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Jevotovsky DS, Suarez M, Chopra H, Marascalchi BJ. Peripheral nerve stimulation (PNS) of the phrenic nerve for intractable hiccups: a novel use case report. Reg Anesth Pain Med 2024:rapm-2024-105796. [PMID: 39106986 DOI: 10.1136/rapm-2024-105796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2024] [Accepted: 07/25/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Intractable hiccups, defined as those persisting for over 1 month, represent a rare but significant clinical challenge often associated with substantial morbidity and refractory to standard treatments. CASE PRESENTATION This case report describes the innovative use of phrenic nerve peripheral neuromodulation for managing chronic intractable hiccups in a 73-year-old male patient with a 6-year history of daily hiccups. Conventional treatments and interventional procedures had failed to provide lasting relief. Bilateral phrenic nerve peripheral nerve stimulation (PNS) placed under ultrasound guidance resulted in immediate and substantial improvement, with the patient's Hiccup Assessment Instrument score decreasing from 6/10 to 2/10. The patient experienced significant enhancements in speech and quality of life without complications. CONCLUSIONS This novel application of phrenic nerve PNS highlights its potential as a therapeutic strategy for intractable hiccups, underscoring their pathophysiologic involvement of the diaphragm and respiratory muscles. The findings suggest that phrenic nerve PNS could offer a viable treatment option for patients unresponsive to conventional therapies, warranting further research to establish its long-term efficacy and safety.
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Affiliation(s)
| | - Michael Suarez
- Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Harman Chopra
- Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Analysis of Acupoints Combination for Cancer-Related Anorexia Based on Association Rule Mining. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4251458. [PMID: 36304134 PMCID: PMC9596268 DOI: 10.1155/2022/4251458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/25/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022]
Abstract
We investigated the acupoint selection regulations and workable core acupoint combinations in cancer-related anorexia (CA) treatment. The Apriori algorithm, complemented by the FP-growth algorithm, was used to mine association rules based on retrieved randomized control trials (RCTs) and clinical control trials (CCTs). We searched the following databases for acupuncture treatment regimens for CA: PubMed, Embase, Cochrane Central, Web of Science, WanFang Data, VIP, China Journal Full-Text Database (CNKI), and SinoMed (CBM). We extracted acupoints prescriptions from the 27 enrolled RCTs and CCTs for analysis. There have been 38 acupoints refined from 27 prescriptions. The pinnacle three regularly chosen acupoints were Zusanli (ST36), Zhongwan (RN12), and Sanyinjiao (SP6). We investigated 10 association rules, and the consequences confirmed that {RN4} ≥ {RN12}, {PC6} ≥ {ST36}, {RN12, SP6} ≥ {RN4}, {HT7} ≥ {RN12}, and {DU20} ≥ {RN12} had been the most frequent associated rules in the adoption literature. Zusanli (ST36), Sanyinjiao (SP6), Guanyuan (RN4), Zhongwan (RN12), Neiguan (PC6), Shenmen (HT7), and Baihui (DU20) would be regarded as acupuncture prescriptions in the treatment of CA.
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Zhang Y, Jiang X, Wang Z, He M, Lv Z, Yuan Q, Qin W. Efficacy of acupuncture for persistent and intractable hiccups: A protocol for systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2021; 100:e24879. [PMID: 33663115 PMCID: PMC7909209 DOI: 10.1097/md.0000000000024879] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Persistent and intractable hiccups are a common clinical symptom that cause considerable physical pain to patients and severely damage their quality of lives. An increasing number of studies have demonstrated that acupuncture applied at acupoints dominated by Cuanzhu (BL2) can be used as one of the nonpharmacological therapies for controlling intractable hiccups. However, there is insufficient evidence evaluating the safety and effectiveness of those interventions. Therefore, this study is intended to conduct a systematic review and meta-analysis to provide evidence for a further study investigating alternative treatment options for persistent and intractable hiccups. METHODS AND ANALYSIS Randomized controlled trials (RCTs) of adult patients aged >18 years who meet the criteria for intractable hiccup diagnosis will be included, regardless of gender, nationality, and education level. Eight electronic databases will be searched, including 4 Chinese databases (CNKI, SinoMed, Wanfang Database, and Chinese Scientific Journal Database), 4 English databases (Web of Science, Medline, Embase, and Cochrane Library), from their date of establishment to September 2020. Two independent reviewers will evaluate the title summary for each RCT. Disagreements will be discussed with a third commentator. Data integration, heterogeneity analysis, subgroup analysis, and sensitivity analysis, will be performed using R-3.3.2 software. The RevMan 5.3 software will be used for the meta-analysis, and the "risk of bias" assessment will be conducted based on the methodological quality of the included trials recommended by the Cochrane Handbook 5.1. The quality evaluation of this study will be completed by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). RESULTS This study will summarize all the selected trials aimed at estimating the effectiveness, as well as safety, of applying acupuncture at acupoints dominated by Cuanzhu (BL2) to persistent and intractable hiccups. CONCLUSIONS This systematic review will provide evidence to assess the validity and safety of applying acupuncture at acupoints dominated by Cuanzhu (BL2) for persistent and intractable hiccups, which may provide clinicians with more choices in the treatment of this disease. PROSPERO REGISTRATION NUMBER CRD42020114900.
