Nausea and vomiting

Nausea and vomiting may have various causes. The largest number of studies confirming the efficacy of acupuncture and acupressure has been conducted on patients suffering from intra – and postoperative nausea and vomiting, and caused by chemotherapy. Recently, intensified studies are conducted on patients with nausea and vomiting occurring during pregnancy, because of an unusual safety of acupuncture and limited choice of implementation of different therapies. As in case of the discussed ailments, it is important to apply the therapy during the onset, studies of efficacy of acupressure as the method of auto therapy have been conducted. In the case of this method, research inspired producers to introduce to the market elastic compression bands stimulating one of the acupuncture points on the forearm. It has been observed that compression bands help to alleviate or reduce nausea and vomiting in locomotive disease.

STRENGTH OF EVIDENCE
Power of arguments
  • Intra/postoperative nausea and vomiting
  • Nausea and vomiting after chemotherapy
  • Nausea and vomiting in pregnancy
  • Nausea connected with migraine
  • Nausea stemming from different causes in Emergency Ward
Intra/postoperative nausea and vomiting

Nausea and vomiting occurring 24 hours after surgeries are common complications of operations and anesthesia. In most cases, they are not dangerous and resolve spontaneously. However, in some cases they may cause serious consequences such as disturbance of electrolyte balance, dehydration, venous hypertension and bleeding. Sometimes rare complications such as intestinal perforation may be observed. These complications lead to prolonged stay of patients on postoperative wards, thus increasing costs of treatment. Because of limited efficiency and serious side effects of antiemetic drugs application, complementary and alternative methods have been studied. Acupuncture has been regarded as one of the most promising methods.

In December 2013, a review of articles and meta-analysis of acupuncture efficacy was published in a prestigious periodical Public Library of Sciences (PLoS)(source)1. In the meta-analysis 30 randomized, control clinical groups have been studied (1276 patients in studied groups and 1258 in control groups). In the result of conducted statistical analysis, acupuncture was proved as an efficient, safe and economically wise method of prevention and treatment of postoperative nausea and vomiting.

Four years earlier, a report prepared by the most conservative body supervising the quality of Cochrane Library describing the efficacy of stimulation of the individual point Pc-6 in prevention of postoperative nausea and vomiting was published(source)2. The discussed meta-analysis encompassed 4- studies (4858 patients). The following conclusions were drawn:

  1. In a comparison with “false” interventions, stimulation of the point Pc-6 significantly reduces:
    1. Nausea
    2. Vomiting
    3. Application of antiemetic drugs
  2. Significant disparities between efficiency of antiemetic drugs and stimulation of the acupuncture point Pc-6 were not observed, with reduced number and seriousness of complications in case of using acupuncture pint stimulation.

The efficiency of acupuncture and acupressure has been also proved in cases of special subgroups of patients.

In 2006, meta-analysis discussing efficiency of stimulation of acupuncture points in the treatment of postoperative nausea and vomiting in children was published(source)3. The authors analyzed the results of 12 randomized, controlled clinical studies, proving the procedure and acupressure as an efficient method of treatment of postoperative vomiting and nausea in children. The efficacy of acupuncture is higher than of acupressure, and is not lower than of drugs. According to the discussed analysis electro stimulation of acupuncture points in children does not provide statistically significant results.

In the report published in 2012 by scientists working for Cochrane Library, the efficacy of acupressure in alleviating of intra-operative nausea in women with cesarean section(source)4. However, in the following case, statistical significance in reducing postoperative nausea was not proved.

  1. Acupuncture in the point Pc-6 significantly reduces the number of early postoperative vomiting (0-6 hours) and nausea (0-24 hours)
  2. Acupressure in the point Pc-6 significantly reduces the number of postoperative nausea and vomiting (0-24 hours)
  3. Electroacupuncture in the point Pc-6 significantly reduces the number of postoperative nausea and vomiting  (0-24 hours)
  4. Stimulation of the point Pc-6 together with other points results in significant reduction of postoperative nausea and vomiting (0-24), however, the quality of this research was poor.

