Intervention Review

Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting

  1. Jeanette Ezzo1,*,
  2. Mary Ann Richardson2,
  3. Andrew Vickers3,
  4. Claire Allen4,
  5. Suzanne Dibble5,
  6. Brian F Issell6,
  7. Lixing Lao7,
  8. Michael Pearl8,
  9. Gilbert Ramirez9,
  10. Joseph A Roscoe10,
  11. Joannie Shen11,
  12. Jane C Shivnan12,
  13. Konrad Streitberger13,
  14. Imad Treish14,
  15. Grant Zhang15

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 20 FEB 2006

DOI: 10.1002/14651858.CD002285.pub2

Database Title

Additional Information

How to Cite

Ezzo J, Richardson MA, Vickers A, Allen C, Dibble S, Issell BF, Lao L, Pearl M, Ramirez G, Roscoe JA, Shen J, Shivnan JC, Streitberger K, Treish I, Zhang G. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD002285. DOI: 10.1002/14651858.CD002285.pub2.

Author Information

  1. 1

    James P. Swyers Enterprises, Research, Baltimore, Maryland, USA

  2. 2

    National Institutes of Health, National Center for Complementary and Alternative Medicine, Bethesda, Maryland, USA

  3. 3

    Memorial Sloan-Kettering Cancer Center, Integrative Medicine Service, New York, NY, USA

  4. 4

    The Cochrane Collaboration Secretariat, Oxford, UK

  5. 5

    University of California, Institute for Health and Ageing, San Francisco, CA, USA

  6. 6

    University of Hawaii, Cancer Research Center of Hawaii, Honolulu, Hawaii, USA

  7. 7

    University of Maryland School of Medicine, Complementary Medicine Program, Baltimore, Maryland, USA

  8. 8

    Long Island Gynecologic Oncologists, PC, Smithtown, New York, USA

  9. 9

    Florida International University, Robert Stempel College of Public Health and Social Work, Miama, Florida, USA

  10. 10

    University of Rochester Cancer Center, Behavioral Medicine Unit, Rochester, New York, USA

  11. 11

    Centers for Disease Control & Prevention, Air Pollution & Respiratory Health, Atlanta, GA, USA

  12. 12

    The Institute for Johns Hopkins Hospital, Baltimore, MD, USA

  13. 13

    University of Heidelberg, Department of Anaesthesiology, Heidelberg, Germany

  14. 14

    King Hussein Cancer Center, Department of Pharmacy, Amman, Jordan

  15. 15

    University of Maryland School of Medicine, Center for Integrative Medicine, Ellicott City, MD, USA

*Jeanette Ezzo, Research, James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland, 21209, USA. jeanetteezzo@gmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 20 JAN 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT3 inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms.

Objectives

The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.

Search methods

We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts.

Selection criteria

Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both.

Data collection and analysis

Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes.

Main results

Eleven studies (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval (CI) 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% CI 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% CI -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics.

Authors' conclusions

This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Acupuncture for nausea and vomiting which has been induced by having chemotherapy treatment

This review looked at whether stimulating acupuncture points could reduce nausea and vomiting caused by chemotherapy. Acupuncture points can be stimulated by acupuncture applied with electricity (electroacupuncture), acupuncture without electricity (manual acupuncture), acupressure (pressing on the points usually with fingertip), or electrical stimulation on the skin surface such as wristwatch-like devices. Electroacupuncture reduced first-day vomiting, but manual acupuncture did not. Acupressure reduced first-day nausea, but was not effective on later days. Acupressure showed no benefit for vomiting. Electrical stimulation on the skin showed no benefit. All trials also gave anti-vomiting drugs, but the drugs used in the electroacupuncture trials were not the most modern drugs, so it is not known if electroacupuncture adds anything to modern drugs. Trials of electroacupuncture with modern drugs are needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

針對化療引起噁心或嘔吐的針灸點刺激

對於化療引起噁心或嘔吐最近的進展是使用5HT3抑制劑和dexamethasone。然而，很多人依然經驗這這些症狀，且專業醫師們鼓勵額外的方法來減少這些症狀。

目標

本文目的是評估使用針灸點刺激於癌症病人對化療所引起的急性及延遲噁心或嘔吐的效果。

搜尋策略

我們尋找了MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care和Supportive Care Specialized Register, Cochrane Cancer Specialized Register,和會議摘要。

選擇標準

藉由各種方法(針、電刺激、磁鐵、或者是指壓按摩)的針灸點刺激評估化療引起噁心及/或嘔吐的隨機取樣試驗。

資料收集與分析

數據由原始試驗者提供並使用固定效果模型匯集分析。相對危險性是將數據分成兩類再計算。噁心的嚴重程度以標準化的平均值差異計算。嘔吐的次數以加權化的平均值差異計算。

主要結論

11個試驗(N = 1247)被匯集起來。整體來說，和對照組比較起來所有方法的針灸點刺激可減少急性嘔吐的發生率(RR = 0.82; 95% confidence interval0.69 to 0.99; P = 0.04)，但不是急性或者是延遲性噁心的嚴重度。以治療方法而言，用針刺激可減少急性嘔吐的比率(RR = 0.74; 95% confidence interval0.58 to 0.94; P = 0.01)，但不是急性噁心的嚴重度。電針灸可減少急性嘔吐的比率(RR = 0.76; 95% confidence interval0.60 to 0.97; P = 0.02)，但手按摩針灸並沒有；針灸對延遲性症狀並沒有報告。針灸可減少平均急性噁心的嚴重度(SMD = −0.19; 95% confidence interval0.37 to −0.01; P = 0.04)但不是急性嘔吐或者是延遲性症狀。非侵犯性電刺激對任何結果均沒有幫助。所有的試驗均同時使用抗嘔吐藥物，而且所有的試驗(除電針灸試驗外)皆使用現時最好的抗嘔吐藥物。

作者結論

這篇回顧術後噁心和嘔吐的輔助治療，其數據顯示針灸點刺激的可能有其生物效應。電針灸已經證明對化療產生的急性嘔吐有幫助，但是合併電針灸及目前最新的抗嘔吐藥物的治療和針對頑固性症狀的病人是需要再研究以了解臨床的適切性。即使無控制組的比較，教導病人自我執行針灸，似乎對於急性噁心有保護效果。當病人接受目前最新的抗嘔吐藥物治療，非侵犯性電刺激似乎無法對臨床狀況有適切幫助。

翻譯人

本摘要由三軍總醫院林斈府翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

電針灸對於化療後第一天的嘔吐是有效的，但多項試驗認為現代的止吐藥是需要的。這一篇回顧旨在檢視是否刺激針灸點可減少化療造成的噁心和嘔吐。針灸點可以電力的針灸(電針灸)、未使用電力的針灸(手動針灸)、指壓按摩(通常使用指尖壓在這些點上)來刺激、或者是在皮膚表面以腕錶式裝置之電刺激所刺激。電針灸減輕第一天的嘔吐，但手動針灸並沒有。針灸減輕第一天的噁心，但對於接下來的幾天並沒有效果。針灸對於嘔吐沒有益處。皮膚表面的電刺激沒有幫助。所有的試驗也都給予止吐藥物，但這些藥物使用在電針灸試驗中的並不是最先進的藥物，所以電針灸加入任何一種現代的藥物的成效並不知道。電針灸合併現代止吐藥物的試驗是需要的。

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