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Michel-Cherqui M, Ma S, Bacrie J, Huguet S, Lemaire N, Le Guen M, Fischler M. Auriculotherapy and acupuncture treatments for chemotherapy-induced nausea and vomiting: a multicenter clinical trial. Support Care Cancer 2024; 32:560. [PMID: 39085664 DOI: 10.1007/s00520-024-08768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 07/25/2024] [Indexed: 08/02/2024]
Abstract
PURPOSE Nausea and vomiting complicating chemotherapy (CINV) remain side effects despite preventive and curative treatments. We hypothesize that acupuncture (ACU), auriculotherapy (AUR), and their combination (ACU-AUR), could decrease, compared to usual treatment (UT), the intensity of acute nausea in patients already treated according to the antiemetic guidelines and presenting nausea with or without vomiting in the earlier cycle. METHODS In this multicenter study, patients were treated just before chemotherapy according to randomization. ACU consisted of implanting bilaterally on each forearm, one semi-permanent needle at point P6. AUR consisted of implanting bilaterally on each pavilion of the ear, one semi-permanent needle at point O. All patients received systematic preventive drug treatment according to antiemetic guidelines. Main outcome was intensity of nausea at 24 h after chemotherapy using a numeric scale ranging from 0 (no nausea) to 10 (maximum symptoms). RESULTS One hundred and fifteen patients were included. Baseline characteristics were similar between groups at inclusion. Intensity of nausea at 24 h after chemotherapy, was statistically different between the groups (covariance intergroup analysis, p = 0.005) and was significantly lower for the all-treatment groups vs UT group (p = 0.007 for AUR, p = 0.008 for ACU, and p = 0.0009 for AUR-ACU). AUR-ACU also decreased intensity of delayed nausea when compared to UT (p = 0.023). AUR, ACU and AUR-ACU had no effect on acute and delayed vomiting episodes. No serious adverse event due to the studied treatments was reported in our study. CONCLUSION AUR or ACU reduce intensity of acute and delayed nausea in patients treated by optimal antiemetic treatment. TRIAL REGISTRATION NUMBER CLINICALTRIALS gov identifier NCT02767791, registered on May 10, 2016.
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Affiliation(s)
- Mireille Michel-Cherqui
- Department of Anesthesiology and of Pain Management, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Sabrina Ma
- Department of Anesthesiology and of Pain Management, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
| | - Joy Bacrie
- Department of Medical Oncology, Curie Institute - Hospital Rene Huguenin, 92210, Saint-Cloud, France
| | - Sophie Huguet
- Supportive Care Department, Hôpital Emmanuel Rain, 95500, Gonesse, France
| | | | - Morgan Le Guen
- Department of Anesthesiology and of Pain Management, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France
- University of Versailles SQY-Paris Saclay, 78180, Montigny-Le-Bretonneux, France
| | - Marc Fischler
- Department of Anesthesiology and of Pain Management, Hôpital Foch, 40 Rue Worth, 92150, Suresnes, France.
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Tan MY, Mo CY, Zhao Q. Research hotspots and trends on acupuncture therapy on vomiting from 1990 to 2022: A bibliometric analysis. Complement Ther Med 2023; 76:102962. [PMID: 37406969 DOI: 10.1016/j.ctim.2023.102962] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 06/23/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVES Acupuncture treatment (AT) is commonly utilized for vomiting; however, limited bibliometric analyses exist in this area. Employing a bibliometric approach, we conducted a comprehensive review spanning three decades to assess the research landscape, advancements, and emerging trends in AT for vomiting. METHODS We collected the related literature data from the Web of Science Core Collection (WOSCC) from 1990 to 2022. VOSviewer and R studio were used to perform the bibliometric analysis of AT on vomiting. The status of authors, countries, affiliations, annual publications, keywords, and journals were analyzed accordingly. RESULTS The earliest relevant paper was published in 1990. Streitberger, K was the most productive author (7 records) and had significant influence (225 reference times, H-Index = 7). The United States had the highest publication count (224 records) and received the most recognition (9719 reference times, H-Index = 52). MEDICINE had the highest number of outputs (34 records), while ANESTHESIA AND ANALGESIA was the most cited journal (1045 reference times). The institution with the most works was Chengdu University of Traditional Chinese Medicine (CDUTCM) (13 records), and the University of California, Los Angeles received the most citations (1252 reference times). Recent and future research hotspots included AT for postoperative vomiting and post-chemotherapy vomiting. Systematic reviews and meta-analyses were the predominant study types. CONCLUSIONS The current status and development prospects of AT for vomiting are shown in this study. In addition, this article provides valuable ideas and potential directions for future research activities.
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Affiliation(s)
- Mo-Yao Tan
- Chengdu First People's Hospital, Chengdu, Sichuan, China
| | - Chao-Yue Mo
- College of Life and Science, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Qian Zhao
- Chengdu First People's Hospital, Chengdu, Sichuan, China.
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Xiao C, Qin M, Xia H, Xing Q, Wang D, Qian W. Effects of PC6 acupressure on acute and delayed nausea and vomiting induced by chemotherapy in patients with malignant neoplasm: a meta-analysis. Support Care Cancer 2023; 31:510. [PMID: 37548707 DOI: 10.1007/s00520-023-07976-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVE Evaluating the intervention effect of PC6 acupressure on chemotherapy-induced acute, delayed nausea, and vomiting in malignant tumor patients. METHOD Eleven databases had been retrieved from January 2010 through January 2022. The published meta-analysis literature was hand-searched, and the language was limited to English and Chinese. The protocol of this meta-analysis was registered with PROSPERO (registration number: CRD42022323693). Two reviewers independently selected relevant eligible articles, extracted data, and evaluated the risk of bias. Meta-analysis was statistically analyzed using software RevMan 5.3. RESULT Ten randomized controlled trials with 975 patients were included. Only two studies were assessed as high quality; eight studies were evaluated as moderate. Meta-analysis showed that compared with the control group, PC6 acupressure reduced the occurrence number of acute (SMD = -0.39,95CI (-0.73, -0.05) P = 0.02), delayed (SMD = -0.51, 95% CI (-0.96, -0.05) P = 0.03) nausea and acute (SMD = -0.42,95% CI (-0.79, -0.06) P = 0.02), delayed (SMD = -0.37, 95% CI (-0.77, 0.03) P = 0.07) vomiting; it reduced the severity of acute (SMD = -0.34, 95% CI (-0.57, -0.11) P = 0.004), delayed (SMD = -0.79, 95% CI (-1.33, -0.25) P = 0.004) nausea and acute (SMD = -0.51, 95% CI (-0.79, -0.23) P = 0.0004), delayed (SMD = -0.50, 95% CI (-0.84, -0.17) P = 0.003) vomiting, while it did not reduced the experience time on acute and delayed CINV. CONCLUSION The meta-analysis shows the effectiveness of PC6 acupressure in preventing and treating nausea and vomiting. Large, high-quality, well-designed randomized controlled trials are needed in the future to determine the efficacy of PC6 acupressure on chemotherapy-induced nausea and vomiting.
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Affiliation(s)
| | - Ming Qin
- Xuzhou Medical University, Xuzhou, JiangSu, China
| | - Huiling Xia
- Xuzhou Medical University, Xuzhou, JiangSu, China
| | - Qianqian Xing
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, JiangSu, China
| | - Dan Wang
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, JiangSu, China
| | - Weiwei Qian
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, JiangSu, China.
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Abstract
Among the side effects of anticancer treatment, chemotherapy-induced nausea and vomiting (CINV) is one of the most feared given its high prevalence, affecting up to 40% of patients. It can impair patient’s quality of life and provoke low adherence to cancer treatment or chemotherapy dose reductions that can comprise treatment efficacy. Suffering CINV depends on factors related to the intrinsic emetogenicity of antineoplastic drugs and on patient characteristics. CINV can appear at different times regarding the administration of antitumor treatment and the variability of risk according to the different antitumor regimens has, as a consequence, the need for a different and adapted antiemetic treatment prophylaxis to achieve the desired objective of complete protection of the patient in the acute phase, in the late phase and in the global phase of emesis. As a basis for the recommendations, the level of emetogenicity of anticancer treatment is considered and they are classified as high, moderate, low and minimal emetogenicity and these recommendations are based on the use of antiemetic drugs with a high therapeutic index: anti 5-HT, anti-NK and steroids. Despite having highly effective treatments, clinical reality shows that they are not applied enough, so evidence-based recommendations are needed to show the best options and help in decision-making. To cover all the antiemetic prophylaxis options, we have also included recommendations for oral treatments, multiday regimens and radiation-induced emesis prevention.
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Acupuncture Effects on Cerebral Blood Flow during Normoxia and Normobaric Hypoxia: Results from a Prospective Crossover Pilot Study. TECHNOLOGIES 2021. [DOI: 10.3390/technologies9040102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cerebral blood flow (CBF) is significantly influenced by exposure to hypoxia, both hypobaric and normobaric. Alterations in cerebral blood flow can play a crucial role in the pathogenesis of acute mountain sickness (AMS) and its symptoms, especially headache, dizziness, and nausea. Acupuncture has been proven to be effective in treating some cerebrovascular disorders and PC6 Nei Guan stimulation seems to enhance cerebral blood flow. Therefore, we have hypothesized that PC6 Nei Guan stimulation could affect CBF in acute hypoxia and could be used to contrast AMS symptoms. We evaluated blood flow in the middle cerebral artery (MCA) in normoxia, after 15 min in normobaric hypoxia (fraction of inspired oxygen (FiO2) 14%, corresponding to 3600 m a.s.l.) in basal conditions, and after PC6 Nei Guan stimulation, both by needle and by pressure. No comparisons with other acupuncture points and sham acupuncture were done. PC6 stimulation seemed to counteract the effects of acute normobaric hypoxia on end-diastolic velocity (EDV) in MCA, especially after acupuncture, and significantly reduced systolic and diastolic blood pressure. A rebalance of CBF could control some AMS symptoms, but further studies are necessary.