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Affiliation(s)
- Yu Zhang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Xudong Jiang
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Zhijie Wang
- Shanxi Province Hospital of Traditional Chinese Medical, Taiyuan
| | - Mingming He
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
| | - Zimeng Lv
- The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei
| | - Qing Yuan
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Weixun Qin
- The Fourth Department of Acupuncture and Moxibustion, Shaanxi Traditional Chinese Medicine Hospital, Xi’an
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Kako J, Kajiwara K, Kobayashi M. Traditional Influences Within Studies of Nonpharmacological Interventions for Hiccups in Adults: A Systematic Review. J Pain Symptom Manage 2020; 60:e34-e37. [PMID: 32688013 DOI: 10.1016/j.jpainsymman.2020.07.007] [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] [Received: 05/30/2020] [Revised: 07/11/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Jun Kako
- Division of Nursing Science, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
| | - Kohei Kajiwara
- Japanese Red Cross Kyushu International College of Nursing, Fukuoka, Japan
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Ma R, Li Y, Liu S, Zhao W. Acupuncture for cancer-related hiccups: Protocol for a systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore) 2020; 99:e19973. [PMID: 32443299 PMCID: PMC7253799 DOI: 10.1097/md.0000000000019973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/20/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Hiccups are involuntary contractions of the diaphragm and intercostal muscles, which lead to sudden contractions of the glottis. CAM, such as acupuncture is commonly used and stimulation of the vagus nerve and interference with phrenic nerve conduction are also used to treat hiccups. However, there is little evidence on the effectiveness of acupuncture for cancer-related hiccups. We will plan to conduct a systematic review and meta-analysis of RCTs to evaluate the current evidence on the effects of acupuncture for cancer-related hiccups. METHOD The following databases will be searched: PubMed, the Cochrane Library, Wanfang Data, China National Knowledge Infrastructure (CNKI), SinoMed, VIP, Medline, Embase, and EI. Randomized controlled trials will be included to evaluate the effect and safety of acupuncture on cancer patients with hiccups. We will set standards for the curative effect on the basis of the standard of cure and improvement for clinical disease diagnoses. The risk of bias will be assessed by the Cochrane risk of bias tool. We will conduct a meta-analysis and sensitivity analysis, as well as a subgroup analysis if high heterogeneity is present, using Revman 5.3. We will use funnel plots to identify potential reporting biases. We will test asymmetry using Egger test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) will be used to evaluate the quality of evidence. RESULTS This study will be to assess the effect and safety of acupuncture for cancer-related hiccups. CONCLUSIONS This study will assess the effect of acupuncture for cancer-related hiccups and provide reliable evidence for the choice of treatments.
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Affiliation(s)
- Rui Ma
- Department of Otolaryngology, the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine
| | - Yan Li
- Department of Otolaryngology, the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine
| | - Songjiang Liu
- First affiliated Hospital, Heilongjiang University of Chinese Medicine
| | - Wenhui Zhao
- Harbin Medical University Cancer Hospital, Harbin, China
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Reichenbach ZW, Piech GM, Malik Z. Chronic Hiccups. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2020; 18:43-59. [PMID: 31974814 DOI: 10.1007/s11938-020-00273-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Nearly 4000 patients will be admitted to hospital in the US this year for hiccups. Hiccups are controlled by a complex reflex arc between peripheral receptors and the brainstem. Any disruption along this pathway may produce hiccups. Typically, hiccups resolve spontaneously but in certain pathologies symptoms may persist. Persistent hiccups may be considered a sign of underlying pathology. The most common cause involves GERD. RECENT FINDINGS Based on etiologies, studies have shown that first-line therapy should use a proton pump inhibitor (PPI) and involve appropriate gastrointestinal consultation. If symptoms persist, other etiologies such as central causes need to be explored. SUMMARY We review the pathophysiology of hiccups including multiple causes and the appropriate work up for each. We review several studies examining new treatments, both pharmacological and interventional, that may help patients. Initial therapy should still involve a PPI but several new therapies may be beneficial.