“Acupuncture is as effective as pharmacotherapy in preventing postoperative nausea and vomiting, with less frequent and less serious adverse events”

“In treatment of intra- and postoperative nausea and vomiting in children acupuncture is as effective as pharmacotherapy and more effective than acupressure”

Nausea and vomiting after chemotherapy

The number of life-saving or prolonging therapies applied in oncological patients cause difficult to reduce side-effects, among which patients and their families are most afraid of nausea and vomiting(source)5. A lot of oncologists are afraid of recommending acupuncture to their patients, as it was regarded as a method relatively contraindicated in treatment of oncological diseases. However, the results of clinical studies conducted in recent years prove effectiveness of acupuncture in reducing of nausea and vomiting in the course of anticancer therapy.

The group supervised by Professor Mary K. Garcia from the University of Texas prepared a review of literature studying the efficiency of acupuncture in the treatment and care of patients with cancer(source)6. After the analysis of 41 randomized, controlled clinical studies the authors agreed upon, that acupuncture may be regarded as a proper method of additional treatment of nausea and vomiting caused by chemotherapy.

The similar conclusions were drawn by British scientists who prepared another review of literature on symptomatic application of acupuncture in oncological patients, published in 2013(source)7. On the basis of analysis of 17 reviews, they concluded, that there are enough proofs to implement acupuncture in treatment of nausea and vomiting occurring in the course anticancer therapy.

The results of this study were proved in other studies, which results were published after the publication of the articles discussed in a preceding section. The researchers from Turkey proved, that acupressure of the point Pc-6 significantly reduces nausea, vomiting and anxiety in patients with breast cancer(source)8.  The group of researchers from Montreal proved acupuncture as an efficient method of treatment in a number of symptoms in patients with carcinoma of lungs, such as pain, appetite loose, nausea, nervosity and others(source)9.

“Acupuncture is effective as adjunctive method of treatment of nausea and vomiting caused by chemotherapy”

Nausea and vomiting in pregnancy

Nausea and vomiting are common complaints in pregnant women, especially between 5 and 18 week. Their intensification and nuisance may vary. In most cases, they regress spontaneously and there are not very strong. However, nausea and vomiting sometimes may be very strong, which not only may disturb everyday life but also may be harmful for developing fetus, because of electrolyte disorders, dehydration, and diaphragm spasm. For safety reasons, in pregnant women antiemetic drugs are not recommended. Thus, patients seek help of non-pharmacological methods, among which acupressure is becoming more and more popular because of its efficacy and safety.

However, in most patients, acupuncture cannot be applied self-dependently. Thus, most studies focus on effectiveness of acupressure, and not on acupuncture. The number and quality of studies on acupuncture are low. Therefore, there is a non-sufficient number of data to draw conclusions. Yet, the efficiency of acupressure is confirmed by various studies and recently published meta-analysis.

In 2006, a meta-analysis of fourteen studies was published(source)10. After calculation, the authors concluded that both acupressure and electric stimulation of acupuncture points constitute efficient treatment method of nausea and vomiting. In the case of acupuncture, statistically significant results were not obtained, probably because of discussed earlier difficulties and nuisances when applied self-dependently.

Similar conclusions were presented in a recently published report of Cochrane Library (included 37 studies)(source)11, which focus on various ways of nausea and vomiting treatment in pregnancy. The authors did not find enough evidence to choose one method, also pharmacological. However, it was agreed upon that there is no sufficient number of proofs of efficiency of acupressure, electric stimulation of acupuncture points and ear acupuncture.

“Pregnant women may use auto-acupressure gaining control over the symptoms”

“Both acupressure and electric stimulation of acupuncture points are effective methods of treatment of nausea and vomiting”

Nausea connected with migraine

In 2012, the group of researchers from the Department of Obstetrics and Gynecology of the University of Turin presented the results of their experiment on the acupressure in controlling nausea stemming from migraine(source)12. 40 patients with migraine, in each onset nausea appeared, were examined during six migraine episodes. They were or were not randomly prescribed to a group using compression bands at the point Pc-6. In the studied group, the intensity of nausea was significantly lower, what is more, patients significantly more often signaled reduction (50%) of nausea than in the controlled group.

