title: Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting.
abstract: BACKGROUND
  There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT(3) inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms.
  
  
  OBJECTIVE
  The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.
  
  
  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.
  
  
  METHODS
  Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both.
  
  
  METHODS
  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.
  
  
  RESULTS
  Eleven trials (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval 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% confidence interval 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% confidence interval 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% confidence interval -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.
  
  
  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.
authors.affiliation: James P. Swyers Enterprises, 1905 West Rogers Ave, Baltimore, Maryland 21209, USA. jeanetteezzo@prodigy.net
authors.forename: J M
authors.initials: JM
authors.lastname: Ezzo
authors.forename: M A
authors.initials: MA
authors.lastname: Richardson
authors.forename: A
authors.initials: A
authors.lastname: Vickers
authors.forename: C
authors.initials: C
authors.lastname: Allen
authors.forename: S L
authors.initials: SL
authors.lastname: Dibble
authors.forename: B F
authors.initials: BF
authors.lastname: Issell
authors.forename: L
authors.initials: L
authors.lastname: Lao
authors.forename: M
authors.initials: M
authors.lastname: Pearl
authors.forename: G
authors.initials: G
authors.lastname: Ramirez
authors.forename: Ja
authors.initials: J
authors.lastname: Roscoe
authors.forename: J
authors.initials: J
authors.lastname: Shen
authors.forename: J C
authors.initials: JC
authors.lastname: Shivnan
authors.forename: K
authors.initials: K
authors.lastname: Streitberger
authors.forename: I
authors.initials: I
authors.lastname: Treish
authors.forename: G
authors.initials: G
authors.lastname: Zhang
mesh_terms: D015669:Acupuncture Points; D000932:Antiemetics / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000009:adverse effects*; D015671:Electroacupuncture; D006801:Humans; D009325:Nausea / Q000139:chemically induced / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D014839:Vomiting / Q000139:chemically induced / Q000628:therapy*
chemical_list: D000932:Antiemetics; D000970:Antineoplastic Agents