The use of motion sickness bands to control nausea and vomiting in a group of hospice patients

Objective: To explore the potential benefits of using motion sickness bands (MSBs) to control nausea and vomiting in a hospice-based patient population.

Methods: A nonblinded, yearlong observational study.

Results: From February 2003 to February 2004, 33 patients entered into the study. The mean age of the study cohort was 67 years, with a predominance of females to males and cancer as the most common admitting diagnosis. Twenty-nine of the 33 patients studied showed a positive response to the intervention for a response rate of 88 percent.

Conclusions: MSBs demonstrated efficacy in controlling nausea and vomiting in a group of hospice patients. Added benefits of patient empowerment and financial savings also were noted. Further study is warranted.

[The efficiency of Lyapko applicators usage in the treatment of patients with comorbidity of hypertension and chronic pancreatitis based on the heart rate variability]

Efficiency of the acupressure methodics of Lyapko applicators including in the treatment of patients with comorbidity of hypertension and chronic pancreatitis is estimated based on the study of the dynamics of the clinic and the state of autonomic nervous system using heart rate variability. The significant autonomic disorders were found in the studied group. More pronounced effect of this method of acupuncture was confirmed for the treatment of comorbidity of the studied pathologies, especially with regard to autonomic disorders.

Acupressure bands are effective in reducing radiation therapy-related nausea

Previous studies have shown that acupressure bands can reduce chemotherapy-related nausea. Patients' expectations of efficacy account for part of this outcome. We conducted a three-arm randomized clinical trial to investigate the effectiveness of acupressure bands in controlling radiation therapy-induced nausea and to test whether an informational manipulation designed to increase expectation of efficacy would enhance the effectiveness of the acupressure bands. Patients who experienced nausea at prior treatments were randomized to either standard care (Arm 1, n=29) or standard care plus acupressure bands with either neutral (Arm 2, n=30) or positive (Arm 3, n=29) information regarding the efficacy of the bands. Patients reported nausea for two days prior to randomization (baseline) and for five days following using a seven-point semantic rating scale (1=not nauseated to 7=extremely nauseated). Patients in Arms 2 and 3 combined reported greater reduction in average nausea than patients in Arm 1 (P=0.01; mean(bands)=0.70, mean(no bands)=0.10). This equates to a 23.8% decrease in nausea in the band groups compared to a 4.8% decrease in the control group, a 19% difference. The informational manipulation failed to alter efficacy expectations and there was no statistically significant difference in nausea between patients in Arms 2 and 3. Acupressure bands are an effective, low-cost, nonintrusive, well-accepted, and safe adjunct to standard antiemetic medication. An attempt to boost the efficacy of the acupressure bands by providing positive information was not successful.

Efficacy of wrists overnight compression (HT 7 point) on insomniacs: possible role of melatonin?

AIM

Insomnia is a major problem which decreases life quality. Many causes are involved with it and anxiety is often associated. The underlying mechanism is not completely understood, even though different factors seem to be associated. Among them melatonin and its circadian rhythm is thought to have an important role. In addition, acupressure and acupuncture are known to ameliorate insomnia and anxiety, when a specific wrist point is stimulated (HT 7 Shenmen). With these bases, the aim of the present study has been to evaluate the efficacy of an acupressure device, ''H7-insomnia control'', positioned on HT 7 points, during the night, in terms of general health and anxiety levels, together with the evaluation of sleep quality and the urinary melatonin metabolite 6-hydroxymelatonin sulphate determination, in a number of insomniacs.

METHODS

Forty patients with insomnia were divided into two groups and randomly received either the H7 or placebo treatments, in a double-blind protocol, for 20 nights. Before and after treatments every subject answered a series of questionnaires (General Health Questionnaire 28 items; State-Trait Anxiety Inventory; Pittsburgh Sleep Quality Index) and collected 24 h urines, divided into two samples of 12 h each. Urinary melatonin metabolite was then determined using a RIA method.

RESULTS

Data obtained indicate that the device H7-insomnia control is efficacious to ameliorate quality of sleep and reduce anxiety levels in insomniacs, at a higher extent than in the placebo group. In addition, the 24 hours urinary melatonin metabolite rhythm, obtained at the end of treatment, was considered as being normal in a higher percentage of H7-treated patients, with respect to the placebo group.

