the next chemotherapy; (b) the same child who was administered wristband acupressure before the first chemotherapy was administered placebo wristband acupressure before the next chemotherapy. After all interventions, the severity and number of episodes of nausea and vomiting and additional antiemetic needs in the children were monitored for 24 h. Results: In both groups, the severity and number of nausea and vomiting were lower according to their own placebo groups. Manual and wristband acupressure were effective in reducing the severity and number of nausea and vomiting, but manual acupressure was more effective in reducing the severity and number of nausea and vomiting in comparison to wristband acupressure ( p < .05). No statistically significant difference was found between the groups regarding additional antiemetic drug use. Discussion: In this study, manual and wristband acupressure were determined to be effective in reducing the severity and number of nausea and vomiting related to chemotherapy.
Chapter
Integrative medicine is an emerging field with many possible applications in Neurology. Patients living with neurological disease have been hungry for more guidance and study in this area. There is huge interest in wellness and helping patients make better lifestyle choices to influence the outcomes of their disease and to improve quality of life. We review the definitions, current literature and discuss limitations and identify questions for further research.
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Introduction: Most pregnant women (50-90%) generally experience nausea and vomiting during pregnancy, which usually subsides at 16-20 weeks of gestation. Approximately 0.5-2 percent experience severe nausea and vomiting, known as HG, which necessitates hospitalization. Since 2.000, the Ministry of Health of the Republic of Indonesia has been developing acupressure self-care, among other things, by implementing acupressure training (Teknologi Tepat Guna-TTG) for mild complaints about health workers. Objective: This review discusses several studies that demonstrated the effect of acupressure on HG, as well as the mechanism of acupressure, the points used, and treatment strategies. Method: The Google Scholar and PubMed databases were searched for studies published between 2010 and 2020 on how acupressure affects HG using the keywords acupressure, hyperemesis gravidarum, and PC6 point. Randomized clinical trials on human subjects and studies that measured nausea vomiting index in pregnant woman as outcomes were included. Studies that did not include clinical effects of acupressure were excluded. Results: The following studies on HG (n=4) were discovered. These studies suggested that acupressure might be considered to reduce symptoms of nausea and vomiting in pregnant women. Conclusion: Acupressure at PC6 may reduce nausea and vomiting in pregnant women by influencing gastrointestinal function via nerve stimulation to inhibit cerebral cortex function. Self-care acupressure at the PC6 point may be a therapeutic option to reduce HG during the Covid-19 pandemic.
Article
Background and purpose Acupressure and showers are methods that can help reduce pain severity. This study thus aims to determine the effects of acupressure and showers on labour pain and postpartum comfort. Methods In this randomized controlled trial (RCT), the control group consisted of 40 pregnant women, while the experimental groups consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4–5, 6–7 and 8–10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale for Pain (VASP) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data. Results Pain was significantly reduced in both of the experimental groups, in contrast to the control group, in all periods of the study (p < 0.001). Postpartum comfort also significantly increased in the experimental groups compared to the control group (p < 0.05). Conclusion Acupressure and showers are effective in reducing labour pain and increasing postpartum comfort. Midwives and nurses can therefore apply them as inexpensive and easy to administer methods for labour pain relief.
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We enrolled 156 patients into the trial, including 52 in the placebo group, 53 in the metoclopramide group, and 51 in the acupressure wristband group. Demographic and clinical characteristics of the three groups were similar (Table 1). At recovery, fewer people in the control group had no nausea than in the other two groups, but the difference was not statistically significant (Table 2). At 2 hours after surgery, only 3 patients in the metoclopramide group (5.7% of patients in the group) and 2 patients in the acupressure group (3.9% of patients in the group) compared with no patients in the control group were without nausea symptoms. Five patients in the control group had severe nausea compared with no patients in either the metoclopramide and acupressure groups. The statistical comparison showed a statistically significant difference between the three groups (Table 2). At 6 hours after surgery, everyone in the control had some degree of nausea while 9 patients in the metoclopramide group (17% of patients in the group) and 7 patients in the acupressure group (13.7% of patients in the group) were without nausea symptoms. The statistical comparison showed a statistically significant difference between the three groups. At 24 hours after surgery, none of the patients in the three groups had severe nausea, while 47 patients in the control group (90.4% of patients in the group), 49 patients in the metoclopramide group (92.5% of patients in the group) and 49 patients in the acupressure group (96.1% of patients in the group) were without nausea symptoms. The statistical comparison indicated that there was no difference in the number of cases of nausea between the three groups at 24 hours after operation.
