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Clinical Studies Showing Significant Results from P6 Acupressure for Nausea Relief

Post-Operative (Anesthesia) Nausea:

Ferrara-Love R, Sekeres L, Bircher NG. Nonpharmacologic treatment of postoperative nausea. J Perianesth Nurs 1996;Dec, 11(6):378-383. N=90; P=0.0001

MSN/MBA program, Duquesne University , Pittsburgh , PA , USA .

Nausea is the most common postoperative complication of anesthesia. Appropriately applied acupressure offers a safe and cost-effective nursing approach to the prevention of this problem. This study tested the effect of acupressure on the incidence of postoperative nausea in same-day surgery patients. METHODS: Ninety outpatient surgery patients were randomly assigned to one of three groups. The treatment group (n = 30) received bilateral elastic bands designed to exert pressure on the appropriate location on the distal aspect of the wrist during the perioperative period. The placebo group (n = 30) had elastic bands incapable of acupressure placed on their wrists. The control group (n = 30) received routine nursing and medical interventions for nausea and vomiting. Antiemetics were prescribed by the anesthesiologist and administered to patients in all three groups if nausea persisted and/or emesis occurred. The incidences of nausea or vomiting were tabulated separately for operating room, PACU phase I, and PACU phase II, and compared using Fisher's Exact Test. RESULTS: The incidence of nausea and vomiting did not differ overall in the OR or PACU phase I. However, in PACU phase II the incidence was 10% in the treatment group, 20% in the placebo group, and 50% in the control group (overall, P = .0001). Treatment wrist bands reduced the incidence of nausea and vomiting as compared with the control group (P = .0001), as did the placebo wrist bands (P = .0033). The numerical trend suggests that the incidence is reduced by half. The incidence of nausea can be significantly reduced by the use of placebo and suggests that further reduction can be obtained by using acupressure.

Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section.Br J Anaesth 2000;84(4):463-467. N=94; P=0.002

Department of Anaesthesia, Rotunda Hospital , Dublin , Ireland .

The efficacy of acupressure at the P6 point in the prevention of nausea and vomiting during and after Caesarean section was studied. A double-blind, randomized controlled study of acupressure vs placebo was designed. Ninety-four patients scheduled for Caesarean section were included. The anaesthetic technique and postoperative analgesia were standardized. The use of acupressure reduced the incidence of nausea or vomiting from 53% to 23% compared with placebo (95% confidence interval (CI) 0.34-0.25; P = 0.002) during the operation and from 66% to 36% compared with placebo (95% CI 0.34-0.19; P = 0.003) after the operation. Other variables were similar between the groups.

Harmon D, Gardiner J, Harrison R, et al. Acupressure and the prevention of nausea and vomiting after laparoscopy.Br J Anaesth 1999;82(3):387-390. N=104; P=0.005

Department of Anaesthesia, Rotunda Hospital , Dublin , Ireland .

The efficacy of currently available antiemetics remains poor. Concern with their side effects and the high cost of the newer drugs has led to renewed interest in non-pharmacological methods of treatment. We have studied the efficacy of acupressure at the P6 point in the prevention of nausea and vomiting after laparoscopy, in a double-blind, randomized, controlled study of acupressure vs placebo. We studied 104 patients undergoing laparoscopy and dye investigation. The anaesthetic technique and postoperative analgesia were standardized. Failure of treatment was defined as the occurrence of nausea and/or vomiting within the first 24 h after anaesthesia. The use of acupressure reduced the incidence of nausea or vomiting from 42% to 19% compared with placebo, with an adjusted risk ratio of 0.24 (95% CI 0.08-0.62; P = 0.005). Other variables were similar between groups.

Fan CF, Tanhui E, Joshi S, et al. Acupressure treatment for prevention of postoperative nausea and vomiting.Anesth Analg 1997;Apr, 84(4):821-825. Comment in: Anesth Analg 1997;Apr, 84(4):712-714. N=200; P=0.0058

Department of Anesthesiology, Maimonides Medical Center , Brooklyn , New York 11219 , USA .