Nausea stemming from different causes in Emergency Ward

Recently, an interesting article based on analysis of application of acupuncture in Emergency Ward of hospital in Melbourne in patients complaining of pain and/or nausea was published. More than a half of patients (57%) signaled maximum satisfaction after acupuncture, and 84,3% positively answered on a question, whether they want to use acupuncture again (definitely yes – 52,5%, rather yes – 31,8%). The authors conclude that acupuncture is a safe and accepted by patients way of treatment of pain and/or vomiting in Emergency Room.

BIBLIOGRAPHY

1 Cheong KB, Zhang JP, Huang Y, Zhang ZJ „The effectiveness of acupuncture in prevention and treatment of postoperative nausea and vomiting–a systematic review and meta-analysis.” PLoS One. 2013 Dec 13;8(12):e82474. doi: 10.1371/journal.pone.0082474. eCollection 2013.

2 Lee A, Fan LT „Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting.” Cochrane Database Syst Rev. 2009 Apr 15;(2):CD003281. doi: 10.1002/14651858.CD003281.pub3

3 Dune LS, Shiao SY „Metaanalysis of acustimulation effects on postoperative nausea and vomiting in children.” Explore (NY). 2006 Jul-Aug;2(4):314-20

4 Griffiths JD1, Gyte GM, Paranjothy S, Brown HC, Broughton HK, Thomas J „Interventions for preventing nausea and vomiting in women undergoing regional anaesthesia for caesarean section.” Cochrane Database Syst Rev. 2012 Sep 12;9:CD007579. doi: 10.1002/14651858.CD007579.pub2.

5 Gill P; Grothey A; Loprinzi, C. „Nausea and Vomiting in the Cancer Patient”. Oncology. 2006, pp 1482-1496 doi:10.1007/0-387-31056-8_83

6 Garcia MK, McQuade J, Haddad R, Patel S, Lee R, Yang P, Palmer JL, Cohen L „Systematic review of acupuncture in cancer care: a synthesis of the evidence.” J Clin Oncol. 2013 Mar 1;31(7):952-60. doi: 10.1200/JCO.2012.43.5818. Epub 2013 Jan 22.

7 Towler P, Molassiotis A, Brearley SG „What is the evidence for the use of acupuncture as an intervention for symptom management in cancer supportive and palliative care: an integrative overview of reviews.” Support Care Cancer. 2013 Oct;21(10):2913-23. doi: 10.1007/s00520-013-1882-8. Epub 2013 Jul 19

8 Genç F, Tan M „The effect of acupressure application on chemotherapy-induced nausea, vomiting, and anxiety in patients with breast cancer.” Palliat Support Care. 2014 Apr 30:1-10. [Epub ahead of print]

9 Kasymjanova G, Grossman M, Tran T, Jagoe RT, Cohen V, Pepe C, Small D, Agulnik J „The potential role for acupuncture in treating symptoms in patients with lung cancer: an observational longitudinal study.” Curr Oncol. 2013 Jun;20(3):152-7. doi: 10.3747/co.20.1312

10 Helmreich RJ, Shiao SY, Dune LS „Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women.” Explore (NY). 2006 Sep-Oct;2(5):412-21

11 Matthews A, Haas DM, O’Mathúna DP, Dowswell T, Doyle M „Interventions for nausea and vomiting in early pregnancy.” Cochrane Database Syst Rev. 2014 Mar 21;3:CD007575. doi: 10.1002/14651858.CD007575.pub3.

12 Allais G, Rolando S, Castagnoli Gabellari I, Burzio C, Airola G, Borgogno P, Schiapparelli P, Allais R, Benedetto C. „Acupressure in the control of migraine-associated nausea.” Neurol Sci. 2012 May;33 Suppl 1:S207-10. doi: 10.1007/s10072-012-1069-y

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