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Diep C, Karibe H, Goddard G, Phan Y, Shubov A. Acupuncture and Transcutaneous Electrical Acupoint Stimulation Do Not Suppress Gag Reflex. Med Acupunct 2021; 33:353-357. [PMID: 35003504 DOI: 10.1089/acu.2021.0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Objective: Gagging is a problem for many dental patients, as well as patients undergoing medical procedures, such as intubation. Research to date on the gag reflex has been limited by a lack of objective measures for measuring this reflex. Materials and Methods: A validated quantitative method was used to measure if acupuncture or transcutaneous electrical acupoint stimulation (TEAS) at Pericardium 6 (PC 6) and Stomach 36 (ST 36) suppressed the gag reflex, compared with a sham placebo. The subjects were 60 healthy adults randomly chosen to receive acupuncture, TEAS, or sham-TEAS on PC 6, located on the forearm, and ST 36, located on the lower leg. The gag reflex was measured by inserting a saliva ejector slowly down each participant's throat to determine the maximum tolerance of the gag reflex; the insertion length was used as an index of this reflex. Results: There was a significant difference in pre- and postintervention insertion lengths in all groups (paired t-test; all groups; P < 0.001). The differences in the insertion length among the groups (P = 0.76) and the interaction effect (group × time) were not significant (P = 0.79; 2-way analysis of variance). Conclusions: This study suggested that PC 6 and ST 36 stimulation was no different than placebo for alleviating the gag reflex.
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Affiliation(s)
- Cynthia Diep
- University of California-Los Angeles, Los Angeles, CA, USA
| | - Hiroyuki Karibe
- Department of Pediatric Dentistry, Nippon Dental University, Tokyo, Japan
| | - Greg Goddard
- University of California System, San Francisco, CA, USA
| | - Yen Phan
- University of California-Los Angeles, Los Angeles, CA, USA
| | - Andrew Shubov
- University of California-Los Angeles, Los Angeles, CA, USA
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Emami-Sahebi A, Elyasi F, Yazdani-Charati J, Zamaniyan M, Rahmani Z, Shahhosseini Z. The effects of individual cognitive behavior therapy on nausea and vomiting of pregnancy: A quasi-experimental study. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Saadatnia S, Tiznobaik A, Saber A. The effects of psychological counseling and acupressure based on couple therapy procedure for alleviation of vomiting and nausea in pregnant women in Iran country. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 19:423-427. [PMID: 33962493 DOI: 10.1515/jcim-2020-0308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 02/17/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Nausea and vomiting have psychological negative effects on some pregnant women during gestation. Different strategies have been used for the treatment of nausea and vomiting during pregnancy, such as acupressure and psychological interventions. This study was conducted to evaluate the effects of psychological counseling and acupressure based on couple therapy procedures on vomiting and nausea in pregnant women in Iran. METHODS Two hundred and eight women were divided into four groups (n=52): 1) they did not any intervention (control group), 2) they received the psychological intervention, 3) they received acupressure intervention, and 4) they received a combination of psychological + acupressure interventions. To investigate the effects of interventions on nausea and vomiting, the Rhodes index of nausea, vomiting and retching were used. The counseling period has lasted for 4 weeks. The pressure intervention on the site was conducted in clockwise form for 1 min and anticlockwise form for another 1 min. RESULTS Groups did not have a significant difference for abortion and income (p>0.05). The effects of counseling, and acupressure interventions on severity and period of vomiting and nausea were not significant (p>0.05), but the intervention based on counseling and acupressure decreased severity of vomiting and nausea (p<0.05). CONCLUSIONS The intervention based on counseling and acupressure could not reduce nausea and vomiting during the gestation, but the intervention based on a combination of both decreased nausea and vomiting. It can be suggested to apply an intervention based on a combination of counseling and acupressure in short-time period for decreasing nausea and vomiting in women during pregnancy.
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Affiliation(s)
- Sahar Saadatnia
- Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Azita Tiznobaik
- Department of Midwifery, Maternity and Child Care Research Center, Faculty of Nursing and Midwifery, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Saber
- Department of Nutritional Sciences, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Malec M, Shega JW. Management of Gastrointestinal Symptoms (Nausea, Anorexia and Cachexia, Constipation) in Advanced Illness. Med Clin North Am 2020; 104:439-454. [PMID: 32312408 DOI: 10.1016/j.mcna.2019.12.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Anorexia and cachexia, nausea and vomiting, and constipation are gastrointestinal symptoms that commonly accompany serious illness. Basic science and clinical research continue to improve the understanding of their pathophysiology. Thorough assessment necessitates history, physical examination, and laboratory and diagnostic testing. Pharmacologic management attempts to counteract or reverse the underlying pathophysiologic mechanisms that accompany each symptom, which may benefit from a multimodal approach to achieve adequate control. Future improvements in management require investments in clinical research to determine the efficacy of novel agents along with comparator studies to better understand which treatments should be used in what sequence or combination.
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Affiliation(s)
- Monica Malec
- Section of Geriatrics and Palliative Medicine, Department of Medicine, University of Chicago, 5841 South Maryland Avenue (MC 6098), Chicago, IL 60637, USA
| | - Joseph W Shega
- Vitas Healthcare, Miami, FL, USA; University of Central Florida, Orlando, FL, USA.
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Tan HS, Habib AS. The optimum management of nausea and vomiting during and after cesarean delivery. Best Pract Res Clin Anaesthesiol 2020; 34:735-747. [PMID: 33288123 DOI: 10.1016/j.bpa.2020.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 12/28/2022]
Abstract
Intraoperative and postoperative nausea and vomiting (IONV and PONV) afflict up to 80% of parturients undergoing cesarean delivery with neuraxial anesthesia. Preventing nausea and emesis is a top priority for women undergoing cesarean delivery and is included in the quality of recovery measures and enhanced recovery after cesarean delivery protocols. The majority of known perioperative emetic triggers can be avoided or mitigated by optimizing anesthetic and surgical management. IONV may arise from spinal anesthesia-induced hypotension, intraoperative pain, and medications such as uterotonics and antibiotics. Furthermore, uterine exteriorization and peritoneal irrigation increase IONV risk. Conversely, preventing PONV mainly focuses on optimizing analgesia through an opioid-sparing, multimodal strategy. In addition, combination prophylactic antiemetic therapy should be instituted in this high-risk population to further reduce the risk of IONV and PONV.
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Affiliation(s)
- Hon Sen Tan
- Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA
| | - Ashraf S Habib
- Department of Anesthesiology, Division of Women's Anesthesia, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA.
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Abstract
The relevance of functional gastrointestinal (GI) disorders and their impact on quality of life for many patients has become an increasingly important topic in gastroenterology. A gastroenterologist can expect to see 40% of patients for motility and functional GI disorders, thus highlighting the necessity for physicians to have a strong foundation of knowledge in treatment strategies for these patients with complex disorders. A significant number of patients who suffer with functional GI disorders turn to complementary and alternative therapies to maintain control over their symptoms and often are happy with therapeutic results. This narrative presents information and treatment algorithms for the gastroenterologist to better understand and use some of the most common complementary and alternative therapies for patients with functional dyspepsia, nausea and vomiting, and irritable bowel syndrome.
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Tara F, Bahrami-Taghanaki H, Amini Ghalandarabad M, Zand-Kargar Z, Azizi H, Esmaily H, Azizi H. The Effect of Acupressure on the Severity of Nausea, Vomiting, and Retching in Pregnant Women: A Randomized Controlled Trial. Complement Med Res 2020; 27:252-259. [PMID: 32018274 DOI: 10.1159/000505637] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 12/24/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Nausea and vomiting are common problems during pregnancy. Previous studies have shown that stimulation at Neiguan (PC6) acupoint can be effective in controlling pregnancy-induced nausea and vomiting. However, more evidence is required for approving this method on controlling pregnancy-induced nausea and vomiting. The aim of this study was to determine the efficacy of PC6 acupoint pressure stimulation on the severity of nausea, vomiting, and retching in pregnant women. METHOD This randomized, multi-center clinical trial was conducted on pregnant women referring to Health Centers and Ommolbanin Hospital in Mashhad, Iran, during December 2016 to September 2017. Women with first singleton pregnancy and below 12 weeks were included. Patients were randomly allocated into three groups of (1) PC6 pressure (4 times a day, for 10 min), (2) sham acupressure, and (3) medication with vitamin B6 and metoclopramide. Assessment of severity of nausea, vomiting, and retching was done based on the Rhodes Index on the first and fifth day (before and after the intervention). Pearson chi-square test, one-way ANOVA, Kruskal-Wallis, and Wilcoxon tests were used for statistical analysis using SPSS version 18. This clinical trial was registered at the Iranian Registry of Clinical Trials (IRCT) with the code IRCT201512187265N6. RESULTS Ninety patients with a mean age of 26.40 ± 4.73 years were studied in 3 groups of 30. There was no significant difference between the 3 groups in terms of the severity outcomes before the intervention, while, after the intervention, the three groups were significantly different on the fifth day in terms of vomiting frequency, distress from retching, distress from vomiting, duration of nausea, distress from nausea, amount of vomiting, frequency of nausea, and frequency of retching (p < 0.001 for each outcome). According to the linear regression analysis, the correlation between occupation with vomiting frequency (beta coefficient = 0.252) and nausea severity (beta coefficient = -0.213) was statistically significant. CONCLUSION It seems that PC6 acupoint pressure can reduce the severity of nausea, vomiting, and retching in pregnant women.
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Affiliation(s)
- Fatemeh Tara
- Department of Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamidreza Bahrami-Taghanaki
- Department of Chinese and Complementary Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | | | | | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoda Azizi
- Department of Chinese and Complementary Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran,
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Galeshi M, Ghanbarpour A, Naeimi Rad M, Asghari S. A comparison of the effect of pressure on the KID21 (Youmen) and P6 (Neiguan) points on the severity of nausea and vomiting of pregnancy. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:/j/jcim.ahead-of-print/jcim-2019-0035/jcim-2019-0035.xml. [PMID: 31971914 DOI: 10.1515/jcim-2019-0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/18/2019] [Indexed: 11/15/2022]
Abstract
Background Nausea and vomiting of pregnancy (NVP) is the most common problem for women in early pregnancy. The present study was conducted to compare the effect of pressure on KID21 and P6 on the severity of NVP. Methods This single-blind clinical trial was conducted on pregnant women in their first trimester with NVP, referring to the clinic of Ayatollah Rouhani Hospital of Babol, Iran, in 2017. Eighty-two participants were randomly divided into KID21 and P6 pressure groups. The researcher applied pressure on these two points 20 min each day for four consecutive days. The severity of nausea and vomiting was then assessed using the visual analog scale (VAS) by the patient and counting its frequency in 24 h, respectively. Finally, the collected data were analyzed using SPSS 22 by repeated measures ANOVA and paired sample T-Test. Results The severity of NVP in the 82 participating pregnant women decreased in both groups (p<0.001), and there was no significant difference between the two groups in terms of the severity of NVP (p=0.68), although the reduction in nausea was greater in the P6 group than KID21 group, and the reduction in vomiting was greater in the KID21 group than the P6 group. Effect size for vomiting and nausea was 0.28 and 0.16, respectively. No side-effects were observed in the two groups during these four days. Conclusions Pressure on P6 and KID21 points has no advantage over each other in the treatment of NVP, but acupressure is an effective, complication-free, inexpensive and accessible treatment for this complication.