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Affiliation(s)
- Zachary Wilmer Reichenbach
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
- Center for Substance Abuse Research (CSAR), Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Gregory M Piech
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA
| | - Zubair Malik
- Department of Gastroenterology, Lewis Katz School of Medicine at Temple University Hospital, 3401 N. Broad St., 8th floor Parkinson Pavilion, Philadelphia, PA, 19140, USA.
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Abstract
PURPOSE OF REVIEW Singultus or hiccups (HU) is a common, usually temporary, event. Its potentially serious consequences are often overlooked. This review explores published evidence describing HU burden (clinical, economic, and quality of life [QoL] consequences) across patient populations. RECENT FINDINGS Literature review identified 81 articles (including 57 individual case reports). We extracted relevant information to better understand the burden of HU and to identify knowledge gaps for future study. HU are physiologic events that can complicate existing medical conditions and treatments regardless of duration. Relatively short episodes can have devastating consequences in patients who have pre-existing conditions. HU appear to impact physical and psychological health, diminish QoL, increase healthcare resource use, and increase costs. A better understanding of HU burden is needed.
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Li XB, Wu DJ, Yang MC. Acupuncture for hiccups: A systematic review protocol of high-quality randomized trials. Medicine (Baltimore) 2019; 98:e18343. [PMID: 31860989 PMCID: PMC6940168 DOI: 10.1097/md.0000000000018343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 11/13/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND A Hiccup is a common disease that often occurs along with other chronic or acute conditions. At present, there is a lack of feasible therapies for hiccups, and acupuncture is a treatment method with enormous clinical practice worldwide. METHODS Based on a pre-defined search strategy, we searched seven databases and screened them by two independent investigators, without language and publication status restriction from inception to date. We use the pre-set form to incorporate data and utilize Revman software to synthesize data. We will evaluate the risk of bias in the inclusion of the study based on the Cochrane 'Risk of bias' assessment tool. The quality of the evidence will be evaluated according to the GRADEpro software. RESULTS This systematic review will evaluate the efficacy and safety of acupuncture treatment for hiccups. The entire process will be referred to the Cochrane handbook recommended by the Cochrane Collaboration. CONCLUSION This review will provide systematic evidence to summarize whether acupuncture is an effective intervention in the treatment of hiccup.
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Affiliation(s)
- Xiao-Bing Li
- Department of Gastroenterology, The First People's Hospital of Pinghu City, Jiaxing
| | - Dong-Jie Wu
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
| | - Min-Chun Yang
- Department of Chinese Medicine, Zhejiang Hospital, Hangzhou, China
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Yang H, Zhang R, Zhou J, Cheng Y, Li J, Xiao Q, Yin Z, Xu G, Zhao L, Liang F. Acupuncture therapy for persistent and intractable hiccups: Protocol of a systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17561. [PMID: 31689761 PMCID: PMC6946359 DOI: 10.1097/md.0000000000017561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 09/19/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Persistent and intractable hiccups bring serious inconvenience to patients' work and daily life, and impair their quality of life. Relevant studies showed that acupuncture therapy might be effective in treating persistent and intractable hiccups. However, there is no consistent conclusion so far. The aim of our research is to investigate the safeties and effectiveness of acupuncture in treating patients with persistent and intractable hiccups. METHODS We will search randomized controlled trials (RCTs) using acupuncture therapy to treat persistent and intractable hiccups in the following 6 English electronic databases and 3 Chinese electronic databases: MEDLINE, EMBASE, the Cochrane Library, Web of Science, PsycINFO, Allied and Alternative Medicine (AMED), Chinese National Knowledge Infrastructure (CNKI), Chinese Scientific Journals Database (VIP) and Wanfang data. The cure rate and the total effective rate will be considered as the primary outcomes. Complete cessation within a given period post-treatment of hiccups, changes in frequency or intensity of hiccups, concomitant symptom score, and adverse events will be considered as secondary outcomes. We will use Endnote software 9.1 for studies selection, Review Manager software 5.3, and STATA 13.0 software for analysis and synthesis. RESULTS we will synthesize current studies to evaluate the the safeties and effectiveness of acupuncture for persistent and intractable hiccups. CONCLUSION Our study will provide evidence of acupuncture therapy for persistent and intractable hiccups.
