Acustimulation involves electrostimulation of acupressure points (most commonly, the P6 point) by transcutaneous, electrical stimulation through a wristband device. A wristband device currently available is the Reliefband®, a class-II device approved by the U.S. Food and Drug Administration for the treatment of chemotherapy induced nausea and vomiting (CINV). The device delivers slow, weak, electrical impulses to the P6 point via two metallic electrodes. Patients can adjust the electrical output to deliver 10-35 milliamps per pulse. Reliefband® (for the indication of CINV) requires a prescription. Acustimulation has been evaluated in CINV and fatigue.
Chao, L.F., Zhang, A.L., Liu, H.E., Cheng, M.H., Lam, H.B., & Lo, S.K. (2009). The efficacy of acupoint stimulation for the management of therapy-related adverse events in patients with breast cancer: A systematic review. Breast Cancer Research and Treatment, 118, 255–267.
To scrutinize the evidence of using acupoint stimulation (APS) by any modality on managing adverse events related to anticancer therapies in patients with breast cancer
English databases searched were PubMed, Cochrane library, Embase, the Cumulative Index to Nursing and Allied Health, and PsycINFO.
Chinese databases searched were CNKI, CEPS, and WanFang as well as manual searching.
Search keywords were medical terms of breast cancer (e.g., breast neoplasm, breast carcinoma, breast tumor) combined separately with at least one of the following: acupuncture, acupressure, auricular acupuncture, ear acupuncture, acupuncture points, electroacupuncture, acupoint, transcutaneous electric nerve stimulation, moxibustion.
Studies were included if they
Studies were excluded if they were
Initial review involved 843 titles and abstracts and 51 full-text articles. Of those, 26 studies were included in the report.
Study evaluation began with two independent reviewers using a modified Jadad scale, assessing 3 aspects: randomization procedure (2 points); dropout and withdrawal discussion (1 point); and blinding (2 points). Studies were classified as high quality if they attained a score of 3 or higher.
Evaluated literature included 18 randomized controlled trials (RCTs) and eight controlled clinical trials published between 1999 and 2008. Nine trials included conventional acupuncture, 6 included electroacupuncture, 5 included drug injection in acupoints, 3 included self-acupressure, and 3 included acupoint stimulation by wristbands or acumagnet. Eighteen were in English, and 8 were in Chinese.
Nine of the 26 studies were rated as high quality. Adverse effects (outcomes) of the APS included vasomotor syndrome, chemotherapy-induced nausea and vomiting (CINV), post-mastectomy pain, joint symptoms, lymphedema, leukopenia, and adverse events.
Eleven studies investigated CINV and APS with acupoints P6 and ST36. Ten of the CINV studies reported APS significantly improved emesis caused by breast cancer therapy.
The most common outcome evaluated by APS in the studies was CINV. APS was noted to be effective in reducing acute emesis caused by breast cancer therapy. Authors reported that APS is beneficial in the management of CINV, especially in the acute phase.
Healthcare providers should consider using APS as an option for the management of CINV.
Roscoe, J.A., Matteson, S.E., Morrow, G.R., Hickok, J.T., Bushunow, P., Griggs, J., … Smith, J. (2005). Acustimulation wrist bands are not effective for the control of chemotherapy-induced nausea in women with breast cancer. Journal of Pain and Symptom Management, 29, 376-384.
Patients receiving doxorubicin and cyclophosphamide were randomized to one of three arms.
Participants were told to wear the assigned band and adjust the acustimulation dial to increase or decrease the acustimulation; they could wear the band as frequently as desired over five days.
All participants were treated at outpatient centers at one of four Rochester, NY, area cancer centers.
The study design was a randomized, three-arm trial.
No significant differences were found in any study measures among the three treatment conditions.
The study does not support the use of acustimulation bands as an adjunct to antiemetics in female patients with breast cancer.
Roscoe, J.A., Morrow, G.R., Hickok, J.T., Bushunow, P., Pierce, I., Flynn, P.J., … Atkins, J.N. (2003). The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting: A University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. Journal of Pain and Symptom Management, 26, 731-740.