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Affiliation(s)
- Mina Galeshi
- Clinical Research Development Unit of Rouhani Hospital, Master of Science, Babol University of Medical Sciences, Babol, Iran
| | - Azita Ghanbarpour
- Infertility and Reproductive Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.,Department of Gynecology and Obstetrics, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| | - Mojgan Naeimi Rad
- Clinical Research Development Unit of Rouhani Hospital, Master of Science, Babol University of Medical Sciences, Babol, Iran
| | - Shokat Asghari
- Basic of Science, Rouhani Hospital, Babol University of Medical Science, Babol, Iran
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Eachempati P, Kumbargere Nagraj S, Kiran Kumar Krishanappa S, George RP, Soe HHK, Karanth L. Management of gag reflex for patients undergoing dental treatment. Cochrane Database Syst Rev 2019; 2019:CD011116. [PMID: 31721146 PMCID: PMC6953338 DOI: 10.1002/14651858.cd011116.pub3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The gag reflex is an involuntary defence mechanism to protect the pharynx and throat from foreign objects. Gagging is a common problem encountered during dental treatment, making therapeutic procedures distressing and often difficult or even impossible to perform. Various interventions can be used to control the gag reflex: anti-nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behavioural therapies, acupressure, acupuncture, laser, and prosthetic devices. This is an update of the Cochrane Review first published in 2015. OBJECTIVES To assess the effects of pharmacological and non-pharmacological interventions for the management of gagging in people undergoing dental treatment. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the Cochrane Oral Health's Trials Register (to 18 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 2) in the Cochrane Library (searched 18 March 2019), MEDLINE Ovid (1946 to 18 March 2019), Embase Ovid (1980 to 18 March 2019), CINAHL EBSCO (1937 to 18 March 2019), AMED Ovid (1985 to 18 March 2019), and the proceedings of the International Association for Dental Research (IADR) online (2001 to 18 March 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. We also conducted forwards citation searching on the included studies via Google Scholar. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We included randomised controlled trials (RCTs), involving people who were given a pharmacological or non-pharmacological intervention to manage gagging that interfered with dental treatment. We excluded quasi-RCTs. We excluded trials with participants who had central or peripheral nervous system disorders, who had oral lesions or were on systemic medications that might affect the gag sensation, or had undergone surgery which might alter anatomy permanently. DATA COLLECTION AND ANALYSIS We independently selected trials, extracted data, and assessed risk of bias. We followed Cochrane's statistical guidelines. We assessed the overall certainty of the evidence using GRADE. MAIN RESULTS We included four trials at unclear risk of bias with 328 participants (263 adults and 65 children who were four years or older), in which one trial compared acupuncture and acupressure (with thumb, device and sea band) at P6 (point located three-finger breadths below the wrist on the inner forearm in between the two tendons) to sham acupuncture and acupressure with and without sedation. One trial compared acupuncture at P6 point to sham acupuncture. These trials reported both completion of dental procedure and reduction in gagging (assessor and patient reported) as their outcomes. One cross-over and one split-mouth trial studied the effect of laser at P6 point compared to control. One trial reported reduction in gagging and another reported presence or absence of gagging during dental procedure. Acupuncture at P6 showed uncertain evidence regarding the successful completion of dental procedure (RR 1.78, 95% CI 1.05 to 3.01; two trials, 59 participants; very low-certainty evidence) and uncertain evidence regarding the reduction in gagging (RR 2.57, 95% CI 1.12 to 5.89; one trial, 26 participants; very low-certainty evidence) in comparison to sham acupuncture. Acupuncture at P6 with sedation did not show any difference when compared to sham acupuncture with sedation (RR 1.08, 95% CI 0.91 to 1.28; one trial, 34 participants; very low-certainty evidence). Acupressure using thumb pressure with or without sedation showed no clear difference in completing dental procedure (RR 0.96, 95% CI 0.84 to 1.10; one trial, 39 participants; very low-certainty evidence; and RR 0.85, 95% CI 0.50 to 1.46; one trial, 30 participants; very low-certainty evidence; respectively), or reduction in gagging (RR 1.06, 95% CI 0.92 to 1.23; one trial, 39 participants; very low-certainty evidence; and RR 0.92, 95% CI 0.60 to 1.41; one trial, 30 participants; very low-certainty evidence; respectively) when compared to sham acupressure with or without sedation. Acupressure at P6 with device showed uncertain evidence regarding the successful completion of dental procedure (RR 2.63, 95% CI 1.33 to 5.18; one trial, 34 participants; very low-certainty evidence) and uncertain evidence regarding the reduction in gagging (RR 3.94, 95% CI 1.63 to 9.53; one trial, 34 participants; very low-certainty evidence) when compared to sham acupressure. However, device combined with sedation showed no difference for either outcome (RR 1.16, 95% CI 0.90 to 1.48; one trial, 27 participants; very low-certainty evidence; and RR 1.26, 95% CI 0.93 to 1.69; one trial, 27 participants; very low-certainty evidence; respectively). Acupressure using a sea band with or without sedation showed no clear difference in completing dental procedure (RR 0.88, 95% CI 0.67 to 1.17; one trial, 21 participants; very low-certainty evidence; and RR 1.80, 95% CI 0.63 to 5.16; one trial, 19 participants; very low-certainty evidence; respectively), or reduction in gagging (RR 0.88, 95% CI 0.67 to 1.17; one trial, 21 participants; very low-certainty evidence; and RR 2.70, 95% CI 0.72 to 10.14; one trial, 19 participants; very low-certainty evidence; respectively) when compared to sham acupressure with or without sedation. Laser at P6 showed a difference in absence of gagging (odds ratio (OR) 86.33, 95% CI 29.41 to 253.45; one trial, 40 participants; very low-certainty evidence) and reduction in gagging (MD 1.80, 95% CI 1.53 to 2.07; one trial, 25 participants; very low-certainty evidence) during dental procedure when compared to dummy laser application. No noteworthy adverse effects were reported. For acupuncture at P6, the trial authors were unsure whether the reported adverse effects were due to participant anxiety or due to the intervention. None of the trials on acupressure or laser reported on this outcome. We did not find trials evaluating any other interventions used to manage gagging in people undergoing dental treatment. AUTHORS' CONCLUSIONS We found very low-certainty evidence from four trials that was insufficient to conclude if there is any benefit of acupuncture, acupressure or laser at P6 point in reducing gagging and allowing successful completion of dental procedures. We did not find any evidence on any other interventions for managing the gag reflex during dental treatment. More well-designed and well-reported trials evaluating different interventions are needed.
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Affiliation(s)
- Prashanti Eachempati
- Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Department of Prosthodontics, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
| | - Sumanth Kumbargere Nagraj
- Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Manipal, Department of Oral Medicine and Oral Radiology, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
| | - Salian Kiran Kumar Krishanappa
- Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Department of Prosthodontics, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
| | - Renjith P George
- Faculty of Dentistry, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Department of Oral Pathology, Jalan Batu Hampar, Bukit Baru, Melaka, Melaka, Malaysia, 75150
| | - Htoo Htoo Kyaw Soe
- Faculty of Medicine, Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Department of Community Medicine, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
| | - Laxminarayan Karanth
- Melaka-Manipal Medical College, Manipal Academy of Higher Education (MAHE), Department of Obstetrics and Gynaecology, Bukit Baru, Jalan Batu, Hampar, Melaka, Malaysia, 75150
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15
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Bao T, Deng G, DeMarzo LA, Zhi WI, DeRito JL, Blinder V, Chen C, Li QS, Green J, Pendleton E, Mao JJ. A Technology-Assisted, Brief Mind-Body Intervention to Improve the Waiting Room Experience for Chemotherapy Patients: Randomized Quality Improvement Study. JMIR Cancer 2019; 5:e13217. [PMID: 31697238 PMCID: PMC6873148 DOI: 10.2196/13217] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 06/21/2019] [Accepted: 07/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Patients waiting for chemotherapy can experience stress, anxiety, nausea, and pain. Acupressure and meditation have been shown to control such symptoms. Objective This study aimed to evaluate the feasibility and effectiveness of an integrative medicine app to educate patients about these self-care tools in chemotherapy waiting rooms. Methods We screened and enrolled cancer patients in chemotherapy waiting rooms at two Memorial Sloan Kettering Cancer Center locations. Patients were randomly assigned into an intervention arm in which subjects watched acupressure and meditation instructional videos or a control arm in which they watched a time- and attention-matched integrative oncology lecture video. Before and after watching the videos, we asked the patients to rate four key symptoms: stress, anxiety, nausea, and pain. We performed the analysis of covariance to detect differences between the two arms postintervention while controlling for baseline symptoms. Results A total of 223 patients were enrolled in the study: 113 patients were enrolled in the intervention arm and 110 patients were enrolled in the control arm. In both groups, patients showed significant reductions in stress and anxiety from baseline (all P<.05), with the treatment arm reporting greater stress and anxiety reduction than the control arm (1.64 vs 1.15 in stress reduction; P=.01 and 1.39 vs 0.78 in anxiety reduction; P=.002). The majority of patients reported that the videos helped them pass time and that they would watch the videos again. Conclusions An integrative medicine self-care app in the waiting room improved patients’ experiences and reduced anxiety and stress. Future research could focus on expanding this platform to other settings to improve patients’ overall treatment experiences.