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Affiliation(s)
- Han Yang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Rufei Zhang
- Affiliated Sichuan Provincial Rehabilitation Hospital of Chengdu University of TCM
| | - Jun Zhou
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Ying Cheng
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Juan Li
- College of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, China
| | - Qiwei Xiao
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Zihan Yin
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Guixing Xu
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Ling Zhao
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
| | - Fanrong Liang
- College of Acupuncture and Moxibustion and Tuina, Chengdu University of Traditional Chinese Medicine
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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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Xu J, Qu Y, Yue Y, Zhao H, Gao Y, Peng L, Zhang Q. Treatment of persistent hiccups after arthroplasty: effects of acupuncture at PC6, CV12 and ST36. Acupunct Med 2019; 37:72-76. [PMID: 30843420 DOI: 10.1136/acupmed-2016-011304] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE There are multiple treatment options for hiccups, including non-pharmacological therapies, but little evidence of superiority of one treatment over another. The aim of this study was to investigate the effects of acupuncture on persistent hiccups after arthroplasty. METHODS From April 2010 to December 2015, 15 patients with primary unilateral total hip/knee arthroplasty were diagnosed with persistent hiccups and given acupuncture at PC6, CV12 and ST36. Each acupuncture session lasted 30 min. The total number of treatment sessions was determined by the persistence of symptoms, but acupuncture was administered no more than three times over the course of a week. The hiccups assessment instrument (HAI) was used to assess the severity of hiccups pre-treatment and post-treatment. Adverse events were also recorded. RESULTS Absolute resolution was observed in all 15 patients after less than three acupuncture sessions. Of these, 10 patients required only one acupuncture session, 3 patients required two sessions and 2 patients required three sessions. The HAI score improved after each round of acupuncture treatment (P<0.05). The average HAI score improved significantly post-acupuncture compared to baseline values pre-treatment (P<0.05). Symptoms accompanying the hiccups included pain in the diaphragmatic area (five patients), mild dyspnoea (three patients), dysphagia (two patients) and nausea/vomiting (one patient). All these accompanying symptoms disappeared at the point of resolution of the hiccups. There were no adverse effects related to acupuncture during the study period. CONCLUSION Based on our results, acupuncture may represent a potential treatment option for hiccups after arthroplasty. Caution must be exercised, however, given the lack of a control group. Accordingly, randomised controlled trials will be required to verify the efficacy and effectiveness of acupuncture for the treatment of hiccups.
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Affiliation(s)
- Jianda Xu
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
| | - Yuxing Qu
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
| | - Yongbin Yue
- 2 Department of Orthopaedics, Linyi People's Hospital, Linyi, Shandong Province, China
| | - Hong Zhao
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
| | - Yi Gao
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
| | - Libo Peng
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
| | - Qi Zhang
- 1 Department of Orthopaedics, Changzhou Traditional Chinese Medical Hospital, Changzhou, Jiangsu Province, China
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Abstract
RATIONALE Pathophysiologic mechanisms of the central nervous system, such as stroke, can be associated with intractable hiccups. Intractable hiccups can be associated with potentially fatal consequences, thus requiring safe management in an inpatient rehabilitation facility (IRF) setting with a multidisciplinary team approach to optimize mobility and feeding. PATIENT CONCERNS A 49-year-old male presented to the emergency department with complaints of vomiting and dizziness. DIAGNOSES Head computed tomography revealed moderate acute inferior cerebellar infarct in the territory of the posterior inferior cerebellar artery. He required a percutaneous endoscopic gastrostomy tube for feeding and developed severe intractable hiccups which he rated 7/10 on the hiccup assessment instrument (HAI) on IRF admission. Functional independence measure (FIM) score for transfers was 2 (maximum assist), walking was 1 (total assist), stairs were not attempted on IRF admit due to safety concerns, and feeding (eating) was 1 (total assist). INTERVENTIONS Anterior and posterior diaphragm kinesio taping was applied on day 6 of IRF physical therapy in an attempt to inhibit diaphragm spasm and intractable hiccups given that pharmacologic interventions had not been effective up to that point (Table 3). OUTCOMES The HAI decreased from 7/10 on day 6 of IRF physical therapy to 0/10 on day 8. The taping was reapplied every 3 to 5 days. On IRF day 9, his diet was advanced to a regular consistency with extra moisture and thin liquids. On day 21, hiccup severity remained 0/10 on the HAI, while FIM score for transfers was 4 (minimal assist), walking was 4 (minimal assist), stairs was 4 (minimal assist), and feeding (eating) was 7 (independent). LESSONS Diaphragm kinesio taping is a very effective treatment at reducing hiccup severity in a patient after ischemic stroke, while at the same time reducing burden of care for caregivers per FIM score improvement and improving diet to that of regular consistency with extra moisture and thin liquids.