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Previous reports have suggested that acupressure is effective in reducing pain and improving sleep quality; however, its effects on alertness have not been characterized. The aim of this study was to determine whether two different acupressure treatments have opposing effects on alertness in a full-day classroom setting. This was a cross-over (two-treatments; three periods), single-blinded, randomized trial. The University of Michigan School of Public Health was the setting. Students attending a course in clinical research design and statistical analysis at the University of Michigan participated in the study. Blinded subjects were randomized to two acupressure treatment sequences: stimulation-relaxation-relaxation or relaxation-stimulation-stimulation. Acupressure treatments were self administered over 3 consecutive days. Pre- and post-treatment alertness scores were assessed each day using the Stanford Sleepiness Scale (SSS). Changes in the SSS score (afternoon-morning) were analyzed using a mixed regression model of fixed and random effects. Important factors that were expected to affect alertness, such as caffeine and previous night's sleep, were also assessed. Baseline characteristics and protocol compliance were similar between the two sequences. Stimulation acupressure treatment yielded a 0.56-point greater difference in score on the SSS, corresponding to less fatigue, compared to the relaxation acupressure treatment (p = 0.019). Day of study (p = 0.004) and hours of overnight sleep (p = 0.042) also significantly affected the change in SSS scores. Incorporating participants' beliefs as to which treatment they received did not significantly alter the observed treatment effect. Acupressure at stimulation and relaxation points has differential effects on alertness in a classroom setting. Further research is necessary to confirm these findings and to determine whether stimulation and relaxation acupressure are equally effective in influencing alertness.
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Unlabelled: Since the publication of the original Symptom Management Model (Larson et al. 1994), faculty and students at the University of California, San Francisco (UCSF) School of Nursing Centre for System Management have tested this model in research studies and expanded the model through collegial discussions and seminars. Aim: In this paper, we describe the evidence-based revised conceptual model, the three dimensions of the model, and the areas where further research is needed. Background/rationale: The experience of symptoms, minor to severe, prompts millions of patients to visit their healthcare providers each year. Symptoms not only create distress, but also disrupt social functioning. The management of symptoms and their resulting outcomes often become the responsibility of the patient and his or her family members. Healthcare providers have difficulty developing symptom management strategies that can be applied across acute and home-care settings because few models of symptom management have been tested empirically. To date, the majority of research on symptoms was directed toward studying a single symptom, such as pain or fatigue, or toward evaluating associated symptoms, such as depression and sleep disturbance. While this approach has advanced our understanding of some symptoms, we offer a generic symptom management model to provide direction for selecting clinical interventions, informing research, and bridging an array of symptoms associated with a variety of diseases and conditions. Finally, a broadly-based symptom management model allows the integration of science from other fields.
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Purpose: To evaluate the efficacy of acupressure wristbands in the prevention of postoperative nausea and vomiting (PONV). Methods: Two hundred ASAI - II patients undergoing elective endoscopic urological procedures were included in a randomized, prospective, double blind, placebo-controlled study. Spherical beads of acupressure wristbands were placed at the P6 points in the anterior surface of both forearms in Group 1 patients (acupressure group, n=100) whereas, in Group 2(control group, n=100) they were placed inappropriately on the posterior surface. The acupressure wristbands were applied 30 min before induction of anesthesia and were removed six hours postoperatively. Anesthesia was induced with thiopental and maintained with nitrous oxide and oxygen, fentanly, isoflurane and vecuronium. The tracheas were extubated on the operation table after patients received neostigmine and atropine. Post operative nausea and vomiting were evaluated separately as none, mild, moderate or severe at the time of patient’s arrival in PACU, then at six hours and twenty-four hours after surgery by a blinded observer. Results: In the acupressure group, 25 patients had PONV compared with 29 patients in the control group (P=NS). Conclusion: Application of acupressure wristbands at the P6 of both forearms 30 min before induction of anesthesia did not decrease the incidence of PONV in patients undergoing endoscopic urological procedures.
Article
Minute sphere acupressure has been used for more than 2000 yr and remains popular in Japan. The points most relevant to abdominal surgery are those associated with meridian flows crossing or originating in the abdomen. We tested the hypothesis that minute sphere therapy reduces pain and analgesic requirements after open abdominal surgery. Participating patients were given standardized desflurane and fentanyl anesthetic. On completion of surgery, they were randomly assigned to untreated control or minute sphere acupressure at the Neiguan, Zusanli, Sanyinjiao, and Gongsun points. Each site was covered with bulky gauze dressings so that patients could not determine their assignments. Postoperative pain was treated with IV morphine via a patient-controlled analgesia pump. Our primary a priori end-points were pain and opioid consumption on the first postoperative morning. Data are reported as median (25th percentile, 75th percentile). Fifty-three patients (30 controls and 23 minute spheres) completed the study. Morphine requirements (47 mg [27, 58] vs 41 mg [25, 69]) and pain scores (29.5 mm [16, 59] vs 40 mm [22, 58]) were similar in the control and acupressure groups. These data provide an 80% power for detecting a 50% difference in morphine consumption at an α of 0.05. Minute sphere treatment at the Neiguan, Zusanli, Sanyinjiao, and Gongsun points thus failed to provide analgesia after abdominal surgery.
