title: Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting.
abstract: OBJECTIVE
  Assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.
  
  
  METHODS
  Randomized trials of acupuncture-point stimulation by needles, electrical stimulation, magnets, or acupressure were retrieved. Data were provided by investigators of the original trials and pooled using a fixed-effects model.
  
  
  RESULTS
  Eleven trials (N = 1,247) were pooled. Overall, acupuncture-point stimulation reduced the proportion of acute vomiting (relative risks [RR] = 0.82; 95% CI, 0.69 to 0.99; P = .04), but not the mean number of acute emetic episodes or acute or delayed nausea severity compared with controls. By modality, stimulation with needles reduced the proportion of acute vomiting (RR = 0.74; 95% CI, 0.58 to 0.94; P = .01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI, 0.60 to 0.97; P = .02), but manual acupuncture did not; delayed symptoms were not reported. Acupressure reduced mean acute nausea severity (standardized mean difference = -0.19; 95% CI, -0.38 to -0.01; P = .03) and most severe acute nausea, 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.
  
  
  CONCLUSIONS
  This review complements data on postoperative nausea and vomiting, suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies with state-of-the-art antiemetics as well as studies for refractory symptoms are needed to determine clinical relevance. Acupressure seems to reduce chemotherapy-induced acute nausea severity, though studies did not involve a placebo control. Noninvasive electrostimulation seems unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.
authors.affiliation: JPS Enterprises, Baltimore, MD 21209, USA. jeanetteezzo@prodigy.net
authors.forename: Jeanette
authors.initials: J
authors.lastname: Ezzo
authors.forename: Andrew
authors.initials: A
authors.lastname: Vickers
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Richardson
authors.forename: Claire
authors.initials: C
authors.lastname: Allen
authors.forename: Suzanne L
authors.initials: SL
authors.lastname: Dibble
authors.forename: Brian
authors.initials: B
authors.lastname: Issell
authors.forename: Lixing
authors.initials: L
authors.lastname: Lao
authors.forename: Michael
authors.initials: M
authors.lastname: Pearl
authors.forename: Gilbert
authors.initials: G
authors.lastname: Ramirez
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Roscoe
authors.forename: Joannie
authors.initials: J
authors.lastname: Shen
authors.forename: Jane
authors.initials: J
authors.lastname: Shivnan
authors.forename: Konrad
authors.initials: K
authors.lastname: Streitberger
authors.forename: Imad
authors.initials: I
authors.lastname: Treish
authors.forename: Grant
authors.initials: G
authors.lastname: Zhang
mesh_terms: D015669:Acupuncture Points; D000208:Acute Disease; D000970:Antineoplastic Agents / Q000009:adverse effects*; D004599:Electric Stimulation Therapy; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000628:therapy*; D009369:Neoplasms / Q000188:drug therapy; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome; D014840:Vomiting, Anticipatory / Q000209:etiology / Q000628:therapy*
chemical_list: D000970:Antineoplastic Agents