Postoperative nausea and vomiting are still common problems after general anesthesia, especially in ambulatory surgery. Drug therapy is often complicated with central nervous system symptoms. We studied a nonpharmacological method of therapy--acupressure--at the Pericardium 6 (P.6) (Nei-Guan) meridian point. Two hundred consecutive healthy patients undergoing a variety of short surgical procedures were included in a randomized, double-blind study: 108 patients were in the acupressure group (Group 1) and 92 patients were in the control group (Group 2). Spherical beads of acupressure bands were placed at the P.6 points in the anterior surface of both forearms in Group 1 patients, while in Group 2 they were placed inappropriately on the posterior surface. The acupressure bands were placed before induction of anesthesia and were removed 6 h postoperatively. They were covered with a soft cotton wrapping to conceal them from the blinded observer who evaluated the patients for presence of nausea and vomiting and checked the order sheet for any antiemetics prescribed. In both groups, the age, gender, height, weight, and type and duration of surgical procedures were all comparable without significant statistical difference. In Group 1, only 25 of 108 patients (23%) had nausea and vomiting as compared to Group 2, in which 38 of 92 patients (41%) had nausea and vomiting (P = 0.0058). We concluded that acupressure at the P.6 (Nei-Guan) point is an effective prophylaxis for postsurgical nausea and vomiting and therefore a good alternative to conventional antiemetic treatment.

Alkaissi A, Evertsson K, Johnsson V.-A, Ofenbartl L, Kalman S. P6 acupressure may relieve nausea and vomiting after gynecological surgery: an effectiveness study in 410 women Can J Anesth, December 1, 2002; 49(10): 1034 - 1039. N=410; P=0.0168

Department of Anaesthesiology and Intensive Care, Eksjö Hospital , Linköping , Sweden .

Purpose: To investigate the effect of sensory stimulation of the P6 point on postoperative nausea and vomiting (PONV) after gynecological surgery in the everyday clinical setting (effectiveness study).

Methods: Four hundred and ten women undergoing general anesthesia for elective gynecological surgery were included in a prospective, consecutive, randomized, multicentre, placebo-controlled, double-blind clinical trial with a reference group. One group was given bilateral P6 acupressure (n = 135), a second group similar pressure on bilateral non-acupressure points (n = 139), and a third group (n = 136) served as reference group. Nausea (scale 0–6), vomiting, pain, and satisfaction with the treatment were recorded. Primary outcome was complete response, i.e., no nausea, vomiting or rescue medication for 24 hr. Results were analyzed by applying logistic regression with indicators of treatments, type of operation and risk score for PONV as explanatory variables.

Results: Complete response was more frequent in the P6 acupressure group than in the reference group (P = 0.0194) Conversely, the incidence of PONV was 46% in the reference group, 38% after pressure on a non-acupoint and 33% after P6 acupressure. The decrease from 46% to 33% was statistically significant. When considering vaginal cases separately, the decrease in PONV was from 36% to 20% (P = 0.0168). The corresponding decrease from 59% to 55% in the laparoscopic surgery group was not statistically significant.

Conclusion: P6 acupressure is a non-invasive method that may have a place as prophylactic antiemetic therapy during gynecological surgery.

Eizember FL , Tomaszewski CA , Kerns WP 2nd. Acupressure for prevention of emesis in patients receiving activated charcoal.J Toxicol Clin Toxicol 2002;40(6):775-780. N=187; P=0.043

Emergency Medicine & Toxicology, Carolinas Medical Center , Charlotte , North Carolina 28232-2861 , USA .

OBJECTIVE: Vomiting after activated charcoal decontamination is problematic. Acupressure (traditional Chinese medicine) is an effective treatment for emesis, but has not been tested in overdose patients. We sought to determine (1) the incidence of emesis after activated charcoal and (2) the ability of acupressure to prevent emesis due to activated charcoal. METHODS: Consecutive overdose patients were enrolled in a preliminary, prospective study to determine the incidence of emesis after activated charcoal. Awake patients, > 18 years, received 1 g/kg activated charcoal orally or via nasogastric tube, and then observedfor 1 hour. These patients served as controls forpart 2 of the study, where acupressure bands were placed on overdose patients at the Nei-Guan P-6 point of both wrists prior to activated charcoal, followed by 1 hour observation. Exclusion criteria included: ipecac decontamination, antiemetic drug ingestion, antiemetic drug therapy within 1 hour of activated charcoal, or intubation. RESULTS: Eighty-one patients were included in the control group and 106 patients in the acupressure treatment group. Demographics and ingested substances were similar in both groups. 21/81 (25.9%) in the control group vomited and 15/106 (14.2%) in the acupressure group vomited. Acupressure reduced emesis by 46% (p = 0.043; chi2). Within the acupressure group, the median duration of prophylactic acupressure was 5 minutes in those patients without vomiting compared to 4 minutes in those patients with vomiting (NS; Wilcoxon rank sum test). CONCLUSION: The incidence of emesis after activated charcoal at our institution was 26%. Prophylactic acupressure reduced activated charcoal-induced vomiting by 46%. Investigators suggest 5 minutes of acupressure prior to activated charcoal.