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Son HW, Cho YW, Kim YU, Shin YJ. Stellate ganglion block for the treatment of intractable hiccups - A case report -. Anesth Pain Med (Seoul) 2018. [DOI: 10.17085/apm.2018.13.2.192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Hee-won Son
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young Woo Cho
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Young-ung Kim
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Yong-joon Shin
- Department of Anesthesiology and Pain Medicine, Ulsan University Hospital, Ulsan, Korea
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Yue J, Liu M, Li J, Wang Y, Hung ES, Tong X, Sun Z, Zhang Q, Golianu B. Acupuncture for the Treatment of Hiccups following Stroke: A Systematic Review and Meta-Analysis. Acupunct Med 2017; 35:2-8. [DOI: 10.1136/acupmed-2015-011024] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/04/2022]
Abstract
Objectives To assess the effectiveness and safety of acupuncture for hiccups following stroke. Methods Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials. Results Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies. Conclusions Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.
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Affiliation(s)
- Jinhuan Yue
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
- Department of Anesthesia, Stanford University, Stanford, California, USA
| | - Ming Liu
- College of Basic Medical Sciences, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Jun Li
- Department of Personnel, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yuming Wang
- Department of Rehabilitation, Chinese Medicine Hospital of Daqing, Daqing, China
| | - E-Sing Hung
- Department of Education, Five Branches University, California, USA
| | - Xin Tong
- Department of Medical Clinic, Atlantic Institute of Oriental Medicine, Florida, USA
| | - Zhongren Sun
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Qinhong Zhang
- Department of Acupuncture and Moxibustion, College of Acupuncture and Moxibustion, Heilongjiang University of Chinese Medicine, Harbin, China
- Department of Anesthesia, Stanford University, Stanford, California, USA
| | - Brenda Golianu
- Department of Anesthesia, Stanford University, Stanford, California, USA
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15
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Acupuncture: could it become everyday practice in oncology? Contemp Oncol (Pozn) 2016; 20:119-23. [PMID: 27358589 PMCID: PMC4925730 DOI: 10.5114/wo.2016.60065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 07/16/2014] [Indexed: 12/04/2022] Open
Abstract
Acupuncture is a complementary and alternative medical treatment (CAM) which is increasingly used in the care of cancer patients. Traditionally derived from Chinese medicine, nowadays it is becoming a part of evidence-based oncology. The use of acupuncture in these patients has been recommended by the American Cancer Society (ACS) for the treatment of side effects associated with conventional cancer therapy and cancer-related ailments. A growing body of evidence supports the use of acupuncture in the treatment of cancer-induced pain and chemotherapy-related nausea and vomiting. Also other indications, such as xerostomia, fatigue, hot flashes, anxiety and peripheral neuropathy, are being constantly evaluated. This article summarizes the most important discoveries related to the possible usefulness of this method in contemporary oncology. Emphasis is placed on the results of randomized controlled trials with an adequate level of evidence. However, explanation of the mechanisms responsible for these effects requires confirmation in further studies with an adequate level of evidence. In future, acupuncture may become an interesting and valuable addition to conventional medicine.