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Affiliation(s)
- Ting Bao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Gary Deng
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Lauren A DeMarzo
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - W Iris Zhi
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Janice L DeRito
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Victoria Blinder
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Connie Chen
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Qing S Li
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jamie Green
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Eva Pendleton
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Jun J Mao
- Integrative Medicine Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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16
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Baek JY, Trinh TA, Huh W, Song JH, Kim HY, Lim J, Kim J, Choi HJ, Kim TH, Kang KS. Electro-Acupuncture Alleviates Cisplatin-Induced Anorexia in Rats by Modulating Ghrelin and Monoamine Neurotransmitters. Biomolecules 2019; 9:biom9100624. [PMID: 31635295 PMCID: PMC6843597 DOI: 10.3390/biom9100624] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/08/2019] [Accepted: 10/15/2019] [Indexed: 01/31/2023] Open
Abstract
Anorexia is common in patients with cancer, mostly as a side effect of chemotherapy. The effect of electro-acupuncture (EA) on ameliorating cancer-related symptoms have been studied in animal models and in clinical trials. The aim of this study was to determine optimal conditions for the application of EA to alleviate anorexia, followed by the study of molecular mechanisms affecting its therapeutics. Anorexia was induced in male Wistar rats by injecting cisplatin, which was then followed by EA treatment at CV12, the acupuncture point located in the center of the abdominal midline. Body weight and food intake were measured daily throughout the duration of the study. The levels of monoamine neurotransmitters in the plasma were quantitatively analyzed by HPLC-ECD. Gastrointestinal hormone concentrations were elucidated with ELISA kits. RT-qPCR was performed to evaluate the mRNA expression of ghrelin (GHRL), neuropeptide Y (NPY), and pro-opiomelanocortin. The expression of c-Fos in the nucleus tractus solitarii was detected using western blotting analysis. The optimal conditions of EA to alleviate anorexia in rats was determined to be 1 unit for intensity and 10 Hz for frequency. EA treatment at CV12 reduced the levels of plasma monoamine neurotransmitters 5-hydroxytryptamine, 5-hydroxyindoleacetic acid, dopamine, and norepinephrine; as well as stimulated the expression of GHRL and NPY to alleviate cisplatin-induced anorexia in rats. EA stimulation at CV12 could be used to treat cisplatin-induced anorexia in rats.
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Affiliation(s)
- Ji Yun Baek
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
- Department of Food Science, Gyeongnam National University of Science and Technology, Jinju 52725, Korea.
| | - Tuy An Trinh
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
| | - Wonsang Huh
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
| | - Ji Hoon Song
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
| | - Hyun Young Kim
- Department of Food Science, Gyeongnam National University of Science and Technology, Jinju 52725, Korea.
| | - Juhee Lim
- College of Pharmacy and Institute of Pharmaceutical Sciences, CHA University, Seongnam 13488, Korea.
| | - Jinhee Kim
- College of Pharmacy and Institute of Pharmaceutical Sciences, CHA University, Seongnam 13488, Korea.
| | - Hyun Jin Choi
- College of Pharmacy and Institute of Pharmaceutical Sciences, CHA University, Seongnam 13488, Korea.
| | - Tae-Hun Kim
- Korean Medicine Clinical Trial Center, Korean Medicine Hospital, Kyung Hee University, Seoul 02447, Korea.
| | - Ki Sung Kang
- College of Korean Medicine, Gachon University, Seongnam 13120, Korea.
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17
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Lown EA, Banerjee A, Vittinghoff E, Dvorak CC, Hartogensis W, Melton A, Mangurian C, Hu H, Shear D, Adcock R, Morgan M, Golden C, Hecht FM. Acupressure to Reduce Treatment-Related Symptoms for Children With Cancer and Recipients of Hematopoietic Stem Cell Transplant: Protocol for a Randomized Controlled Trial. Glob Adv Health Med 2019; 8:2164956119870444. [PMID: 31453017 PMCID: PMC6696841 DOI: 10.1177/2164956119870444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 06/02/2019] [Accepted: 07/02/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We describe the study design and protocol of a pragmatic randomized controlled trial (RCT) Acupressure for Children in Treatment for a Childhood Cancer (ACT-CC). OBJECTIVE To describe the feasibility and effectiveness of an acupressure intervention to decrease treatment-related symptoms in children in treatment for cancer or recipients of a chemotherapy-based hematopoietic stem cell transplant (HSCT). DESIGN Two-armed RCTs with enrollment of 5 to 30 study days. SETTING Two pediatric teaching hospitals. PATIENTS Eighty-five children receiving cancer treatment or a chemotherapy-based HSCT each with 1 parent or caregiver. INTERVENTION Patients are randomized 1:1 to receive either usual care plus daily professional acupressure and caregiver delivered acupressure versus usual care alone for symptom management. Participants receive up to 20 professional treatments. MAIN OUTCOME A composite nausea/vomiting measure for the child. SECONDARY OUTCOMES Child's nausea, vomiting, pain, fatigue, depression, anxiety, and positive affect. PARENT OUTCOMES Depression, anxiety, posttraumatic stress symptoms, caregiver self-efficacy, and positive affect. Feasibility of delivering the semistandardized intervention will be described. Linear mixed models will be used to compare outcomes between arms in children and parents, allowing for variability in diagnosis, treatment, and age. DISCUSSION Trial results could help childhood cancer and HSCT treatment centers decide about the regular inclusion of trained acupressure providers to support symptom management.
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Affiliation(s)
- E Anne Lown
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Anu Banerjee
- Department of Neurological Surgery, University of California, San Francisco, California
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, California
| | - Christopher C Dvorak
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Wendy Hartogensis
- Osher Center for Integrative Medicine, University of California, San Francisco, California
| | - Alexis Melton
- Division of Pediatric Allergy, Immunology, & Blood and Marrow Transplantation, University of California, San Francisco, California
| | - Christina Mangurian
- Department of Psychiatry, School of Medicine, University of California, San Francisco, California
| | - Hiroe Hu
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Deborah Shear
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Robyn Adcock
- Compass Care/Integrative Pediatric Pain and Palliative Care (IP3), UCSF Benioff Children’s Hospital, San Francisco, California
| | - Michael Morgan
- Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, California
| | - Carla Golden
- Department of Pediatric Hematology-Oncology, UCSF Benioff Children’s Hospital, Oakland, California
| | - Frederick M Hecht
- Osher Center for Integrative Medicine, University of California, San Francisco, California
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18
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Meissner K, Talsky N, Olliges E, Jacob C, Stötzer OJ, Salat C, Braun M, Flondor R. Individual Factors Contributing to Nausea in First-Time Chemotherapy Patients: A Prospective Cohort Study. Front Pharmacol 2019; 10:410. [PMID: 31133847 PMCID: PMC6524707 DOI: 10.3389/fphar.2019.00410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 04/01/2019] [Indexed: 12/13/2022] Open
Abstract
Objective The expectation of developing side effects can enhance the likelihood to develop them – a phenomenon referred to as nocebo effect. Whether nocebo effects can be reduced by lowering negative expectancies, is not clear. The aim of this prospective study was to learn more about the factors contributing to nausea expectancy and their potential role in actual occurrence of nausea in patients undergoing chemotherapy for the first time in their life. Methods Patients scheduled for moderately emetogenic chemotherapeutic regimens filled in questionnaires to assess state anxiety and quality of life and to rate the expectancy of nausea as a side effect of chemotherapy. Patient diaries were used to monitor the severity of post-chemotherapy nausea in the 4 days following chemotherapy administration. Bivariate analyses complemented by multiple regression analyses were performed to identify the relationship between nausea expectation and nausea occurrence. Results 121 female patients (mean age 53 years) with completed questionnaires were included in the analyses. The majority of the patients had a diagnosis of breast cancer (86%). The two main sources for nausea expectancy were positive history of nausea in other situations and state anxiety. Patients with high expectancy levels (first quartile) experienced greater nausea than those with lower expectancy levels. Bivariate analyses revealed a weak but non-significant association between nausea expectation and post-chemotherapy nausea. When controlling for age, type of cancer, history of nausea, state and trait anxiety, and global quality of life, positive history of nausea (OR = 2.592; 95% CI, 1.0 to 6.67; p < 0.05), younger age (OR = 0.95; 95% CI, 0.92 to 0.99; p < 0.05), and a lower quality of life (OR = 0.97; 95% CI, 0.94 to 1.0; p < 0.05), but not nausea expectancy (OR = 1.014; 95% CI, 0.51 to 2.02; p = 0.969), predicted the occurrence of post-chemotherapy nausea. Conclusion In this female cohort, younger patients with lower initial quality of life and a positive history of nausea were at higher risk to develop nausea after first time chemotherapy. These patients may benefit from psychological co-interventions that aim to enhance quality of life.
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Affiliation(s)
- Karin Meissner
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Nicola Talsky
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Elisabeth Olliges
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Division of Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Carmen Jacob
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany.,Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Oliver J Stötzer
- Haematology and Oncology, Outpatient Cancer Care Center, Munich, Germany
| | - Christoph Salat
- Haematology and Oncology, Outpatient Cancer Care Center, Munich, Germany
| | - Michael Braun
- Breast Center, Department of Gynecology, Red Cross Hospital, Munich, Germany
| | - Raluca Flondor
- Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Munich, Germany
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19
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Psychological interventions for nausea and vomiting of pregnancy: A systematic review. Taiwan J Obstet Gynecol 2019; 57:644-649. [PMID: 30342643 DOI: 10.1016/j.tjog.2018.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2018] [Indexed: 01/17/2023] Open
Abstract
Various studies have investigated the role that psychological factors play in the etiology of nausea and vomiting during pregnancy. The current research was aimed at reviewing the psychological interventions that are implemented to treat the aforementioned conditions. Vocabulary from the Medical Subject Headings database was used as basis for identifying search keywords, which were then employed to search for relevant articles in PubMed, Web of Science, Google Scholar, PsycINFO, Scopus, the Scientific Information Database, IranMedex, Magiran, and IranDoc. A total of 174,270 articles published in the period between 1985 and 2017 were obtained. After the elimination of repetitive and unrelated articles, six clinical trials were evaluated using the Oxford quality scoring system or Jadad scale. Psychological interventions for nausea and vomiting during pregnancy fall into four categories, namely, behavioral therapy, mindfulness-based cognitive therapy, hypnosis, and progressive muscle relaxation. On the basis of the Jadad scale, all the reviewed studies were evaluated as being of poor methodological quality. Further studies are needed to obtain strong evidence on the effectiveness of psychological interventions for the treatment of women suffering from nausea and vomiting during pregnancy.