Felhendler D, Lisander B. Pressure on acupoints decreases postoperative pain.Clin J Pain 1996;Dec, 12(4):326-329. N=30; P<0.05 (1 hr PostOp); P<0.0001 (24 hrs PostOp)

Department of Anesthesiology, Faculty of Health Sciences, Linkoping , Sweden .

Our objective was to study the analgesic effect of acupoint pressure on postoperative pain in a controlled single-blind study. Forty patients undergoing knee arthroscopy in an ambulatory surgery unit in a university-affiliated hospital were randomized to receive either an active stimulation (AS) or a placebo stimulation (PS) 30 min after awakening from anesthesia. We stimulated 15 classical acupoints in the AS group, on the side contralateral to surgery, with a firm pressure and a gliding movement across the acupoint. In the PS group, 15 nonacupoints were subjected to light pressure in the same areas as the acupoints in the AS group. We assessed pain using a 100-mm visual analog scale (VAS) before sensory stimulation, after 30 and 60 min, and after 24 h. We recorded heart rate, systolic arterial pressure, and skin temperature before stimulation and after 30 and 60 min. We assessed skin blood flow with laser Doppler before stimulation and after 1 and 30 min. Sixty minutes and 24 h after AS, VAS pain scores were lower than in the placebo group (p < 0.05 and 0.0001, respectively). There were no significant changes in the autonomic variables. The results indicate that pressure on acupoints can decrease postoperative pain.

Agarwal A, Bose N, Gaur A, et al. Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy.Can J Anaesth 2002;Jun-Jul, 49(6):554-560. N=150; P<0.05

Department of Anesthesia, and Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow , India .

Purpose: To compare the efficacy of acupressure wrist bands and ondansetron for the prevention of postoperative nausea and vomiting (PONV).

Methods: One hundred and fifty ASA I–II, patients undergoing elective laparoscopic cholecystectomy were included in a randomized, prospective, double-blind and placebo-controlled study. Patients were divided into three groups of 50. Group I was the control; Group II received ondansetron 4 mg iv just prior to induction of anesthesia; in Group III acupressure wristbands were applied at the P6 points. Acupressure wrist bands were placed inappropriately in Groups I and II. The acupressure wrist bands were applied 30 min prior to induction of anesthesia and removed six hours following surgery. Anesthesia was standardized. PONV were evaluated separately as none, mild, moderate or severe within six hours of patients' arrival in the postanesthesia care unit and then at 24 hr after surgery by a blinded observer. If patients vomited more than once, they were given 4 mg ondansetron iv as the rescue antiemetic. Results were analyzed by Z test. A P value of < 0.05 was taken as significant.

Results: The incidence of PONV and the requirement of rescue medication were significantly lower in both the acupressure and ondansetron groups during the first six hours.

Conclusion:Acupressure at P6 causes a significant reduction in the incidence of PONV and the requirement for rescue medication in the first six hours following laparoscopic cholecystectomy, similar to that of ondansetron 4 mg iv.

Alkaissi A, Stalnert M, Kalman S. Effect and placebo effect of acupressure (P6) on nausea and vomiting after outpatient gynaecological surgery.Acta Anaesthesiol Scand 1999;43(3):270-274. N=60; P<0.05

Department of Anaesthesiology and Intensive Care, University Hospital in Linkoping , Sweden .

BACKGROUND: Acupuncture and acupressure have previously been reported to possess antiemetic effect. We wanted to investigate the "true" and placebo effect of acupressure in prevention of postoperative nausea and vomiting (PONV). PATIENTS AND METHODS: Sixty women undergoing outpatient minor gynaecological surgery were entered into a double-blind and randomised study. One group received acupressure with bilateral stimulation of P6 (A), a second group received bilateral placebo stimulation (P) and a third group received no acupressure wrist band and served as a reference group (R). PONV was evaluated as number of patients with complete response (no PONV), nausea only or vomiting. In addition, the need for rescue antiemetic medication and nausea after 24 h was registered. RESULTS: Complete response was obtained in 11, 11 and 9 patients in groups, A, P and R, respectively. Nine, 7 and 6 patients had nausea before discharge home, and 1, 1 and 8 patients were nauseated (8 vs 1 patient: P < 0.05) 24 h after operation in A, P and R groups, respectively. When compared to placebo acupressure (2 patients vomited and 5 needed rescue), significantly (P < 0.05) fewer needed rescue antiemetic medication after acupressure at P6 (no vomiting or rescue medication). When compared to the observation group (5 vomited and 4 needed rescue antiemetics), significantly fewer vomited after acupressure (P < 0.05) CONCLUSION: In patients undergoing brief gynaecological surgery, placebo effect of acupressure decreased nausea after 24 h but vomiting and need of rescue antiemetics was reduced only by acupressure with the correct P6 point stimulation.

