Acupressure

Acupressure

PEP Topic 
Sleep-Wake Disturbances
Description 

Acupressure is a therapeutic technique of applying digital pressure (pressure applied by the digits or hands) in a specified 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 have also 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 (CINV), depression, fatigue, pain, and sleep-wake disturbances.

Effectiveness Not Established

Research Evidence Summaries

Cerrone, R., Giani, L., Galbiati, B., Messina, G., Casiraghi, M., Proserpio, E., . . . Gardani, G. (2008). Efficacy of HT 7 point acupressure stimulation in the treatment of insomnia in cancer patients and in patients suffering from disorders other than cancer. Minerva Medica, 99, 535–537.

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Study Purpose:

To evaluate the efficacy of HT 7 point acupressure for the treatment of insomnia in patients with cancer as compared to patients with medical illnesses other than cancer.

Intervention Characteristics/Basic Study Process:

Patients were included if they reported sleeping disorders lasting at least three months, lacked response to benzodiazepine drugs, reported no chronic pain, and had no current drug therapy inhibiting the induction of sleep. Acupressure devices (H7 insomnia control, Consultream s.as., Como, Italy) were applied to both wrists starting at 10 pm each night for at least two weeks.

Sample Characteristics:

  • The sample was comprised of 25 patients (32% male, 68% female).
  • Median age was 62 years (range 48–75).
  • Cancer diagnoses included breast, colorectal, and non-small cell lung cancer.
  • Other medical illnesses included anxiety, idiopathic insomnia, and depression.

Setting:

Not specified

Phase of Care and Clinical Applications:

The phase of care was not stated.

Study Design:

The study was a prospective, single-group trial.

Measurement Instruments/Methods:

  • H7 Insomnia Control, Consulteam s.a.s., Como, Italy (intervention instrument)    
  • No measure of sleep quality was stated.  
  • Duration and pressure of acupressure was not stated.
     

Results:

Sleep quality improved in the first 10 days for 15 of 25 patients (60%). A greater number of oncology patients had improvements in sleep quality (79%) than those with other medical illnesses (36%), but this did not represent a statistical difference (no test statistic reported by the authors).

Conclusions:

HT 7 improved insomnia in patients with cancer and other medical illnesses.

Limitations:

  • The study had a small sample size, with less than 30 patients.
  • The study used a convenience sample.
  • The description of intervention and measures was inadequate.
  • There was no stated measure of sleep quality.
  • Chi-square values and other statistical values were not reported by the authors.
  • There was no stated control of anxiety or depression in patients with cancer.
  • No usual care control group was used.
  • There was no stated control of potential confounding factors or medical conditions.
  • The article lacked standard components of study reporting.

Nursing Implications:

Further information is needed to accurately draw conclusions regarding the usefulness of acupressure in oncology patients.

Frisk, J., Källström, A. C., Wall, N., Fredrikson, M., & Hammar, M. (2012). Acupuncture improves health-related quality-of-life (HRQoL) and sleep in women with breast cancer and hot flushes. Supportive Care in Cancer, 20, 715–724.

doi: 10.1007/s00520-011-1134-8
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Study Purpose:

To evaluate the effectiveness of electroacupuncture (EA) and hormone therapy (HT) on health-related quality of life (HRQoL) and sleep in breast cancer survivors with vasomotor symptoms.

Intervention Characteristics/Basic Study Process:

Women who had completed treatment for breast cancer were randomized to receive EA for 12 weeks or HT for 24 months. They completed the Psychological and General Wellbeing Index (PGWI) and Women’s Health Questionnaire (WHQ) pretreatment for vasomotor symptoms; during treatment; and at 6, 9, 12, 18, and 24 months after the start of treatment.

Sample Characteristics:

  • The sample was comprised of 18 female patients.  
  • Mean age was 54.1 years (range 47–69). 
  • Patients had completed treatment for breast cancer in situ for a T1 or T2 tumor with a maximum of four metastatic lymph nodes or T3 tumors without metastatic lymph nodes.
  • Patients also had:
    • Vasomotor symptoms 
    • Been seen by a breast surgeon or oncologist within the last three months and were not receiving active treatment for breast cancer  
    • No clinical or mammographic signs of recurrence.