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20
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Ea versus Sham Acupuncture and no Acupuncture for the Control of Acute and Delayed Chemotherapy-Induced Nausea and Vomiting: A Pilot Study. Acupunct Med 2018; 33:277-83. [DOI: 10.1136/acupmed-2015-010781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2015] [Indexed: 11/03/2022]
Abstract
Objective To assess the feasibility of undertaking a high-quality randomised controlled study to determine whether EA gives better control of delayed chemotherapy-induced nausea and vomiting (CINV) than sham EA or standard antiemetic treatment alone. Methods Patients having their first cycle of moderately or highly emetogenic chemotherapy were randomised to EA, sham EA or standard care. EA was given for 30 min on day 1 at the time of chemotherapy and on day 3 using standard acupuncture points bilaterally. Sham EA was given to points adjacent to true EA points. All patients received usual care, comprising antiemetics, according to hospital guidelines. The primary outcomes related to study feasibility, and the clinical outcome measure was the change in Functional Living Index Emesis (FLIE) score captured on days 1 and 7. Results 153 participants were screened between April 2009 and May 2011. Eighteen patients did not meet the inclusion criteria, 37 declined to participate and the absence of an acupuncturist or lack of consent from the treating oncologist excluded a further 38 patients; 60 patients were recruited. The FLIE was completed on day 7 by 49 participants; 33 of 40 patients returned on day 3 for treatment. The nausea and vomiting scores were low in all three arms. Adverse events were generally mild and infrequent. Conclusions It was feasible to undertake a randomised EA trial on a busy day oncology unit. As few patients experienced nausea with their first cycle of chemotherapy, it was not possible to determine whether EA improves CINV over standard care. An enriched enrolment strategy is indicated for future studies. A simple numerical rating scale may prove a better objective nausea measure than the FLIE. Trial Registration Number ACTRN12609001054202.
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21
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Costi JM, da Silva JBG, Min LS, Moré AOO, Hokama AL. Teaching Acupuncture: The Brazilian Medical Residency Programme. Acupunct Med 2018; 30:350-3. [DOI: 10.1136/acupmed-2012-010184] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Acupuncture has had a successful story in Brazil. With its use in the public health system supported by legislation since 1988, its recognition as a medical specialty in 1995 enabled the introduction of an annual board examination and the creation of an official Medical Residency Programme. Since then, medical acupuncture has developed considerably, mostly through its massive spread into the Brazilian public health system. Brazil is the only country outside China that has created a Medical Residency Programme on Acupuncture. The 2-year programme consists of 5760 training hours, beginning with major clinical areas (internal medicine, neurology, orthopaedics and gynaecology) during 24 weeks in the first year. The residents study and practice acupuncture using the traditional Chinese Medicine approach and also the biomedical model. Specialists educated by this programme are therefore expected to have an optimum knowledge of both Western and Eastern medicine. Since it was first created, nine public health institutions have adopted the residency programme on acupuncture so, rather than being an alternative therapy, acupuncture has become an easily accessible and well-accepted conventional medical resource in Brazil.
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Affiliation(s)
- Jéssica Maria Costi
- Hospital Regional de São José Dr Homero de Miranda Gomes, São José, Santa Catarina, Brazil
| | | | - Li Shih Min
- Hospital Universitário da Universidade Federal de Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Ari Ojeda Ocampo Moré
- Hospital Universitário da Universidade Federal de Santa Catarina (former resident), Florianópolis, Santa Catarina, Brazil
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22
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Affiliation(s)
- Kerstin Austin
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
| | - Kelley Wilson
- Clinical Nutrition Services; University of Wisconsin Hospital and Clinics; Madison Wisconsin USA
| | - Sumona Saha
- Department of Gastroenterology and Hepatology; University of Wisconsin School of Medicine and Public Health; Madison Wisconsin USA
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23
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Chen B, Guo Y, Zhao X, Gao LL, Li B, Zhao TY, Zhang QW, Zou JX, Li MY, Guo YM, Guo Y, Pan XF. Efficacy differences of electroacupuncture with single acupoint or matching acupoints for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. Trials 2017; 18:477. [PMID: 29029639 PMCID: PMC5640953 DOI: 10.1186/s13063-017-2186-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 09/13/2017] [Indexed: 11/25/2022] Open
Abstract
Background Previous studies have shown that acupuncture is beneficial for the alleviation of chemotherapy-induced nausea and vomiting. However, there is a lack of clinical evidence concerning the effects of acupoint-matching on chemotherapy-induced nausea and vomiting. Methods/design This is a parallel randomized controlled trial to evaluate the occurrence of nausea and vomiting after chemotherapy (the incidence of nausea and vomiting, frequency, VAS score, RINVR rating) as the main outcome for cancer. Quality of life, anxiety and depression scores are the secondary outcomes. Quality of life, anxiety and depression scores are the secondary phase. Use of remedy drugs, routine blood examination, and blood biochemical tests are the safety evaluation. We also compare the different effects of ST36 (single acupoint), CV12 (single acupoint), and ST36-CV12 matching groups. Discussion The results of this trial are expected to explore the effects of matching different acupoints and to offer biologic plausibility for the use of acupuncture in the treatment of chemotherapy-induced nausea and vomiting (CINV). Trial registration This trial is registered with clinicaltrials.gov NCT02195921, The date of registration was 17 July 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2186-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bo Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Yang Guo
- The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Xue Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Li-Li Gao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Bo Li
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Tian-Yi Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Qi-Wen Zhang
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Jin-Xing Zou
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Ming-Yue Li
- Clinical Practice Teaching Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China
| | - Yong-Ming Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China
| | - Yi Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China.
| | - Xing-Fan Pan
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, 88 Yuquan Road, Nankai District, Tianjin, 300193, China.
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24
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Cihan YB. Is it Possible to use Acupressure to Reduce Adverse Effects Related to Radiotherapy? Acupunct Med 2017. [DOI: 10.1136/acupmed-2016-011286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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25
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Johnson MI. Transcutaneous electrical nerve stimulation (TENS) as an adjunct for pain management in perioperative settings: a critical review. Expert Rev Neurother 2017; 17:1013-1027. [DOI: 10.1080/14737175.2017.1364158] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mark I. Johnson
- Centre for Pain Research, School of Clinical and Applied Sciences, Leeds Beckett University City Campus, Leeds, UK
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26
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Wang H, Yu MW, Shi GX, Zhang GL, Li QW, Zhang CX, Han Y, Xu YM, Zhang Q, Wang XM, Yang GW. WITHDRAWN: Effect of acupuncture therapy on lung cancer patients with cancer-related fatigue during chemotherapy: Study protocol for a randomized controlled trial. Contemp Clin Trials Commun 2017. [DOI: 10.1016/j.conctc.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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27
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Miao J, Liu X, Wu C, Kong H, Xie W, Liu K. Effects of acupressure on chemotherapy-induced nausea and vomiting-a systematic review with meta-analyses and trial sequential analysis of randomized controlled trials. Int J Nurs Stud 2017; 70:27-37. [DOI: 10.1016/j.ijnurstu.2017.02.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 02/06/2017] [Accepted: 02/09/2017] [Indexed: 01/10/2023]
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28
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Mehta P, Dhapte V, Kadam S, Dhapte V. Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments. J Tradit Complement Med 2017; 7:251-263. [PMID: 28417094 PMCID: PMC5388088 DOI: 10.1016/j.jtcme.2016.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/12/2016] [Accepted: 06/15/2016] [Indexed: 12/20/2022] Open
Abstract
Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.
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Affiliation(s)
- Piyush Mehta
- Department of Quality assurance, Bharati Vidyapeeth University, Poona College of Pharmacy, Pune 38, India
| | - Vishwas Dhapte
- Department of Chemistry, Bharati Vidyapeeth University, Yashwantrao Mohite College, Pune 38, India
| | - Shivajirao Kadam
- Bharati Vidyapeeth University, Bharati Vidyapeeth Bhavan, Lal Bahadur Shastri Marg, Pune 38, India
| | - Vividha Dhapte
- Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth University, Pune, India
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Xie J, Chen LH, Ning ZY, Zhang CY, Chen H, Chen Z, Meng ZQ, Zhu XY. Effect of transcutaneous electrical acupoint stimulation combined with palonosetron on chemotherapy-induced nausea and vomiting: a single-blind, randomized, controlled trial. CHINESE JOURNAL OF CANCER 2017; 36:6. [PMID: 28069044 PMCID: PMC5223354 DOI: 10.1186/s40880-016-0176-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 12/07/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Chemotherapy-induced nausea and vomiting adversely affects the quality of life of patients who receive chemotherapy via intravenous infusion or transcatheter arterial chemoembolization (TACE). This study aimed to investigate the clinical effects of transcutaneous electrical acupoint stimulation (TEAS) on nausea and vomiting after TACE. METHODS A total of 142 patients who received TACE with cisplatin for primary or metastatic liver cancer were assigned to the active-acupuncture (n = 72) or placebo-acupuncture (n = 70) groups using a covariate-adaptive randomization at a ratio of 1:1. The acupoints Hegu (LI4), Neiguan (P6), and Zusanli (ST36) were stimulated twice daily for 6 days. The effects of TEAS on nausea and vomiting were assessed by using occurrence rate and severity of these symptoms. Anorexia scale and M. D. Anderson Symptom Inventory (MDASI) scores were secondary endpoints and were used to assess the effect of TEAS on patient appetite and quality of life. The safety of the treatments was also monitored. RESULTS Between the two groups, the differences in occurrence rates and severities of nausea and vomiting after TACE were not significant (all P > 0.05). From the second day after TACE, anorexia scores were significantly lower in the active-acupuncture group than in the placebo-acupuncture group and continued to decrease over time with treatment (all P values less than 0.01). On days 0, 1, and 2, the mean MDASI scores for the active-acupuncture group were slightly lower than those for the placebo-acupuncture group, but the differences were not statistically significant (all P > 0.05). No significant differences were found between the two groups in the occurrence rate of any adverse event (P > 0.05). CONCLUSION TEAS appears to be a safe and effective therapy to relieve patients' gastrointestinal discomfort after chemotherapy. Trial registration NCT01895010. Registered 21 June 2013.
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Affiliation(s)
- Jing Xie
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Lei-Hua Chen
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Zhou-Yu Ning
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Chen-Yue Zhang
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Hao Chen
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Zhen Chen
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China.,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China
| | - Zhi-Qiang Meng
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China. .,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China.
| | - Xiao-Yan Zhu
- Department of Integrative Oncology, Fudan University Shanghai Cancer Center, 270 Dong'An Road, Shanghai, 200032, P. R. China. .,Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'An Road, Shanghai, 200032, P. R. China.