Ho CM, Hseu SS, Tsai SK , et al. Effect of P-6 acupressure on prevention of nausea and vomiting after epidural morphine for post-cesarean section pain relief.Acta Anaesthesiol Scand 1996;40(3):372-375. N=60; P<0.05

Department of Anesthesiology, Veterans General Hospital-Taipei, Taiwan , Republic of China .

BACKGROUND: Nausea and vomiting are important side effects following administration of epidural morphine for post-Cesarean section pain relief. Stimulation of the P-6 (Neiguan) acupoint is a traditional Chinese acupuncture modality used for antiemetic purpose; it has been found to be effective. The aim of this study was to evaluate the antiemetic effect of P-6 acupressure in parturients given epidural morphine for post-Cesarean section pain relief. METHOD: In a randomized, double-blind and controlled trial, sixty parturients receiving epidural morphine for post-Cesarean section pain relief were investigated. Parturients were allocated to receive the acupressure bands or placebo bands on the P-6 acupoint bilaterally before the administration of spinal anesthesia and were observed over a 48-hour study period. RESULTS: The incidence of nausea and vomiting was significantly decreased from 43% and 27% in the control group, to 3% and 0% in the acupressure group, respectively (P < 0.05). CONCLUSION: The results demonstrate that prophylactic use of acupressure bands bilaterally on the P-6 acupoint can significantly reduce incidence of nausea and vomiting after epidural morphine for post-Cesarean section pain relief.

Lee A, Done ML. The use of nonpharmacologic techniques to prevent postoperative nausea and vomiting: a meta-analysis.Anesth Analg 1999;Jun, 88(6):1362-1369. Comment in: Anesth Analg 1999;Jun, 88(6):1200-1202.

Department of Anaesthetics, Division of Critical Care, Liverpool Hospital , New South Wales , Australia

We assessed the efficacy of nonpharmacologic techniques to prevent postoperative nausea and vomiting (PONV) by systematic review. These studies included acupuncture, electroacupuncture, transcutaneous electrical nerve stimulation, acupoint stimulation, and acupressure. Of the 24 randomized trials retrieved by a search of articles indexed on the MEDLINE and EMBASE databases (1980–1997), 19 were eligible for meta-analysis. The primary outcomes were the incidence of nausea, vomiting, or both 0–6 h (early efficacy) or 0–48 h (late efficacy) after surgery. The pooled relative risk (RR) and numbers needed to treat (NNT) were calculated. In children, no benefit was found. Some results in adults were significant. Nonpharmacologic techniques were similar to antiemetics in preventing early vomiting (RR = 0.89 [95% confidence interval 0.47–1.67]; NNT = 63 [10-{infty}]) and late vomiting (RR = 0.80 [0.35–1.81]; NNT = 25 [5-{infty}]) in adults. Nonpharmacologic techniques were better than placebo at preventing early nausea (RR = 0.34 [0.20–0.58]; NNT = 4 [3–6]) and early vomiting in adults (RR = 0.47 [0.34–0.64]; NNT = 5 [4–8]). Nonpharmacologic techniques were similar to placebo in preventing late vomiting in adults (RR = 0.81 [0.46–1.42]; NNT = 14 [6-{infty}]). Using nonpharmacologic techniques, 20%–25% of adults will not have early PONV compared with placebo. It may be an alternative to receiving no treatment or first-line antiemetics.

Implications: This systematic review showed that nonpharmacologic techniques were equivalent to commonly used antiemetic drugs in preventing vomiting after surgery. Nonpharmacologic techniques were more effective than placebo in preventing nausea and vomiting within 6 h of surgery in adults, but there was no benefit in children.

Ming JL, Kuo BI, Lin JG, Lin LC. The efficacy of acupressure to prevent nausea and vomiting in post-operative patients.J Adv Nurs 2002;Aug, 39(4):343-351. N=150

Department of Medical Research and Education, Veterans General Hospital-Taipei, Taiwan .