Patients were randomized to one of three study groups.
The intervention or lack of intervention was used in combination with standard antiemetics for chemotherapy-induced nausea and vomiting.
Patients wore devices (if any) continuously for five days, and those in the acustimulation band group could adjust the intensity of stimulation.
The study was conducted at outpatient clinics at 17 geographically diverse member sites of the University of Rochester Clinical Oncology Program.
The study design was a randomized controlled trial.
A possible placebo effect existed.
Roscoe, J.A., Morrow, G.R., Matteson, S., Bushunow, P., & Tian, L. (2002). Acustimulation wristbands for the relief of chemotherapy-induced nausea. Alternative Therapies, 8 (4), 56-63.
This randomized controlled trial used a three-level crossover design (active acustimulation, sham acustimulation, and no acustimulation). All patients received standard antiemetics ordered by the physician. Patients wore a wristband before chemotherapy and as needed. Patients could adjust the stimulation intensity.
The study was conducted at three outpatient oncology clinics in the northeastern United States.
The study was a randomized clinical trial using a three-level crossover design (active acustimulation, sham acustimulation, and no acustimulation).
No statistical differences in average severity of nausea were observed between the interventions. A nearly significant difference was found in the severity of delayed nausea reported during active acustimulation compared to no acustimulation.
Findings were positive but not conclusive.
Caution should be used in patients with pacemakers.
Shen, Y., Liu, L., Chiang, J.S., Meng, Z., Garcia, M.K., Chen, Z., . . . Cohen, L. (2014). Randomized, placebo-controlled trial of K1 acupoint acustimulation to prevent cisplatin-induced or oxaliplatin-induced nausea. Cancer, 121, 84–92.
To examine the effects of electrostimulation at the K1 acupoint located on the sole of the foot on chemotherapy-induced nausea and vomiting (CINV)
After institutional review board approval, 103 patients with metastatic liver cancer undergoing transcatheter arterial infusions (TAIs) of cisplatin or oxaliplatin were recruited and randomized to group A (tropisetron and electroacustimulation at the K1 acupoint) or B (tropisetron and electrostimulation at a placebo point on the heel). The treatment in both groups lasted for 20 minutes one to two hours before TAI on day 1 and then daily (7 am–9 am) for the subsequent five days. The baseline rate, intensity, and duration of CINV were collected for five days after TAI. Quality of life was assessed daily.
Double-blinded, randomized, placebo-controlled, longitudinal clinical trial
No differences were found between groups A and B in regard to the incidence and degree of nausea or vomiting at any time point. Patients in group A had better EuroQoL scores than patients in group B (72.83 versus 65.94, p = 5.04) on day 4 but not other days. No group differences were noted at any time point for MASI scores.
Noninvasive electrostimulation of the K1 point combined with tropisetron had no effect on cisplatin-induced or oxaliplatin-induced nausea or vomiting.
Patients receiving chemotherapy experience CINV frequently with highly emetogenic regimens. Complementary therapies might be helpful in reducing this side effect. Instructing patients to refer to their physicians before trying a new intervention is advisable.
Treish, I., Shord, S., Valgus, J., Harvey, D., Nagy, J., Stegal, J., & Lindley, C. (2003). Randomized double-blind study of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy. Supportive Care in Cancer, 11, 516-521.
Adult cancer patients receiving moderately emetogenic chemotherapy (MEC) or highly emetogenic chemotherapy (HEC) were randomized to receive the active ReliefBand® or an inactive device. All patients received scheduled and as-needed antiemetics. Patients wore devices continuously for five days, except during showering and hand washing.
All participants in this single-site study were inpatients at the University of North Carolina Hospitals.
The study design was a randomized, prospective, double-blind, placebo-controlled trial.
Patients wearing the ReliefBand experienced less vomiting, retching, and nausea severity over the five-day period than patients wearing the inactive device. Vomiting was statistically and significantly reduced during the delayed period, and nausea was significantly reduced during the acute and delayed periods. Functional Living Index Emesis scores did not differ between the two groups.