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Brittner M, Le Pertel N, Gold MA. Acupuncture in Pediatrics. Curr Probl Pediatr Adolesc Health Care 2016; 46:179-83. [PMID: 26867822 DOI: 10.1016/j.cppeds.2015.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 12/04/2015] [Indexed: 12/20/2022]
Abstract
There has been extensive research on the use of acupuncture in adults with a wide array of conditions. Much less research has been conducted on the use of acupuncture in children. In this article, we review the history and philosophy of acupuncture, and the literature on its effectiveness and safety in children and adolescents, giving special attention to the pediatric and adolescent conditions that have been most studied in high-quality randomized controlled trials (RCTs).
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Affiliation(s)
- Mindy Brittner
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Noemie Le Pertel
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
| | - Melanie A Gold
- Department of Pediatrics, Columbia University Medical Center, New York, NY; Department of Population and Family Health, Columbia University Medical Center, New York, NY
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Russell AC, Stone AL, Walker LS. Functional Nausea in Children: A Review of the Literature and Need for Diagnostic Criteria. CHILDREN-BASEL 2016; 3:children3010005. [PMID: 27417243 PMCID: PMC4934479 DOI: 10.3390/children3010005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/03/2016] [Accepted: 03/08/2016] [Indexed: 12/12/2022]
Abstract
Nausea is common amongst children with functional gastrointestinal disorders and is associated with a high burden of somatic and psychosocial comorbidities in both the short and long-term. Current treatments including medications, phytotherapy, stress-reduction techniques, and gastric electrical stimulation for recalcitrant cases, are reviewed. Functional nausea merits its own diagnostic criteria as a pediatric functional gastrointestinal disorder.
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Affiliation(s)
- Alexandra C Russell
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
| | - Amanda L Stone
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN 37203, USA.
| | - Lynn S Walker
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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The efficacy of P6 acupressure with sea-band in reducing postoperative nausea and vomiting in patients undergoing craniotomy: a randomized, double-blinded, placebo-controlled study. J Neurosurg Anesthesiol 2016; 27:42-50. [PMID: 24978062 DOI: 10.1097/ana.0000000000000089] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a multifactorial problem after general anesthesia. Despite antiemetic prophylaxis and improved anesthetic techniques, PONV still occurs frequently after craniotomies. P6 stimulation is described as an alternative method for preventing PONV. The primary aim of this study was to determine whether P6 acupressure with Sea-Band could reduce postoperative nausea after elective craniotomy. Secondary aims were to investigate whether the frequency of vomiting and the need for antiemetics could be reduced. METHODS In this randomized, double-blinded, placebo-controlled study, patients were randomized into either a P6 acupressure group (n=43) or a sham group (n=52). Bands were applied unilaterally at the end of surgery, and all patients were administered prophylactic ondansetron. Postoperative nausea was evaluated with a Numerical Rating Scale, 0 to10, and the frequency of vomiting was recorded for 48 hours. RESULTS We found no significant effect from P6 acupressure with Sea-Band on postoperative nausea or vomiting in patients undergoing craniotomy. Nor was there any difference in the need for rescue antiemetics. Altogether, 67% experienced PONV, and this was especially an issue at >24 hours in patients recovering from infratentorial surgery compared with supratentorial surgery (55% vs. 26%; P=0.014). CONCLUSIONS Unilateral P6 acupressure with Sea-Band applied at the end of surgery together with prophylactic ondansetron did not significantly reduce PONV or the need for rescue antiemetics in patients undergoing craniotomy. Our study confirmed that PONV is a common issue after craniotomy, especially after infratentorial surgery.
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Cutshall SM, Rodgers NJ, Dion LJ, Dreyer NE, Thomley BS, Do A, Wood C, Pronk SC, Bauer BA. A decade of offering a Healing Enhancement Program at an academic medical center. Complement Ther Clin Pract 2015; 21:211-6. [PMID: 26573445 DOI: 10.1016/j.ctcp.2015.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/14/2015] [Accepted: 07/28/2015] [Indexed: 11/16/2022]
Abstract
An increased focus has been given to improving the patient experience in health care. This focus has included placing value in a patient-centric, holistic approach to patient care. In the past decade, the Healing Enhancement Program was developed at 1 large medical center to address this focus through implementation of such integrative medicine services as massage, acupuncture, and music therapy to holistically address the pain, anxiety, and tension that hospitalized patients often experience. We describe the development and growth of this program over the past decade.
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Affiliation(s)
- Susanne M Cutshall
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - Nancy J Rodgers
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - Liza J Dion
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - Nikol E Dreyer
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - Barbara S Thomley
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | - Alexander Do
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA
| | | | | | - Brent A Bauer
- Complementary and Integrative Medicine Program, Mayo Clinic, Rochester, MN, USA.
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Greenlee H, Balneaves LG, Carlson LE, Cohen M, Deng G, Hershman D, Mumber M, Perlmutter J, Seely D, Sen A, Zick SM, Tripathy D. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr 2015; 2014:346-58. [PMID: 25749602 DOI: 10.1093/jncimonographs/lgu041] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The majority of breast cancer patients use complementary and/or integrative therapies during and beyond cancer treatment to manage symptoms, prevent toxicities, and improve quality of life. Practice guidelines are needed to inform clinicians and patients about safe and effective therapies. METHODS Following the Institute of Medicine's guideline development process, a systematic review identified randomized controlled trials testing the use of integrative therapies for supportive care in patients receiving breast cancer treatment. Trials were included if the majority of participants had breast cancer and/or breast cancer patient results were reported separately, and outcomes were clinically relevant. Recommendations were organized by outcome and graded based upon a modified version of the US Preventive Services Task Force grading system. RESULTS The search (January 1, 1990-December 31, 2013) identified 4900 articles, of which 203 were eligible for analysis. Meditation, yoga, and relaxation with imagery are recommended for routine use for common conditions, including anxiety and mood disorders (Grade A). Stress management, yoga, massage, music therapy, energy conservation, and meditation are recommended for stress reduction, anxiety, depression, fatigue, and quality of life (Grade B). Many interventions (n = 32) had weaker evidence of benefit (Grade C). Some interventions (n = 7) were deemed unlikely to provide any benefit (Grade D). Notably, only one intervention, acetyl-l-carnitine for the prevention of taxane-induced neuropathy, was identified as likely harmful (Grade H) as it was found to increase neuropathy. The majority of intervention/modality combinations (n = 138) did not have sufficient evidence to form specific recommendations (Grade I). CONCLUSIONS Specific integrative therapies can be recommended as evidence-based supportive care options during breast cancer treatment. Most integrative therapies require further investigation via well-designed controlled trials with meaningful outcomes.
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Affiliation(s)
- Heather Greenlee
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT).
| | - Lynda G Balneaves
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Linda E Carlson
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Misha Cohen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Gary Deng
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dawn Hershman
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Matthew Mumber
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Jane Perlmutter
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Dugald Seely
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Ananda Sen
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Suzanna M Zick
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
| | - Debu Tripathy
- Department of Epidemiology, Mailman School of Public Health (HG, DH), Herbert Irving Comprehensive Cancer Center, (HG, DH), and Department of Medicine, College of Physicians and Surgeons (DH), Columbia University, New York, NY (HG, DH); School of Nursing, University of British Columbia, Vancouver, BC, Canada (LGB); Department of Oncology, University of Calgary, Calgary, AB, Canada (LEC); Institute for Health and Aging, University of California San Francisco, CA (MC); Chicken Soup Chinese Medicine, San Francisco, CA (MC); Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY (GD); Harbin Clinic, Rome, GA (MM); Gemini Group, Ann Arbor, MI (JP); Ottawa Integrative Cancer Center, Ottawa, ON, Canada (DS); Canadian College of Naturopathic Medicine, Toronto, ON, Canada (DS); Department of Family Medicine, University of Michigan Health System (AS, SMZ), Department of Environmental Health Sciences, School of Public Health (SMZ), and Department of Biostatistics (AS), University of Michigan, Ann Arbor, MI (AS, SMZ); Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX (DT)
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Komesaroff PA. Filling in the Acupuncture Jigsaw Puzzle. Endocrinology 2015; 156:3483-4. [PMID: 26380934 DOI: 10.1210/en.2015-1734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Paul A Komesaroff
- Faculty of Medicine, Nursing and the Health Sciences, Monash University, Melbourne, Victoria 3168, Australia
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Prashanti E, Sumanth KN, Renjith George P, Karanth L, Soe HHK. Management of gag reflex for patients undergoing dental treatment. Cochrane Database Syst Rev 2015:CD011116. [PMID: 26423025 DOI: 10.1002/14651858.cd011116.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Gag reflex is an involuntary defence mechanism to protect the pharynx and throat from foreign objects. Gagging is a common problem encountered during dental treatment, which makes therapeutic procedures distressing and often difficult or even impossible to perform. Various interventions can be used to control the gag reflex; for example, anti-nausea medicines, sedatives, local and general anaesthetics, herbal remedies, behavioural therapies, acupressure, acupuncture, and prosthetic devices. OBJECTIVES To assess the effects of pharmacological and non-pharmacological interventions for the management of gagging in people undergoing dental treatment. SEARCH METHODS We searched the Cochrane Oral Health Group's Trials Register (to 7 April 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (the Cochrane Library, Issue 4, 2014), MEDLINE via OVID (1946 to 7 April 2015), EMBASE via OVID (1980 to 7 April 2015), CINAHL via EBSCO (1980 to 7 April 2015), AMED via OVID (1985 to 7 April 2015), IADR Conference Proceedings (online, 2001 to 7 April 2015), clinical trial registries and Google search engine. SELECTION CRITERIA We included randomised controlled trials (RCTs), involving people who were given a pharmacological or non-pharmacological intervention to manage gagging that interfered with dental treatment. We excluded quasi-RCTs and cross-over trials. We excluded trials with participants who had central or peripheral nervous system disorders; who had oral lesions or were on systemic medications that might affect the gag sensation; or had undergone surgery which might alter anatomy permanently. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials. Three review authors independently extracted data and assessed risk of bias in the included trials. We estimated risk ratios (RRs) for dichotomous data, and mean differences (MDs) for continuous data, with 95% confidence intervals (CIs). We assessed the overall quality of the evidence using the GRADE approach. MAIN RESULTS One RCT, a trial on acupuncture at P6 (Pericardium 6 - situated on the anterior surface of wrist), met the inclusion criteria. It included 33 adults who reported previous nausea during dental procedures that hindered or prevented dental treatment from being carried out properly. The trial was at unclear risk of bias. The outcome reported in this trial was reduction in gagging. We obtained data for our primary outcome (successful completion of dental procedure) by contacting the trial author.Successful completion of dental procedure reported by the assessor showed no difference in acupuncture at P6 group compared to sham acupuncture (RR 1.65, 95% CI 0.59 to 4.57). Reduction in gagging as reported by the assessor showed no difference between acupuncture at P6 and sham acupuncture at any stage (stage 1: MD 0.40, 95% CI -0.12 to 0.93; stage 2: MD 0.49, 95 % CI -0.26 to 1.24; stage 3: MD 0.67, 95% CI -0.18 to 1.53). Reduction in gagging as reported by the participant also showed no difference between acupuncture at P6 and sham acupuncture (MD 0.86, 95% CI -1.13 to 2.85). The quality of the evidence for all outcomes was very low.No noteworthy adverse effects were reported.We did not find trials evaluating any other interventions used to manage gagging in people undergoing dental treatment. AUTHORS' CONCLUSIONS We found very low quality evidence from a single trial that was insufficient to conclude if there is any benefit of acupuncture in reducing gagging and allowing successful completion of dental procedures. We did not find any evidence on any other interventions for managing the gag reflex during dental treatment. More well-designed and well-reported trials evaluating different interventions are needed.