BACKGROUND: Post-operative nausea and vomiting is a common complication following general anaesthesia. Traditional Chinese medicine indicates that acupressure therapy may reduce nausea and vomiting in certain ailments. AIM(S) OF THE STUDY: The aim of this study was to examine the effect of stimulating two acupressure points on prevention of post-operative nausea and vomiting. DESIGN AND METHODS: A randomized block experimental design was used. The Rhodes Index of Nausea, Vomiting and Retching (INVR) questionnaire was used as a tool to measure incidence. To control the motion sickness variable, the subjects who underwent functional endoscopic sinus surgery (FESS) under general anaesthesia were randomly assigned to a finger-pressing group, a wrist-band group, and a control group. There were 150 subjects in total with each group consisting of 50 subjects. The acupoints and treatment times were similar in the finger-pressing group and wrist-band pressing group, whereas only conversation was employed in the control group. RESULTS: Significant differences in the incidence of the post-operative nausea and vomiting were found between the acupressure, wrist-band, and control groups, with a reduction in the incidence rate of nausea from 73.0% to 43.2% and vomiting incidence rate from 90.5% to 42.9% in the former. The amount of vomitus and the degree of discomfort were, respectively, less and lower in the former group. CONCLUSION: In view of the total absence of side-effects in acupressure, its application is worthy of use. This study confirmed the effectiveness of acupressure in preventing post-operative nausea and vomiting.

Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section.Anesth Analg 1997;84(2):342-345. N=75

Department of Anesthesiology, St. Luke's-Roosevelt Hospital Center, College of Physicians and Surgeons of Columbia University, New York, New York 10019, USA.

Nausea and vomiting occur frequently during cesarean section under spinal anesthesia. Metoclopramide reduces intraoperative nausea and vomiting, but not without potential side effects. Acupressure, a noninvasive variation of acupuncture that involves constant pressure on the wrist, has been suggested as an alternative method to prevent nausea and vomiting. The aim of this study was to compare acupressure and intravenous (IV) metoclopramide for the prevention of nausea and vomiting during elective cesarean section under spinal anesthesia. Seventy-five patients were studied in a randomized, prospective, double- blind comparative trial. Group I patients received acupressure bands + 2 mLIV saline, Group II patients received placebo wrist bands + 10 mg IV metoclopramide, and Group III patients received placebo wrist bands + 2 mL IV saline. Patients who received either acupressure or metoclopramide prior to initiation of spinal anesthesia for cesarean section had much less nausea than patients in the placebo group. Acupressure is an effective, non-pharmacologic method to reduce intraoperative nausea during elective cesarean section in the awake patient.

Morning Sickness:

Belluomini J, et al. Acupressure for nausea and vomiting of pregnancy: a randomized, blinded study. Obstetrics and Gynecology 1994;84:245-248 N=60; P=0.0021

OBJECTIVE: To evaluate the effectiveness of acupressure in reducing nausea and vomiting of pregnancy. METHODS: Symptomatic pregnant women were randomized to one of two acupressure groups: one treatment group using an acupressure point (PC-6) and one sham control group using a placebo point. Subjects were blind to the group assignment. Each evening for 10 consecutive days, the subjects completed an assessment scale describing the severity and frequency of symptoms that occurred. Data from the first 3 days were used as pre-treatment scores. Beginning on the morning of the fourth day, each subject used acupressure at her assigned point for 10 minutes four times a day. Data from day 4 were discarded to allow 24 hours for the treatment to take effect. Data from days 5-7 were used to measure treatment effect. RESULTS: Sixty women completed the study. There were no differences between groups in attrition, parity, fetal number, maternal age, gestational age at entry, or pre-treatment nausea and emesis scores. Analysis of variance indicated that both groups improved significantly over time, but that nausea improved significantly more in the treatment group than in the sham control group (F1,58 = 10.4, P = .0021). There were no differences in the severity or frequency of emesis between the groups. There was a significant positive correlation (r = 0.261, P = .044) between maternal age and severity of nausea. CONCLUSIONS: Our results indicate that acupressure at the PC-6 anatomical site is effective in reducing symptoms of nausea but not frequency of vomiting in pregnant women.

Norheim AJ, Pedersen EJ, Fonnebo V, Berge L. Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study. Scand J Prim Health Care. 2001 Mar;19(1):43-7. N=97; P=0.018

Havnegata General Practice, Harstad , Norway .