Article
To comprehend the results of a randomized, controlled trial (RCT), readers must understand its design, conduct, analysis, and interpretation. That goal can be achieved only through complete transparency from authors. Despite several decades of educational efforts, the reporting of RCTs needs improvement. Investigators and editors developed the original CONSORT (Consolidated Standards of Reporting Trials) statement to help authors improve reporting by using a checklist and flow diagram. The revised CONSORT statement presented in this paper incorporates new evidence and addresses some criticisms of the original statement. The checklist items pertain to the content of the Title, Abstract, Introduction, Methods, Results, and Discussion. The revised checklist includes 22 items selected because empirical evidence indicates that not reporting the information is associated with biased estimates of treatment effect or because the information is essential to judge the reliability or relevance of the findings. We intended the flow diagram to depict the passage of participants through an RCT. The revised flow diagram depicts information from four stages of trial (enrollment, intervention allocation, follow-up, and analysis). The diagram explicitly includes the number of participants, for each intervention group, that are included in the primary data analysis. Inclusion of these numbers allows the reader to judge whether the authors have performed an intention-to-treat analysis. In sum, the CONSORT statement is intended to improve the reporting of an RCT, enabling readers to understand a trial's conduct and to assess the validity of its results.
Article
Pain is the primary reason individuals seek health care, and chronic pain is the leading cause of disability. Patients with chronic pain often require treatment with strong analgesics, including opioids. Mounting evidence shows that very high opioid doses or rapidly escalating doses may lead to a paradoxical syndrome of increasing pain that is nonresponsive to opioid therapy. A review of the published literature describing the phenomenon of opioid-induced hyperalgesia was conducted, and management strategies were reviewed. A systematic search of PubMed using Medical Subject Headings terms to narrow search criteria identified 3 treatment strategies. The strategies evaluated in this literature review include opioid rotation, coadministration of N-methyl-D-aspartate receptor antagonists, and coadministration of opioid antagonists. Further research is needed to draw conclusive recommendations. As of now, the safest and most effective treatment strategy showing the best evidence involves the use of opioid rotation.
Article
Background. Traditional Chinese acupressure is a noninvasive technique that employs pressure and massage to acupoints in order to stimulate the balance of life energy that promotes health and comfort. Sleep disturbance is common in patients with end-stage renal disease but no intervention studies have addressed this problem. Aim. The purpose of the present study was to test the effectiveness of acupoints massage for patients with end-stage renal disease and experiencing sleep disturbances and diminished quality of life. Methods. The study was a randomized control trial. A total of 98 end-stage renal disease patients with sleep disturbances were randomly assigned into an acupressure group, a sham acupressure group, and a control group. Acupressure and sham acupressure group patients received acupoints or no acupoints massage three times a week during haemodialysis treatment for a total of 4 weeks. The measures included the Pittsburgh Sleep Quality Index, Sleep Log, and the Medical Outcome Study – Short Form 36. Findings. The results indicated significant differences between the acupressure group and the control group in Pittsburgh Sleep Quality Index subscale scores of subjective sleep quality, sleep duration, habitual sleep efficiency, sleep sufficiency, and global Pittsburgh Sleep Quality Index scores. Sleep log data revealed that the acupressure group significantly decreased wake time and experienced an improved quality of sleep at night over the control group. Medical Outcome Study – Short Form 36 data also documented that acupressure group patients experienced significantly improved quality of life. Conclusion. This study supports the effectiveness of acupoints massage in improving the quality of sleep and life quality of end-stage renal disease patients, and offers a noninvasive therapy for sleep-disturbed patients.
Article
Opinion statement: Symptom management of the actively treated elderly cancer patient represents an undertreated and disproportionately understudied cohort in oncology. There is a dearth of specific recommendations or guidelines regarding drug selection, dosing, and side effects which account for changes in aging physiology, pharmacokinetics, and idiosynchratic reactions. In treating cardinal symptoms and clusters of symptoms including pain, constipation, fatigue/weakness, nausea/vomiting, mucositis/xerostomia, and nutritional depletion syndromes such as malabsorption and anorexia/cachexia, most clinicians base their therapeutic decisions on individual experience. Depending on relative interest and level of competency, symptom management is often narrow in scope, frequently ineffective, and not based on evidence. We discuss these issues in a practical format, by surveying and comparing available core literature to the extent that it readily exists and by incorporating our own experiences.