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Affiliation(s)
- Eachempati Prashanti
- Department of Prosthodontics, Faculty of Dentistry, Melaka-Manipal Medical College, Jalan Batu Hampar, Bukit Baru, Melaka, Malaysia, 75150
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Perception of Therapeutic Qi, a Nonmechanical, Nonpsychological Factor in Acupuncture That Originates from the Therapist. J Acupunct Meridian Stud 2015; 8:203-8. [PMID: 26276457 DOI: 10.1016/j.jams.2014.11.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 11/10/2014] [Accepted: 11/12/2014] [Indexed: 11/22/2022] Open
Abstract
So far, most research attempts to explain the mechanism of the action of acupuncture have focused mostly on mechanically-triggered active factors and have produced inconclusive findings. In this study, we investigate whether acupuncture might also involve nonmechanical, nonpsychological active factors originating in the therapist. In 30 individuals, an acupuncture needle was inserted in the acupoint PC6 using a special device without touching the needle. A second device was used to fix the needle rigidly in place, excluding any mechanical transmission of movement from the handle to the needle's tip. Each participant was exposed in random order to a control and a stimulation phase. During the stimulation phase, the free needle's end was held by the therapist to allow the transmission of Qi; during the control phase, it was left untouched. Participants' subjective sensations during the stimulation phase and the control phase were recorded using a questionnaire. Twenty-two of 28 (79%; p = 0.003) test participants believed that they had received stimulation when it had actually been performed, and 26 (93%; p < 0.001) sensed differences between the two experimental phases. Thus, participants were able to sense the transmission of therapeutic Qi in the absence of mechanical or psychological factors.
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Liodden I, Sandvik L, Valeberg BT, Borud E, Norheim AJ. Acupuncture versus Usual Care for Postoperative Nausea and Vomiting in Children after Tonsillectomy/Adenoidectomy: A Pragmatic, Multicentre, Double-Blinded, Randomised Trial. Acupunct Med 2015; 33:196-203. [DOI: 10.1136/acupmed-2014-010738] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/04/2022]
Abstract
Objectives To investigate the effect of a standardised acupuncture on nausea and vomiting in children after tonsillectomy with or without adenoidectomy when possible placebo effects were precluded. Methods A pragmatic, multicentre, double-blinded, randomised controlled trial. The study was conducted over 10 months in 2012–2013 at three ambulatory clinics. Two hundred and eighty-two children, age 1–11 years, American Society of Anesthesiologists grade ≤II, were included. To equalise expectancy effects, all parents were told that their child would receive acupuncture. However, children were randomly allocated to perioperative bilateral needling acupuncture at PC6, depth 7 mm, mean time 17 min (SD 5–45) during anaesthesia plus usual care, or to usual care only. The regional ethics committee approved this approach. Primary endpoints were nausea and vomiting 24 h postoperatively. Results This study did not demonstrate any effect of acupuncture (95% CI) compared with standard care. The overall vomiting in the acupuncture and usual-care groups was 44.2% and 47.9%, respectively. Nausea was experienced by 31.7% in the acupuncture group and by 32.6% in the usual-care group. The test power was acceptable for comparisons of vomiting. Conclusions The findings suggest that when controlling for possible placebo effects standardised PC6 acupuncture needling during anaesthesia without further stimulation of PC6 is not effective in reducing nausea and vomiting in children after tonsillectomy with or without adenoidectomy. Future studies should investigate acupuncture treatment which balances adequate dose and technique and a feasible, child-friendly acupuncture treatment. Trial Registration Number ClinicalTrials.gov NCT01729052.
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Affiliation(s)
- Ingrid Liodden
- NAFKAM, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Leiv Sandvik
- Faculty of Odontology, University of Oslo, Oslo, Norway
| | - Berit Taraldsen Valeberg
- Faculty of Health Service, Oslo and Akershus College University of Applied Science, Oslo, Norway
| | - Einar Borud
- NAFKAM, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Arne Johan Norheim
- NAFKAM, Institute of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Chen B, Hu SX, Liu BH, Zhao TY, Li B, Liu Y, Li MY, Pan XF, Guo YM, Chen ZL, Guo Y. Efficacy and safety of electroacupuncture with different acupoints for chemotherapy-induced nausea and vomiting: study protocol for a randomized controlled trial. Trials 2015; 16:212. [PMID: 25963295 PMCID: PMC4445984 DOI: 10.1186/s13063-015-0734-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 04/27/2015] [Indexed: 11/23/2022] Open
Abstract
Background Many patients experience nausea and vomiting during chemotherapy treatment. Evidence demonstrates that electroacupuncture is beneficial for controlling chemotherapy-induced nausea and vomiting (CINV). However, the acupoint or matching acupoint with the best efficacy for controlling CINV still remains unidentified. Methods/Design This study consists of a randomized controlled trial (RCT) with four parallel arms: a control group and three electroacupuncture groups (one with Neiguan (PC6), one with Zhongwan (CV12), and one with both PC6 and CV12). The control group received standard antiemetic only, while the other three groups received electroacupuncture stimulation with different acupoints besides the standard antiemetic. The intervention is done once daily from the first day (day 1) to the fourth day (day 4) during chemotherapy treatment. The primary outcome measures include frequency of nausea, vomiting and retching. The secondary outcome measures are the grade of constipation and diarrhea, electrogastrogram, assessment of quality of life, assessment of anxiety and depression, and other adverse effects during the chemotherapy. Assessments are scheduled from one day pre-chemotherapy (day 0) to the fifth day of chemotherapy (day 5). Follow-ups are done from day 6 to day 21. Discussion The aim of this study is to evaluate the efficacy and safety of electro-acupuncture with different acupoints in the management of CINV. Trial registration The register number of randomized controlled trial is NCT02195908. The date of registration was 21 July 2014.
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Affiliation(s)
- Bo Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Shu-xiang Hu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Bao-hu Liu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Tian-yi Zhao
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Bo Li
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yan Liu
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Ming-yue Li
- Clinical Practice Teaching Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Xing-fang Pan
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yong-ming Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Ze-lin Chen
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
| | - Yi Guo
- Acu-moxibustion and Tuina Department of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China. .,Acupuncture Research Center of Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, China.
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Narrative Review of Perioperative Acupuncture for Clinicians. J Acupunct Meridian Stud 2015; 8:264-9. [PMID: 26433805 DOI: 10.1016/j.jams.2014.12.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 12/16/2014] [Accepted: 12/30/2014] [Indexed: 11/20/2022] Open
Abstract
Acupuncture is one of the oldest forms of the natural healing arts. The exact mechanisms of action are unknown at this time; however, current theories to explain the benefits experienced after acupuncture include Traditional Chinese Medicine and Western medicine concepts. Acupuncture may improve the quality of perioperative care and reduce associated complications. Perioperative acupuncture is apparently effective in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain. The Pericardium-6 (P-6; Nei Guan), Yintang (Extra 1), and Shenmen acupuncture points are the most studied and effective acupuncture points in reducing preoperative anxiety, postoperative nausea and vomiting, and postoperative pain experiences. Intraoperatively administered acupuncture may reduce immunosuppression in patients and lessen intraoperative anesthetic requirements, although the clinical usefulness of acupuncture in the intraoperative period remains inconclusive. Perioperative acupuncture is a promising intervention, but additional studies are needed to further understand and define acupuncture's role throughout the perioperative period and determine its clinical usefulness. The purpose of this article is to provide a brief clinical review concerning acupuncture and its application for common issues that occur in the perioperative period.
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Raditic DM, Bartges JW. Evidence-based Integrative Medicine in Clinical Veterinary Oncology. Vet Clin North Am Small Anim Pract 2014; 44:831-53. [DOI: 10.1016/j.cvsm.2014.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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da Silva JBG, Saidah R, Megid CBC, Ramos NA. Adverse events following acupuncture: A prospective survey of 13,884 consultations in a university out-patient acupuncture training clinic in Brazil. Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2013.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
Oncology acupuncture has become a new and promising field of research because more and more cancer patients have sought non-pharmacological alternatives for symptom management. While different mechanisms have been proposed to explain its efficacy, including theories of the neural system, endocrine cytokine or immunological regulation, its eventual role has become that of alleviating the side effects induced by chemotherapy or radiotherapy. In this paper, we have reviewed the related articles focusing on acupuncture mechanisms and applications in cancer care to provide a quick sketch of acupuncture in cancer care. A detailed search was performed to identify the randomized controlled trials (RCTs) and systematic reviews on acupuncture in oncology, using PUBMED and Cochrane. The search terms included: Acupuncture, acupressure, and cancer. Additional terms were used to target specific symptoms (i.e., breast cancer, hot flash, xerostomia, nausea, vomiting, cancer pain, insomnia, fatigue). Two authors independently extracted data for analysis and review. Ultimately, 25 articles underwent full-text review. Recent trials made efforts in studying (a) hot flashes in breast cancer, (b) xerostomia induced by radiotherapy in head and neck cancer, (c) nausea and vomiting post-chemotherapy, (d) cancer pain, and (e) fatigue and insomnia in cancer patients. Controversial results for acupuncture application in cancer care appeared in different categories, but a trend emerged that acupuncture can palliate cancer-related symptoms. The research to date certainly offers us a valid complementary therapy in treating cancer-related symptoms. Meanwhile, practical strategies with safe measures for enhancing the efficacy are needed in further interventions, as well as continuing research with a validated methodology.
