Acupressure is a therapeutic technique of applying digital pressure (pressure applied by the digits or hands) in a specific way on designated points on the body. By applying pressure to one or more acupoints, practitioners correct imbalances by stimulating or easing energy flow. The acupoint most commonly investigated and accessible is P6, which is located on the anterior surface of the forearm, approximately three finger-widths from the wrist crease. Acupressure devices also have been developed; these are considered passive forms of pressure and differ from digital pressure. The Sea-Band® device is an example of a commercially available acupressure device that is a plastic stud incorporated into a wrist band to exert pressure on the P6 acupuncture point. The H7 acupressure point at the wrist has been used to treat insomnia. Acupressure has been examined for its effect on anxiety, chemotherapy-induced nausea and vomiting, depression, fatigue, pain, and sleep/wake disturbances.
Wang, T., Deng, R., Tan, J.Y., & Guan, F.G. (2016). Acupoints stimulation for anxiety and depression in cancer patients: A quantitative synthesis of randomized controlled trials. Evidence-Based Complementary and Alternative Medicine, 2016, 5645632.
STUDY PURPOSE: To review randomized, controlled trials on the current evidence on the therapeutic effects of acupoints stimulation for patients with cancer with anxiety and depression
TYPE OF STUDY: Systematic review
APPLICATIONS: Palliative care
Overall, the findings really did not support acupoints as a useful approach for managing anxiety and depression. Although it has limited risks, it may be useful in patients who do not tolerate oral medications. Results should be interpreted with caution because of the limitations identified. Still, much needs to be researched in this area. Study heterogeneity and lack of standardization of care and design are some of the major limitations to this meta-analysis. Further studies including controls for environmental as well as study site differences are needed before these results can be interpreted. Generalizability is not possible outside of the current study demographics, which should also be taken into account for future studies.
Acupoints could be a safe intervention used in clinical practice for patients with cancer who experience anxiety and depression. No serious harm was reported, so it could be used as an alternative to medications when patients do not tolerate. Still, much research needs to be conducted in this area.
Tang, W.R., Chen, W.J., Yu, C.T., Chang, Y.C., Chen, C.M., Wang, C.H., & Yang, S.H. (2014). Effects of acupressure on fatigue of lung cancer patients undergoing chemotherapy: An experimental pilot study. Complementary Therapies in Medicine, 22, 581–591.
To explore the effects of acupressure on fatigue and other symptoms in patients with lung cancer undergoing chemotherapy
Patients were hospitalized for four days. On day 1, a research assistant (RA) taught patients how to self-administer acupressure, and patients received a handbook including an acupoint map and acupressure methods. On days 2–4 and in subsequent hospitalizations for chemotherapy, an RA assisted patients in acupressure and confirmed their accuracy. Three acupoints were used, and the intervention was done once daily every morning for five months. Patients were instructed to do the acupressure at home each day. Patients were randomly assigned to one of three groups by a coin toss; group A received acupressure with essential oils, group B received only acupressure, and group C received sham acupressure using three sham acupoints. Study data were collected one day before starting chemotherapy, on day 1 of the third chemotherapy cycle, and on day 1 of the sixth chemotherapy cycle. Data were collected 30 minutes after the acupressure intervention.
Three-group, sham controlled, randomized trial
Adherence rates to acupressure varied significantly across groups – for group A, 93%, group B, 91.9%, and group C, 77.3%. Only subscale scores for fatigue in daily activity were lower for the two acupressure groups on day 1 of the third chemotherapy cycle. There were no other significant differences between groups for fatigue. There were no significant differences between groups in anxiety or depression scores. Sleep scores were lower for group A at one time point and group B at another time point compared to the sham control group (p < .05). However, these differences were not consistent across all study time points, and there were no other differences between groups in sleep results.
Potential benefits of acupressure for fatigue and sleep disturbance among patients receiving chemotherapy for lung cancer are not clear in this study. Differences in patient outcomes were not consistent across study time points according to the study group. No effect was demonstrated on anxiety or depression scores.
This study does not provide strong evidence in support of the effectiveness of acupressure for management of fatigue, sleep disturbance, anxiety, or depression. The study did show that self-administration of acupressure was feasible and had no associated adverse effects in patients with advanced lung cancer. This is a low-risk, low-cost intervention that some patients may be interested in using.
Zhang, B., Dong, J.N., Sun, P., Feng, C., & Liu, Y.C. (2017). Effect of therapeutic care for treating fatigue in patients with breast cancer receiving chemotherapy. Medicine, 96, e7750.
The purpose was to evaluate the effect of therapeutic care (TC) with acupressure on fatigue in patients with breast cancer receiving chemotherapy.
Patients were randomized to the intervention or sham control arm. The intervention consisted of acupressure to three points related to energy in the human body (bilateral Hegu, Zusanli, & Sanyinjiao) administered 30 minutes per day, 10 minutes per point, 3 days a week for 12 weeks. Sham control included three points reported to have no relationship to alleviate cancer-related fatigue, first metacarpal head, patella, and inner ankle with same treatment administration, frequency, and duration. Fatigue, anxiety, depression, and sleep were measured at baseline, 6 weeks, and 12 weeks.
PHASE OF CARE: Active antitumor treatment
Randomized control trial
Multidimensional fatigue inventory (MFI), Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index (PSQI)
For those in the intervention group, fatigue improved statistically (p < 0.01) at 6 weeks and maintained improvement at 12 weeks (p < 0.01). Anxiety, depression, and sleep quality improved at 12 weeks (p < 0.01).
Acupressure may be an effective method or type of complementary and alternative therapy in improving fatigue, anxiety, depression, and sleep in patients with breast cancer receiving chemotherapy.
Acupressure focused on points known to help energy may be useful in treating cancer-related fatigue, anxiety, depression, and sleep quality.