CONCLUSION

It is plausible to hypothesize that the wrist acupressure device might be considered a valid tool, without adverse effects since it does not contain pharmaceutical products, that is able to naturally ameliorate sleep quality in insomniacs, acting through a not jet completely clarified mechanism, that may involve melatonin.

Efficacy of HT 7 point acupressure stimulation in the treatment of insomnia in cancer patients and in patients suffering from disorders other than cancer

AIM

The induction of sleep would depend on interaction between gabaergic system and the pineal gland through its main hormone melatonin. Until few years ago benzodiazepines were the only drugs effective in the treatment of insomnia. Recently, however, both melatonin and acupressure have appear to be active in sleep disorders. The aim of study was to evaluate the efficacy of HT 7 point acupressure in insomnia.

METHODS

The study enrolled 25 patients affected by sleep disorders, 14 of whom had a neoplastic disease. They were treated by HT 7 stimulation for al least two consecutive weeks using a medical device named H7 Insomnia Control.

RESULTS

An improvement in the quality of sleep was achieved in 15/25 (60%) patients, with a more evident efficacy in cancer patients (11/14 [79%]).

CONCLUSION

This study confirms previous clinical data showing the efficacy of acupressure in the treatment of sleep disorders, particularly in cancer-related insomnia.

Acupressure and postoperative nausea and vomiting

Despite great strides during the preceding 3 decades, the ability to consistently eliminate postoperative nausea and vomiting (PONV) continues to elude anesthesia practitioners. The occurrence of PONV related to anesthesia and surgery prolongs hospital stays and increases healthcare costs. Protracted recovery times place constraints on patients, healthcare systems, and healthcare financiers. Many pharmacological antiemetics have been developed and are in use in the attempt to alleviate PONV. Side effects and cost profiles of many of these interventions, however, reinforce the broadly held belief that there remains opportunity for improvement. Because the Western culture almost exclusively favors evidence-based scientific practice and interventions, the search continues for an ideal, cost-effective, safe, and efficacious pharmacological agent to prevent PONV. Eastern culture, on the other hand, relies heavily on naturopathic remedies whose successful use has spanned thousands of years. Increasing attention has been given to the potential benefits of nonpharmacological intervention for the prevention of PONV in association with anesthesia care. Therefore, the purpose of this AANA Journal course will be to focus attention on what is known and what is unknown in the literature regarding use of the nonallopathic remedy of acupressure as a nonpharmacological alternative to commonly utilized antiemetic prophylaxis.

Acupressure wristbands for the prevention of postoperative nausea and vomiting in adults undergoing cardiac surgery

OBJECTIVE

To determine whether the application of acupressure bands would lead to a reduction in postoperative nausea and vomiting after cardiac surgery.

DESIGN

Prospective, randomized, double-blind clinical trial.

SETTING

University-affiliated tertiary care teaching hospital.

PARTICIPANTS

Adult patients undergoing cardiac surgery.

INTERVENTIONS

One hundred fifty-two patients were enrolled to receive either acupressure treatment (n = 75) or placebo (n = 77). All patients had acupressure bands placed on both wrists before induction of anesthesia; those in the treatment group had a bead placed in contact with the P6 point on the forearm.

MEASUREMENTS AND MAIN RESULTS

Patients were assessed for nausea, vomiting, and pain scores during the first 24 hours of the postoperative period. The incidences of nausea, vomiting, pain scores, and analgesic and antiemetic requirements were similar between the 2 groups. A subgroup analysis by gender implied that acupressure treatment may be effective only in female patients.

CONCLUSION

Acupressure treatment did not lead to a reduction in nausea, vomiting, or antiemetic requirements in patients after cardiac surgery.

Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial

OBJECTIVES

To assess the effectiveness of continuous PC6 acupressure as an adjunct to antiemetic drug therapy in the prevention and control of nausea and vomiting in the first 24h after myocardial infarction (MI).

DESIGN

Partially randomised, partially blinded placebo-controlled, exploratory clinical study.

SETTING

Coronary Care Unit, Torbay Hospital, Torquay, Devon.

