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.
Lee, E. J., & Frazier, S. K. (2011). The efficacy of acupressure for symptom management: a systematic review. Journal of Pain and Symptom Management, 42, 589–603.
To systematically review randomized, controlled trials that investigated the efficacy of acupressure for the management of symptoms.
Databases searched were CINAHL, MEDLINE, and PubMed.
Search keywords were acupressure, clinical trial, human, and/or randomized.
Studies were included in the review if
Studies were excluded from the review if they
In total, 108 references were screened.
Each experimental study was evaluated for quality using the Cochrane risk of bias (RoB) tool. Articles were evaluated for the presence of each of the six domains, and one point was assigned for each domain present. Scores ranged from zero to six, with higher values indicating higher quality and less risk for bias. All trials were evaluated by two authors, and agreement between them was 100%. A significant likelihood of bias was found in the evaluation.
Only six randomized, controlled trials included were performed to determine the efficacy of acupressure on the reduction of fatigue and improvement of sleep in adults in various populations. Fatigue and insomnia were grouped together because those investigations were typically studied simultaneously.
Patients were undergoing the active treatment phase of care.
Only three studies conducted included a measure of fatigue. Six studies concluded that acupressure was effective in improving fatigue and reducing insomnia. Multiple symptoms were discussed in topic areas; findings from other symptom reviews were not included in the summary.
The review did not provide rigorous support for the use of acupressure for the efficacy of symptom management.
Well-designed randomized, controlled trials are needed to determine the utility and efficacy of acupressure to manage various symptoms in several patient populations. Issues exist when looking at fatigue and insomnia concurrently, such as determining whether fatigue is an intervening variable for insomnia or an outcome variable of insomnia or whether insomnia is an intervening variable for fatigue. A conceptual framework is needed to guide how concurrent or symptom clusters are studied.
Ling, W., Lui, L.Y.Y., So, W.K.W., & Chan, K. (2014). Effects of acupuncture and acupressure on cancer-related fatigue: A systematic review. Oncology Nursing Forum, 41, 581–592.
PHASE OF CARE: All phases
Seven out of eight acupuncture studies showed improvement in CRF, but only four reached statistic significance. All four acupressure studies showed significant improvement. The four studies that showed improvement during initial treatment determined that results could be maintained for as many as 12 weeks. However, the maintenance study did not determine any extra benefit. Three studies reported no side effects. In other studies, adverse events were identified as minor and transient. Four studies used acupressure. These showed positive results. However, three studies were underpowered, and the comparability of study groups was questionable.
Acupuncture and acupressure may be helpful in reducing fatigue. However, because of multiple methodologic flaws in studies reviewed, no firm conclusions can be made regarding the effectiveness of these interventions.
Acupuncture and acupressure appear to be safe and may be effective. Therefore, this intervention may be suggested for patients with CRF. Additional research is needed to confirm their effectiveness.
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.
Zick, S.M., Sen, A., Wyatt, G.K., Murphy, S.L., Arnedt, J.T., & Harris, R.E. (2016). Investigation of 2 types of self-administered acupressure for persistent cancer-related fatigue in breast cancer survivors: A randomized clinical trial. JAMA Oncology, 2, 1470–1476.
To identify improvement in fatigue, sleep, and quality of life in breast cancer survivors using self-administered acupressure
Self-administered relaxing acupressure or stimulating acupressure performed once daily for three minutes for six weeks. Assessments were conducted at baseline, three weeks (to assess technique), six weeks (end of intervention), and 10 weeks (washout).
Self-administered relaxing and stimulating acupressure may improve fatigue in breast cancer survivors who have completed treatment at least 12 months ago. Relaxing acupressure may also improve sleep and quality of life in this patient group.
Self-administered relaxing and stimulating acupressure may be beneficial in the reduction of fatigue in breast cancer survivors who have completed treatment at least 12 months ago. Additional studies could be conducted with those currently receiving treatment and with patients with other cancers.