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Affiliation(s)
- Tsai-Ju Chien
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Internal Medicine, Division of Hemato-Oncology, Branch of Zhong-xing, Taipei City Hospital, Taipei, Taiwan
| | - Chia-Yu Liu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Traditional Chinese Medicine,Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan. ; Taiwan International Traditional Chinese Medicine Training Center, Taiwan
| | - Chung-Hua Hsu
- Institute of Traditional Medicine, National Yang-Ming University, Taipei, Taiwan. ; Department of Traditional Chinese Medicine,Branch of Linsen and Chinese Medicine, Taipei City Hospital, Taipei, Taiwan. ; Taiwan International Traditional Chinese Medicine Training Center, Taiwan
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Pang B, Zhou Q, Li JL, Zhao LH, Tong XL. Treatment of refractory diabetic gastroparesis: Western medicine and traditional Chinese medicine therapies. World J Gastroenterol 2014; 20:6504-6514. [PMID: 24914371 PMCID: PMC4047335 DOI: 10.3748/wjg.v20.i21.6504] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Revised: 01/13/2014] [Accepted: 02/20/2014] [Indexed: 02/06/2023] Open
Abstract
Refractory diabetic gastroparesis (DGP), a disorder that occurs in both type 1 and type 2 diabetics, is associated with severe symptoms, such as nausea and vomiting, and results in an economic burden on the health care system. In this article, the basic characteristics of refractory DGP are reviewed, followed by a discussion of therapeutic modalities, which encompasses the definitions and clinical manifestations, pathogenesis, diagnosis, and therapeutic efficacy evaluation of refractory DGP. The diagnostic standards assumed in this study are those set forth in the published literature due to the absence of recognized diagnosis criteria that have been assessed by an international organization. The therapeutic modalities for refractory DGP are as follows: drug therapy, nutritional support, gastric electrical stimulation, pyloric botulinum toxin injection, endoscopic or surgical therapy, and traditional Chinese treatment. The therapeutic modalities may be used alone or in combination. The use of traditional Chinese treatments is prevalent in China. The effectiveness of these therapies appears to be supported by preliminary evidence and clinical experience, although the mechanisms that underlie these effects will require further research. The purpose of this article is to explore the potential of combined Western and traditional Chinese medicine treatment methods for improved patient outcomes in refractory DGP.
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Cho YH, Kim CK, Heo KH, Lee MS, Ha IH, Son DW, Choi BK, Song GS, Shin BC. Acupuncture for acute postoperative pain after back surgery: a systematic review and meta-analysis of randomized controlled trials. Pain Pract 2014; 15:279-91. [PMID: 24766648 PMCID: PMC4409074 DOI: 10.1111/papr.12208] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 03/01/2014] [Indexed: 12/23/2022]
Abstract
Objectives Acupuncture is commonly used as a complimentary treatment for pain management. However, there has
been no systematic review summarizing the current evidence concerning the effectiveness of
acupuncture for acute postoperative pain after back surgery. This systematic review aimed at
evaluating the effectiveness of acupuncture treatment for acute postoperative pain (≤1 week)
after back surgery. Methods We searched 15 electronic databases without language restrictions. Two reviewers independently
assessed studies for eligibility and extracted data, outcomes, and risk of bias. Random effect
meta-analyses and subgroup analyses were performed. Results Five trials, including 3 of high quality, met our inclusion criteria. The meta-analysis showed
positive results for acupuncture treatment of pain after surgery in terms of the visual analogue
scale (VAS) for pain intensity 24 hours after surgery, when compared to sham acupuncture (standard
mean difference −0.67 (−1.04 to −0.31), P = 0.0003),
whereas the other meta-analysis did not show a positive effect of acupuncture on 24-hour opiate
demands when compared to sham acupuncture (standard mean difference −0.23 (−0.58 to
0.13), P = 0.21). Conclusion Our systematic review finds encouraging but limited evidence for the effectiveness of acupuncture
treatment for acute postoperative pain after back surgery. Further rigorously designed clinical
trials are required.
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Affiliation(s)
- Young-Hun Cho
- School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
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Axelsson CK, Ballegaard S, Karpatschof B, Schousen P. Pressure pain sensitivity as a marker for stress and pressure pain sensitivity-guided stress management in women with primary breast cancer. Scandinavian Journal of Clinical and Laboratory Investigation 2014; 74:399-407. [PMID: 24697620 DOI: 10.3109/00365513.2014.900187] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To validate (1) Pressure Pain Sensitivity (PPS) as a marker for stress and (2) a PPS-guided intervention in women with primary Breast Cancer (BC). METHODS (1) A total of 58 women with BC were examined before and after 6 months of intervention. A control group of 165 women office employees was divided in a High Stress Group (HSG, n = 37) and a Low Stress Group (LSG, n = 128) to evaluate the association between PPS, questionnaire-related Quality of Life (QOL) and self-evaluated stress. (2) A PPS-guided stress management program (n = 40) was compared to a Psychosocial Group Intervention (PGI, n = 91) and no treatment (n = 86) with respect to a European Organization for Research and Treatment of Cancer (EORTC) questionnaire measured QOL. RESULTS (1) Resting PPS and changes in PPS during the intervention period correlated significantly to EORTC and Short Form 36 (SF 36) main scores: (all p < 0.05). Between BC, HSG and LSG there was a significant and positive correlation with respect to PPS, SF 36 main scores, depression, and clinical stress scores (all p < 0.05). However, the BC group scored significantly lower than both HSG and LSG (both p < 0.05) with respect to self-evaluated stress. (2) The PPS-guided intervention group improved EORTC main score, pain and nausea, when compared to the control groups (all p < 0.05). CONCLUSIONS PPS was positively associated with QOL, which was in contrast to self-evaluated stress. PPS-guided intervention improved QOL in women with breast cancer.
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Affiliation(s)
- Christen K Axelsson
- Department of Breast Surgery, Herlev Hospital, Herlev, University of Copenhagen , Denmark
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Tas D, Uncu D, Sendur MA, Koca N, Zengin N. Acupuncture as a Complementary Treatment for Cancer Patients Receiving Chemotherapy. Asian Pac J Cancer Prev 2014; 15:3139-44. [DOI: 10.7314/apjcp.2014.15.7.3139] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chen ZY, Lin L, Wang HH, Zhou Y, Yan JQ, Huang YL, Guo QL. Ondansetron combined with ST36 (Zusanli) acupuncture point injection for postoperative vomiting. Acupunct Med 2014; 32:124-31. [PMID: 24440809 DOI: 10.1136/acupmed-2013-010340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Ondansetron, sometimes combined with acustimulation at PC6 (Neiguan), is commonly used for preventing postoperative nausea and vomiting, but PC6 is not the only point that can be used for this purpose. OBJECTIVES To evaluate the combined effects of ondansetron and ST36 (Zusanli) acupuncture point injection on postoperative vomiting (POV) after laparoscopic surgery. METHODS A randomised, patient and assessor-blinded, placebo-controlled clinical study was conducted. One hundred and sixty patients undergoing laparoscopic surgery were randomly assigned to one of four groups: (1) group P (placebo-control): intravenous normal saline+bilateral non-acupuncture point injection of vitamin B1 (n=40); (2) group O (ondansetron): intravenous ondansetron+bilateral ST36 sham injection (n=40); (3) group A (acupuncture point injection): intravenous normal saline+bilateral acupuncture point injection at ST36 of vitamin B1 (n=40); (4) group C (combination): intravenous ondansetron+bilateral acupuncture point injection at ST36 of vitamin B1 (n=40). Interventions were made on arrival at the postanaesthesia care unit. The primary outcome was the incidence of POV within 24 h after the operation. Secondary outcomes included severity of vomiting, incidence of rescue treatment, patients' satisfaction and the first anal exsufflation time 24 h after the operation. RESULTS The incidence of POV within 24 h postoperative period in each group was P 33%; O 11%, A 9% and C 6%. Outcomes for all intervention groups were significantly better than that for placebo (p<0.01). For the three interventions compared with placebo, the numbers needed to treat (NNTs) were O, NNT=5; A, NNT=5 and C, NNT=4. The secondary outcomes also demonstrated greater benefits of the combined regimen, with improvement seen in all the measures. CONCLUSIONS Ondansetron, acupuncture, and ondansetron and acupuncture combined are effective prophylaxis for POV.
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Affiliation(s)
- Zi Y Chen
- Department of Anesthesiology, Xiangya Hospital, Central South University, , Changsha, Hunan, PR China
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Kwon SJ, Park JS. Effects of Auricular Acupressure on Chemotherapy-induced Nausea, Vomiting, and Serum Serotonin Level. ACTA ACUST UNITED AC 2014. [DOI: 10.7475/kjan.2014.26.3.330] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Soon Jo Kwon
- Department of Nursing, Keimyung College University, Daegu, Korea
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Yoon SW, Jeong JS, Kim JH, Aggarwal BB. Cancer Prevention and Therapy: Integrating Traditional Korean Medicine Into Modern Cancer Care. Integr Cancer Ther 2013; 13:310-31. [PMID: 24282099 DOI: 10.1177/1534735413510023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In spite of billions of dollars spent on cancer research each year, overall cancer incidence and cancer survival has not changed significantly in the last half century. Instead, the recent projection from the World Health Organization suggests that global cancer incidence and death is expected to double within the next decade. This requires an "out of the box" thinking approach. While traditional medicine used for thousands of years is safe and affordable, its efficacy and mechanism of action are not fully reported. Demonstrating that traditional medicine is efficacious and how it works can provide a "bed to bench" and "bench to bed" back approach toward prevention and treatment of cancer. This current review is an attempt to describe the contributions of traditional Korean medicine (TKM) to modern medicine and, in particular, cancer treatment. TKM suggests that cancer is an outcome of an imbalance of body, mind, and spirit; thus, it requires a multimodal treatment approach that involves lifestyle modification, herbal prescription, acupuncture, moxibustion, traditional exercise, and meditation to restore the balance. Old wisdoms in combination with modern science can find a new way to deal with the "emperor of all maladies."
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Affiliation(s)
- Seong Woo Yoon
- Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
| | - Jong Soo Jeong
- Department of Korean Internal Medicine, Kyung Hee University Korean Medicine Hospital at Gangdong, Seoul, Republic of Korea
| | - Ji Hye Kim
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Bharat B Aggarwal
- The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
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