PARTICIPANTS

A total of 301 consecutive patients (205 males, 96 females) admitted following acute MI.

INTERVENTION

The first 125 patients recruited received no additional intervention. Subsequent patients were randomised to receive either continuous PC6 acupressure or placebo acupressure.

OUTCOME MEASURES

(1) Incidence of post-MI nausea and/or vomiting, (2) severity of symptoms, (3) use of antiemetic drugs, over 24h.

RESULTS

There were no significant differences between the groups for the whole 24-h treatment period. However, the PC6 acupressure group experienced significantly lower incidence of nausea and/or vomiting during the last 20h (18%), compared with the placebo (32%) or control (43%) groups (P<0.05). The severity of symptoms and the need for antiemetic drugs were also reduced in the acupressure group, but these differences were not statistically significant.

CONCLUSIONS

Continuous 24-h PC6 acupressure therapy as an adjunct to standard antiemetic medication for post-MI nausea and vomiting is feasible and is well accepted and tolerated by patients. In view of its benefits, further studies are worthwhile using earlier onset of treatment.

Comparative efficacy of acustimulation (ReliefBand) versus ondansetron (Zofran) in combination with droperidol for preventing nausea and vomiting

BACKGROUND

Antiemetic drugs are costly, are associated with variable efficacy, and can produce unwanted side effects when used for prophylaxis against postoperative nausea and vomiting. This clinical study was designed to compare the efficacy of transcutaneous electrical acupoint stimulation using a ReliefBand to ondansetron (Zofran) when utilized alone or in combination for preventing postoperative nausea and vomiting after plastic surgery.

METHODS

A single-center, randomized, double-blind, placebo- and sham-controlled study design was conducted to compare three prophylactic antiemetic treatment regimens in 120 outpatients undergoing plastic surgery procedures with routine low-dose droperidol prophylaxis: (1) ondansetron (n = 40), 4 mg intravenous ondansetron and a sham ReliefBand; (2) acustimulation (n = 40), 2 ml intravenous saline and an active ReliefBand; and (3) combination (n = 40), 4 mg intravenous ondansetron and an active ReliefBand. The incidences of postoperative nausea and vomiting, as well as the need for "rescue" antiemetics, were determined at specific time intervals for up to 72 h after surgery. The outcome variables assessed included recovery times, quality of recovery score, time to resumption of normal diet, and patient satisfaction with the prophylactic antiemetic therapy.

RESULTS

Use of the ReliefBand in combination with ondansetron significantly reduced nausea (20 vs. 50%), vomiting (0 vs. 20%), and the need for rescue antiemetics (10 vs. 37%) compared with ondansetron alone at 24 h after surgery. Furthermore, the ability to resume a normal diet (74 vs. 35%) within 24 h after surgery was significantly improved when the ReliefBand was used to supplement ondansetron (vs. ondansetron alone). Finally, the quality of recovery (90 +/- 10 vs.70 +/- 20) and patient satisfaction (94 +/- 10 vs. 75 +/- 22) scores were significantly higher in the combination group the ondansetron group. There were no significant differences between the ReliefBand and ondansetron when administered as adjuvants to droperidol for antiemetic prophylaxis.

CONCLUSIONS

The ReliefBand compared favorably to ondansetron (4 mg intravenously) when used for prophylaxis against postoperative nausea and vomiting. Furthermore, the acustimulation device enhanced the antiemetic efficacy of ondansetron after plastic surgery.

A randomized clinical trial of the effectiveness of an acupressure device (relief brief) for managing symptoms of dysmenorrhea

OBJECTIVES

To develop and test the safety and effectiveness of an acupressure garment (the Relief Brief) in decreasing the pain and symptom distress associated with dysmenorrhea.

DESIGN

A randomized clinical trial applied a 2 (Relief Brief use or control group) x 3 (baseline and two treatment measurement occasions) mixed factorial design.

PARTICIPANTS

Sixty-one (61) women with moderately severe primary dysmenorrhea were randomly assigned to the standard treatment control group or the Relief Brief acupressure device group after one pretreatment menses, with 58 women reporting the effect on their pain during two post-treatment menstrual cycles. The acupressure garment: The Relief Brief is a cotton Lycra panty brief with a fixed number of lower abdominal and lower back latex foam acupads that provide pressure to dysmenorrhea-relieving Chinese acupressure points.