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16
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Groninger H, Cheng MJ. A case of persistent hiccups successfully managed with pregabalin. PROGRESS IN PALLIATIVE CARE 2014. [DOI: 10.1179/1743291x14y.0000000117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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17
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Thompson AN, Ehret Leal J, Brzezinski WA. Olanzapine and Baclofen for the Treatment of Intractable Hiccups. Pharmacotherapy 2013; 34:e4-8. [DOI: 10.1002/phar.1378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Amy N. Thompson
- Department of Clinical Pharmacy and Outcome Sciences; South Carolina College of Pharmacy; Medical University of South Carolina; Charleston South Carolina
| | - Julie Ehret Leal
- Clinical Pharmacy Specialist in Ambulatory Care; Department of Pharmacy Services; Medical University of South Carolina; Charleston South Carolina
| | - Walter A. Brzezinski
- College of Medicine; Medical University of South Carolina; Charleston South Carolina
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18
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Rizzo C, Vitale C, Montagnini M. Management of intractable hiccups: an illustrative case and review. Am J Hosp Palliat Care 2013; 31:220-4. [PMID: 23408373 DOI: 10.1177/1049909113476916] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Often thought of as a benign and self-limited condition, hiccups can become persistent or intractable, and thus be associated with substantial morbidity and distress. In such cases, an underlying etiology is often present, and may be overlooked. Debilitating hiccups can present a major challenge to optimal symptom management. Various causes of protracted hiccups have been identified including metabolic abnormalities, central nervous system pathology, malignancy, medications, and disorders attributed to cardiac, pulmonary and gastrointestinal etiologies. We present a case of intractable hiccups in a patient with an advanced hematological malignancy and review specific therapies for the management of persistent hiccups.
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Affiliation(s)
- Camielle Rizzo
- 1Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, MI, USA
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19
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Moretto EN, Wee B, Wiffen PJ, Murchison AG. Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev 2013; 2013:CD008768. [PMID: 23440833 PMCID: PMC6452787 DOI: 10.1002/14651858.cd008768.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Persistent and intractable hiccups (typically defined as lasting for more than 48 hours and one month respectively) can be of serious detriment to a patient's quality of life, although they are relatively uncommon. A wide range of pharmacological and non-pharmacological interventions have been used for the treatment of persistent and intractable hiccups. However, there is little evidence as to which interventions are effective or harmful. OBJECTIVES The objective of this review was to evaluate the effectiveness of pharmacological and non-pharmacological interventions used in the treatment of persistent and intractable hiccups of any aetiology in adults. SEARCH METHODS Studies were identified from the following databases: CENTRAL, CDSR, DARE, MEDLINE, EMBASE, CINAHL, PsychINFO and SIGLE (last search March 2012). The search strategy for all the databases searched was based on the MEDLINE search strategy presented in Appendix 1. No additional handsearching of journals was undertaken. Investigators who are known to be carrying out research in this area were contacted for unpublished data or knowledge of the grey literature. SELECTION CRITERIA Studies eligible for inclusion in this review were randomised controlled trials (RCTs) or controlled clinical trials (CCTs). INCLUSION CRITERIA adults (over 18 years old) diagnosed with persistent or intractable hiccups (hiccups lasting more than 48 hours), treated with any pharmacological or non-pharmacological intervention. EXCLUSION CRITERIA less than ten participants; no assessment of change in hiccup frequency or intensity in outcome measures. DATA COLLECTION AND ANALYSIS Two independent review authors assessed each abstract and title for relevance. Disagreement on eligibility was resolved by discussion. Where no abstract was available the full paper was obtained and assessed. We obtained full copies of the studies which met the inclusion criteria for further assessment. Two review authors independently collected data from each appropriate study and entered them into the software Review Manager 5. Two independent review authors assessed the risk of bias using the RevMan 5 'Risk of bias' table following guidance from the Cochrane Handbook of Systematic Reviews of Interventions (Higgins 2009). MAIN RESULTS A total of four studies (305 participants) met the inclusion criteria. All of these studies sought to determine the effectiveness of different acupuncture techniques in the treatment of persistent and intractable hiccups. All four studies had a high risk of bias, did not compare the intervention with placebo, and failed to report side effects or adverse events for either the treatment or control groups. Due to methodological differences we were unable to perform a meta-analysis of the results. No studies investigating pharmacological interventions for persistent and intractable hiccups met the inclusion criteria. AUTHORS' CONCLUSIONS There is insufficient evidence to guide the treatment of persistent or intractable hiccups with either pharmacological or non-pharmacological interventions.The paucity of high quality studies indicate a need for randomised placebo-controlled trials of both pharmacological and non-pharmacological treatments. As the symptom is relatively rare, trials would need to be multi-centred and possibly multi-national.