Women were excluded if they were receiving ongoing breast cancer treatment other than tamoxifen; had other malignancies; or had a history of thromboembolic, cereverbrovascular, or liver disease; porphyria; or active cardiovascular disease.

Setting:

  • Multisite   
  • Outpatient
  • Sweden

Phase of Care and Clinical Applications:

  • Patients were undergoing the long-term follow-up phase of care.
  • The study has clinical applicability for late effects and survivorship and elderly care.

Study Design:

The study was a multicenter, randomized, prospective trial.

Measurement Instruments/Methods:

  • WHQ
  • PGWI
  • Log books for hot flushes and for sleep data, specifically the number of hours slept and times woken

Results:

Nineteen women completed 12 weeks of EA. Eleven women were excluded due to changes in treatment. About 40% of the patients had no other treatment. The HT group had 11 women complete the 24 months of treatment. In both groups, reduction of hot flushes was noted. The EA group had a decrease in the median number of flushes/24 hours of 55% (p < 0.001) after 12 weeks. The decrease was 29% (p = 0.026) after 24 months. In the HT group, the median number of hot flushes/24 hours decreased by 100% (p = 0.001) after 12 weeks of treatment with no further changes. Sleep parameters improved significantly in both groups from baseline, with a WHQ sleep score in the EA group at baseline of 0.50 and at 24 months 0.33; in the HT group, the baseline score of 0.33 to declined 0.00 at 24 months.

The study showed improvement in sleep scores of both groups up to 21 months. The numbers of hours slept per night did not increase, but the numbers of flushes and distress caused by them decreased, resulting in fewer times woken, with overall improvement in HRQoL. Both groups also showed a significant decrease in the number of HF experienced, which was maintained up to 21 months after treatment was stopped.

Conclusions:

EA, compared to HT for management of hot flashes in breast cancer survivors, shows some potential benefit in reducing numbers of hot flashes/24 hours, improving overall WHQ scores.

Limitations:

  • The study had a small sample size, with less than 30 patients.
  • There was a high number of drop-outs in EA group.

Nursing Implications:

HT is not recommended as a safe treatment for vasomotor symptoms for breast cancer survivors. Thus, the value of using that group to compare with a group that received EA is of concern. EA needs further investigation in larger sample sizes. Further research is needed for efficacy of EA in hot flash management for breast cancer survivors and in women treated with aromatase inhibitors experiencing hot flash distress, as this study did not address that phenomenon. 

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. 

doi: 10.1016/j.ctim.2014.05.006
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Study Purpose:

To explore the effects of acupressure on fatigue and other symptoms in patients with lung cancer undergoing chemotherapy

Intervention Characteristics/Basic Study Process:

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.

Sample Characteristics:

  • N = 45  
  • MEAN AGE = 58.3 years
  • MALES: 57.9%, FEMALES: 42.1%
  • KEY DISEASE CHARACTERISTICS: All had lung cancer, the majority were stage IV
  • OTHER KEY SAMPLE CHARACTERISTICS: Education level was varied with most patients having a sixth grade or less education. 70%–80% were married.

Setting:

  • SITE: Single-site    
  • SETTING TYPE: Multiple settings    
  • LOCATION: Taiwan

Phase of Care and Clinical Applications:

  • PHASE OF CARE: Active antitumor treatment

Study Design:

Three-group, sham controlled, randomized trial

Measurement Instruments/Methods:

  • Tang Fatigue Rating Scale 
  • Eastern Cooperative Oncology Group (ECOG) Performance Status rating
  • Hospital Anxiety and Depression (HADS) scale 
  • Pittsburgh Sleep Quality Index

Results:

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.

Conclusions:

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.

Limitations:

  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Key sample group differences that could influence results
  • Subject withdrawals ≥ 10%
  • Other limitations/explanation: The sham control group was significantly older than the other study groups. 21% were lost to follow-up for various reasons; no ITT analysis was described. Data were collected only 30 minutes immediately after acupressure when the patient was in the hospital, so response duration is not known. Repeated use of the same tools may have resulted in testing effect. Adherence was much lower in the control group, so actual group differences due to acupressure cannot be determined.

Nursing Implications:

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.


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