OBJECTIVE: To find out whether acupressure wristband can alleviate nausea and vomiting in early pregnancy. DESIGN: Double-blind, placebo-controlled study. SUBJECTS: 97 women with mean gestational length completed 8-12 weeks. MAIN OUTCOME MEASURES: Symptoms were recorded according to intensity, duration and nature of complaints. RESULTS: 71% of women in the intervention group reported both less intensive morning sickness and reduced duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms. However, a significance level of 5% was reached only in the case of duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.018). CONCLUSIONS: Acupressure wristband might be an alternative therapy for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered.

Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy: a randomized, placebo-controlled, pilot study.J Reprod Med 2001;46(9):835-839. N=60

Department of Nursing, Unit of Caring Sciences, Lund University , Lund , Sweden .

OBJECTIVE: To compare the antiemetic effect of acupressure at the Neiguan point (P6) in a group of healthy women with normal pregnancy and nausea and vomiting during pregnancy (NVP) with a similar group receiving acupressure at a placebo point and another, similar group not receiving any treatment. STUDY DESIGN: A randomized, placebo-controlled, pilot study involving 60 women. RESULTS: It is possible to reduce NVP significantly with acupressure at P6 as compared to acupressure at a placebo point or no treatment at all in healthy women with normal pregnancies. Relief from nausea appeared one day after starting treatment in both the P6 and placebo groups but lasted for only six days in the placebo group. The P6 group, however, experienced significantly less nausea after 14 days as compared to the other two groups. CONCLUSION: This study involved 60 healthy women with normal pregnancy and suffering from NVP. According to the results, in healthy women with normal pregnancy it is possible to reduce NVP significantly at P6 as compared to acupressure at a placebo point and to no treatment.

Slotnick RN. Safe, successful nausea suppression in early pregnancy with P-6 acustimulation.J Reprod Med 2001;Sep, 46(9):811-814. Comment in: J Reprod Med 2001;Dec, 46(12):1079. N=41

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Suite 310, Hofheimer Hall, 825 Fairfax Avenue, Norfolk, VA 23507

OBJECTIVE: To evaluate the safety and effectiveness of P-6 acustimulation for the relief of nausea and vomiting associated with early pregnancy. STUDY DESIGN: Forty-one patients were treated with a P-6 acustimulation device at the Division of Maternal-Fetal Medicine, Eastern Virginia Medical School . Pretreatment nausea severity, posttreatment nausea relief and device effectiveness were patient rated using a 1-5 scale. All neonates were evaluated for congenital abnormalities. RESULTS: Pretreatment nausea severity scores for treated patients averaged 4.2, with most severe and debilitating nausea rated 5. Posttreatment device effectiveness averaged 4.2, with significant or complete relief rated 5. Device ease of use averaged 4.3, with very easy to use rated 5. No congenital abnormalities were found. CONCLUSION: Because current pharmacologic treatments for nausea in early pregnancy are not consistent, efficacious or without unwanted side effects or increased teratogenic risks, acustimulation of P-6 in pregnancy may prove to be a significant therapeutic alternative.

Motion Sickness:

Hu S, Stritzel R, Chandler A, Stern RM. P6 acupressure reduces symptoms of vection-induced motion sickness. Aviat Space Environ Med , July 1, 1995 ; 66(7): 631-4. N=64; P<0.0001

Department of Psychology, Humboldt State University , Arcata , CA 95521 , USA .

PURPOSE: The purpose of the study was to examine the effectiveness of P6 acupressure on nausea associated with visually-induced motion sickness. METHOD: There were 64 subjects randomly divided into 4 groups: P6 acupressure, dummy-point acupressure, sham P6 acupressure, and control. Each subject sat in an optokinetic drum for a 12-min baseline and 12-min drum rotation period. Subjects' electrogastrograms (EGG's) and subjective symptoms of motion sickness were obtained. RESULTS: The results indicated that the subjects in the P6 acupressure group reported significantly less nausea [F(3,60) = 8.16, p < 0.0001] during drum rotation period than those in the dummy-point acupressure, sham acupressure, and control groups. The scores for symptoms of motion sickness of the P6 acupressure group were significantly lower than those in the sham acupressure and control groups [F(3,60) = 3.49, p < 0.02]. Also, the subjects in the P6 acupressure group showed significantly less abnormal gastric myoelectric activity, tachyarrhythmia, than those in the sham acupressure and control groups [F(3,60) = 2.78, p < 0.04]. However, the subjects in the dummy-point acupressure group did not report significantly fewer symptoms and show less tachyarrhythmia than those in the sham acupressure and control groups. CONCLUSION: We conclude that P6 acupressure reduces the severity of symptoms of visually-induced motion sickness and gastric tachyarrhythmia.