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20
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Bredenoord AJ. Management of belching, hiccups, and aerophagia. Clin Gastroenterol Hepatol 2013; 11:6-12. [PMID: 22982101 DOI: 10.1016/j.cgh.2012.09.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 08/27/2012] [Accepted: 09/04/2012] [Indexed: 02/07/2023]
Abstract
Although belching and hiccups are regarded as normal behaviors, they can occur at high frequency or become persistent, becoming bothersome and requiring medical care. Patients with excessive belching frequently have supragastric belches. Excessive belching should be treated as a behavioral disorder. Persistent hiccups, however, can be the first presentation of a serious disorder that requires extensive diagnostic testing. When no cause is found, only the symptoms can be treated. Aerophagia is an episodic or chronic disorder in which patients (children and adults) swallow large quantities of air, which accumulate in the gastrointestinal tract to cause abdominal distention and bloating. These patients should not undergo explorative laparotomy because they do not have ileus. New treatment approaches are needed for patients with aerophagia.
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Affiliation(s)
- Albert J Bredenoord
- Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
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21
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Acupuncture for cancer patients suffering from hiccups: A systematic review and meta-analysis. Complement Ther Med 2012; 20:447-55. [DOI: 10.1016/j.ctim.2012.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/26/2012] [Accepted: 07/27/2012] [Indexed: 11/18/2022] Open
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22
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Menon M. Gabapentin in the treatment of persistent hiccups in advanced malignancy. Indian J Palliat Care 2012; 18:138-40. [PMID: 23093831 PMCID: PMC3477368 DOI: 10.4103/0973-1075.100839] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hiccups are a distressing symptom in advanced malignancies in the setting of palliative care. A case of persistent hiccups treated with oral Gabapentin is presented to highlight the clinical and ethical dilemmas in patients with advanced malignancy. A 70-year-old male with non-small cell cancer of the lung with widespread metastases presented with persistent hiccups. The patient and family sought only symptom relief from home, without hospitalization or further investigations. The hiccups were dramatically relieved by oral Gabapentin, highlighting the recent reports that mention this molecule as being useful for hiccups. Gabapentin is a simple tool that may be utilized by palliative care physicians to relieve hiccups in advanced malignancies.
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Affiliation(s)
- Mahesh Menon
- Department of Pain Medicine and Palliative Care Services, Kokilaben Dhirubhai Ambani Hospital, Four bungalows, Andheri (West), Mumbai-53, India
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23
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Calsina-Berna A, García-Gómez G, González-Barboteo J, Porta-Sales J. Treatment of Chronic Hiccups in Cancer Patients: A Systematic Review. J Palliat Med 2012; 15:1142-50. [DOI: 10.1089/jpm.2012.0087] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Agnès Calsina-Berna
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- San Diego Hospice, Institute for Palliative Medicine, San Diego, California
| | | | - Jesús González-Barboteo
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Josep Porta-Sales
- Palliative Care Service, Institut Català d'Oncologia, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Palliative Care Research Group, Bellvitge Biomedical Research Institute, Universitari de Bellvitge Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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24
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Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer 2012; 20:3009-11. [DOI: 10.1007/s00520-012-1533-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
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25
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Lu W, Rosenthal DS. Recent advances in oncology acupuncture and safety considerations in practice. Curr Treat Options Oncol 2011; 11:141-6. [PMID: 21103962 DOI: 10.1007/s11864-010-0126-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Oncology acupuncture is a new and emerging field of research. Recent advances from published clinical trials have added evidence to support the use of acupuncture for symptom management in cancer patients. Recent new developments include (1) pain and dysfunction after neck dissection; (2) radiation-induced xerostomia in head and neck cancer; (3) aromatase inhibitor-associated arthralgia in breast cancer; (4) hot flashes in breast cancer and prostate cancer; and (5) chemotherapy-induced neutropenia in ovarian cancer. Some interventions are becoming a non-pharmaceutical option for cancer patients, while others still require further validation and confirmation. Meanwhile, owing to the rapid development of the field and increased demands from cancer patients, safety issues concerning oncology acupuncture practice have become imperative. Patients with cancer may be at higher risk developing adverse reactions from acupuncture. Practical strategies for enhancing safety measures are discussed and recommended.
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Affiliation(s)
- Weidong Lu
- Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, SW560, 44 Binney Street, Boston, MA 02115, USA.
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Najm RBWI. Literature Alert. Med Acupunct 2011. [DOI: 10.1089/acu.2010.0780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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