Stern RM, Jokerst MD, Muth ER, Hollis C. Acupressure relieves the symptoms of motion sickness and reduces abnormal gastric activity.Altern Ther Health Med 2001;Jul-Aug, 7(4):91-94. N=25

Gastrointestinal Psychology Laboratory, Pennsylvania State University , University Park , Pa. , USA .

CONTEXT: Acupuncture at the P6 or Neiguan point to treat nausea and vomiting has been practiced in China for many years. More recently, acupressure at P6 has been used successfully to decrease the symptoms of pregnancy sickness and with mixed results to decrease motion sickness. OBJECTIVE: To determine whether an Acuband, a commercially available acupressure wristband, would relieve the symptoms of motion sickness. METHOD: 25 healthy subjects, aged 18 to 22 years, prescreened for susceptibility to motion sickness, were tested on 3 separate occasions in a rotating optokinetic drum with the following conditions: wearing an Acuband on the wrist, wearing an Acuband on the arm, and wearing no Acuband. MAIN OUTCOME MEASURES: Subjective symptoms of motion sickness and abnormal gastric activity, as recorded via electrogastrography, were obtained throughout the procedure. RESULTS: Subjects reported significantly fewer symptoms of motion sickness on days when wearing the Acuband on the wrist or the arm than they did on control days (when they wore no Acuband). Subjects also showed less abnormal gastric activity on the days when wearing an Acuband than they did on control days. CONCLUSION: An Acuband worn on the wrist or forearm decreases the symptoms of motion sickness and the gastric activity that usually accompanies motion sickness.

Chemotherapy Nausea:

Dibble SL, Chapman J, Mack KA, Shih AS. Acupressure for nausea: results of a pilot study.Oncol Nurs Forum 2000;Jan-Feb, 27(1):41-47. N=17; P<0.01

Purpose/Objectives: To compare differences in nausea experience and intensity in women undergoing chemotherapy for breast cancer between those receiving usual care plus acupressure training and treatment and those receiving only usual care.

Design: Single-cycle, randomized clinical trial.

Setting: Outpatient oncology clinic in a major teaching medical center and a private outpatient oncology practice.

Sample: Seventeen women participated in the study. The typical participant was 49.5 years old (SD = 6.0), Caucasian (59%), not married/partnered (76%), on disability (53%), born a U.S. citizen (76%), and heterosexual (88%); lived alone (59%); had at least graduated from high school (100%); and had an annual personal income of $50,000 or greater (65%).

Methods: The intervention included finger acupressure bilaterally at P6 and ST36, acupressure points located on the forearm and by the knee. Baseline and poststudy questionnaires plus a daily log were used to collect data.

Main Research Variables: Nausea experience measured by the Rhodes Inventory of Nausea, Vomiting, and Retching and nausea intensity.

Findings: Significant differences existed between the two groups in regard to nausea experience (p < 0.01) and nausea intensity (p < 0.04) during the first 10 days of the chemotherapy cycle, with the acupressure group reporting less intensity and experience of nausea.

Conclusions: Finger acupressure may decrease nausea among women undergoing chemotherapy for breast cancer.

Roscoe JA, Morrow GR, Hickok JT, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting: a University of Rochester Cancer Center Community Clinical Oncology Program multicenter study.J Pain Symptom Manage 2003;Aug, 26(2):731-742. N=739; P<0.05

University of Rochester Cancer Center , Rochester , New York 14642 , USA .

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.

Shin, Yeong Hee PhD, RN; Kim, Tae Im PhD, RN, et al. Effect of Acupressure on Nausea and Vomiting During Chemotherapy Cycle for Korean Postoperative Stomach Cancer Patients. Cancer Nursing July/August 2004; 27(4):267-274. N=40

Despite the development of effective antiemetic drugs, nausea and vomiting remain the main side effects associated with cancer chemotherapy. The purpose of this study was to examine the effect of acupressure on emesis control in postoperative gastric cancer patients undergoing chemotherapy. Forty postoperative gastric cancer patients receiving the first cycle of chemotherapy with cisplatin and 5-Fluorouracil were divided into control and intervention groups (n = 20 each). Both groups received regular antiemesis medication; however, the intervention group received acupressure training and was instructed to perform the finger acupressure maneuver for 5 minutes on P6 (Nei-Guan) point located at 3-finger widths up from the first palmar crease, between palmaris longus and flexor carpi radialis tendons point, at least 3 times a day before chemotherapy and mealtimes or based on their needs. Both groups received equally frequent nursing visits and consultations, and reported nausea and vomiting using Rhode's Index of Nausea, Vomiting and Retching. We found significant differences between intervention and control groups in the severity of nausea and vomiting, the duration of nausea, and frequency of vomiting. This study suggests that acupressure on P6 point appears to be an effective adjunct maneuver in the course of emesis control.

General Nausea:

Dent HE, Dewhurst NG, Mills SY, Willoughby M. Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial.Complement Ther Med 2003;Jun, 11(2):72-77. N=301; P<0.05

Centre for Complementary Health Studies, University of Exeter , Exeter , Devon , UK .

OBJECTIVES: To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI). DESIGN: Partially randomised, partially blinded placebo-controlled, exploratory clinical study. SETTING: Coronary Care Unit, Torbay Hospital , Torquay, Devon . PARTICIPANTS: A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI. INTERVENTION: The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure. OUTCOME MEASURES: (1) Incidence of post-MI nausea and/or vomiting, (2) severity of symptoms, (3) use of antiemetic drugs, over 24h. RESULTS: There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant. CONCLUSIONS: Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.

Felhendler D, Lisander B. Effects of non-invasive stimulation of acupoints on the cardiovascular system.Complement Ther Med 1999;Dec, 7(4):231-234. N=24

OBJECTIVE: To study the effect of two non-invasive methods to stimulate acupoints on the cardiovascular system. DESIGN: Blind randomized-controlled trial. SETTING: An experimental setting in a university-affiliated hospital. INTERVENTIONS: The subjects (24 healthy male volunteers) were randomized to receive either an active stimulation consisting of pressure on acupoints (P), an active stimulation consisting of stroking along the meridians (S) or a control stimulation (C). MAIN OUTCOME MEASURES: Data on skin blood flow, arterial pressure, heart rate and EKG were recorded continuously from 20 min before stimulation to 30 min after. RESULTS: In P group there was a decrease in systolic arterial pressure, diastolic arterial pressure, mean arterial pressure, heart rate and skin blood flow. These changes were significantly different from those in C group and, as regards diastolic pressure and mean pressure, also from those in S group. There were no significant differences between S and C groups. CONCLUSIONS: Pressure on acupoints can significantly influence the cardiovascular system.

Lu DP, Lu GP, Reed JF 3rd. Acupuncture/acupressure to treat gagging dental patients: a clinical study of anti-gagging effects.Gen Dent 2000;Jul-Aug, 48(4):446-452.

University of Pennsylvania , USA .

Noninvasive methods advocated by some clinicians are not very successful in dealing with patient gagging, while sedation approaches run the risk of the patient aspirating foreign bodies. The P-6 Neikuan acupuncture point, located on the wrist, has been used in the Far East for thousands of years for its anti-nausea and anti-anxiety properties. In the West, it is the acupuncture point most studied. Only recently has interest been shown in the P-6 point for its possible anti-gagging effect. The anti-gagging effect of P-6 stimulation is documented in this article. The P-6 point has remarkable anti-gagging effects if stimulation is applied correctly. Clinicians may apply thumb pressure at the P-6 point to achieve some effect, although this is not as effective as acupuncture. Nevertheless, a substantial percentage of gagging patients would be able to go through dental procedures without gagging when the P-6 point is stimulated.

Wright LD. The use of motion sickness bands to control nausea and vomiting in a group of hospice patients. Am J Hosp Palliat Care . 2005 Jan-Feb;22(1):49-53. N=33

Hospice of Muskegon-Oceana, Muskegon , Michigan , USA .

OBJECTIVE: To explore the potential benefits of using motion sickness bands (MSBs) to control nausea and vomiting in a hospice-based patient population. METHODS: A nonblinded, yearlong observational study. RESULTS: From February 2003 to February 2004, 33 patients entered into the study. The mean age of the study cohort was 67 years, with a predominance of females to males and cancer as the most common admitting diagnosis. Twenty-nine of the 33 patients studied showed a positive response to the intervention for a response rate of 88 percent. CONCLUSIONS: MSBs demonstrated efficacy in controlling nausea and vomiting in a group of hospice patients. Added benefits of patient empowerment and financial savings also were noted. Further study is warranted.