OUTCOME MEASURES

Menstrual pain severity (worst pain and symptom intensity), pain medication use, and adverse effects were analyzed using between-groups and repeated measures analyses of treatment effects. Statistical and clinical significance criteria were applied a priori.

RESULTS

For pain measures and pain medication use, the group main effect, time main effect and group x time interaction were statistically significant. Median pain medication use, the same for both groups at baseline (6 pills per day), dropped to 2 pills per day for the Relief Brief group but remained at 6 pills for the control group at the second treatment cycle. Predicted clinical significance criteria were surpassed: almost all (90%) women wearing the Relief Brief obtained at least a 25% reduction in menstrual pain severity (a 2-3 point drop) compared to only 8% of the control group (z = 6.07; p < 0.05). Relief Brief use was associated with at least a 50% decline in menstrual pain symptom intensity in more than two thirds of the women.

CONCLUSIONS

An acupressure device is an effective and safe nonpharmacologic strategy for the treatment of primary dysmenorrhea. With design modifications, it could serve as a main treatment modality for women who suffer from primary dysmenorrhea and do not wish to or cannot use the conventional pharmacologic agents. In addition, this acupressure device may serve as an adjuvant therapy to medication in more severe cases of dysmenorrhea.

Safe, successful nausea suppression in early pregnancy with P-6 acustimulation

OBJECTIVE

To evaluate the safety and effectiveness of P-6 acustimulation for the relief of nausea and vomiting associated with early pregnancy.

STUDY DESIGN

Forty-one patients were treated with a P-6 acustimulation device at the Division of Maternal-Fetal Medicine, Eastern Virginia Medical School. Pretreatment nausea severity, posttreatment nausea relief and device effectiveness were patient rated using a 1-5 scale. All neonates were evaluated for congenital abnormalities.

RESULTS

Pretreatment nausea severity scores for treated patients averaged 4.2, with most severe and debilitating nausea rated 5. Posttreatment device effectiveness averaged 4.2, with significant or complete relief rated 5. Device ease of use averaged 4.3, with very easy to use rated 5. No congenital abnormalities were found.

CONCLUSION

Because current pharmacologic treatments for nausea in early pregnancy are not consistent, efficacious or without unwanted side effects or increased teratogenic risks, acustimulation of P-6 in pregnancy may prove to be a significant therapeutic alternative.

The effects of acupressure on the incidence of postoperative nausea and vomiting in postsurgical patients

Postoperative nausea and vomiting (PONV) is one of the most common postoperative complications. Aside from pharmacological interventions, other complementary healing modalities have been introduced to assist patients in decreasing PONV and improving postoperative outcomes. This study examined acupressure as a potentially holistic and safe complement to the more traditional approach of using drugs to prevent and/or relieve nausea and vomiting in the postoperative patient. Acupressure involves constant pressure (without puncture of the skin) on the Nei Guan acupuncture points through the use of a British product called Sea-Bands (Sea Band UK Ltd, Leics, England). These bands are made of elasticated fabric, with a small round plastic button inside. A quasi-experimental research design was used to examine the effects of unilateral and bilateral application of acupressure on 157 patients who are prone to PONV: postgynecological, postplastic, and posturological surgery patients. The incidence of PONV was determined through retrospective chart reviews. The hypothesis was that there would be a difference in the incidence of PONV between 5 groups: group 1 (Sea-Bands with acupressure on both wrists), group 2 (Sea-Bands with acupressure on one wrist), group 3 (wristband without acupressure on both wrists), group 4 (wristband without acupressure on one wrist), and group 5 (no wristband). This hypothesis was examined by using a one-way analysis of variance (ANOVA); it was not supported. Neither unilateral nor bilateral application of acupressure significantly affected the incidence of nausea and vomiting. These findings must be viewed with caution, however, because power analysis showed low effect sizes and an inadequate sample size. Further research is recommended with a larger sample size. This study has made perianesthesia nurses more aware of other complementary modalities to assist patients with nausea and vomiting.

Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study

OBJECTIVE

To find out whether acupressure wristband can alleviate nausea and vomiting in early pregnancy.

DESIGN

Double-blind, placebo-controlled study.

SUBJECTS

97 women with mean gestational length completed 8-12 weeks.

MAIN OUTCOME MEASURES

Symptoms were recorded according to intensity, duration and nature of complaints.

RESULTS

71% of women in the intervention group reported both less intensive morning sickness and reduced duration of symptoms. The same tendency was seen in the placebo group, with 59% reporting less intensity and 63% shorter duration of symptoms. However, a significance level of 5% was reached only in the case of duration of symptoms, which was reduced by 2.74 hours in the intervention group compared to 0.85 hours in the placebo group (p = 0.018).

CONCLUSIONS

Acupressure wristband might be an alternative therapy for morning sickness in early pregnancy, especially before pharmaceutical treatment is considered.

Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy

OBJECTIVE

To determine the effect of continuous acupressure at P6 applied by Sea-Bands with acupressure buttons on the frequency and severity of nausea and vomiting of pregnancy during the 1 st trimester.

DESIGN

A two-group, quasi-experimental, posttest-only and posttest-repeated measure.

SETTING

Seventeen medical clinics or offices in southern Michigan.

PARTICIPANTS

Convenience sample of English-speaking, healthy pregnant women in their 1 st trimester, who had at least one episode of nausea, vomiting, or both before their prenatal clinic/office visit where they were recruited. After being accepted for the study, the women were randomly assigned to treatment or placebo groups.

INTERVENTION

Treatment group 1 applied SeaBands with acupressure buttons to both wrists for 4 days and removed the Sea-Bands for 3 subsequent days. Placebo group 2 applied the Sea-Bands without acupressure buttons to both wrists on the same time schedule as group 1.

MAIN OUTCOME MEASURE

Self-report daily diaries of the number of times per day that participants experienced nausea, the severity of nausea, the number of vomiting episodes per day, and the severity of vomiting.

RESULTS

Mann-Whitney U procedures revealed that the treatment group had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the Sea-Bands than did the placebo group. The treatment group also had significantly less frequency and severity of nausea and vomiting of pregnancy while wearing the SeaBands than when not wearing the Sea-Bands.

CONCLUSIONS

Sea-Bands with acupressure buttons are a noninvasive, inexpensive, safe, and effective treatment for the nausea and vomiting of pregnancy.

Simultaneous multiple-modality therapy for tension headaches and neck pain

Eighty-one patients suffering from neck pain and tension-type headaches were treated by the application of a unique physical therapy device combining transcutaneous electrical nerve stimulation (TENS), traction, massage, vibration, and acupressure applied to the forehead, posterior cervical spine, and scapula. The device employed eight silver silicone electrodes for modality application. Its safety and effectiveness were assessed by evaluating patients before and after treatment. No complication ensued. Statistical analysis of visual analog scales for neck pain and headache yielded p values < 0.0001. Analysis of fibromyalgia neck and shoulder trigger points with three controls gave nonsignificant results. Conclusions were that 1) the device is safe and effective as judged by subjective patient input and 2) fibromyalgia trigger points are unaffected by the treatments. More objective measures are needed to provide evidence of efficacy.

Efficacy of a portable acustimulation device in controlling seasickness

BACKGROUND

Nausea and vomiting caused by motion sickness are serious and sometimes debilitating symptoms for commercial and recreational seafarers.

HYPOTHESIS

In order to treat these symptoms, a portable device, the Relief Band, was designed to deliver acustimulation to the Neiguan (P6) acupuncture point.

METHOD

Nine volunteers used the device on a placebo point or the P6 active point on the open seas outside the San Francisco Bay. Motion sickness symptoms were graded from 1 ("feel fine") to 5 ("intermittent vomiting, with or without nausea").

RESULTS

Five subjects with motion sickness initially positioned the device at the placebo site and reported minimal symptom improvement (3.6 +/- 0.6 to 3.4 +/- 1.1) (mean, +/- SD), whereas the other four subjects initially used the device in the P6 position and reported decreased symptoms (4.3 +/- 1.0 to 1.0 +/- 0.2). The position of the Relief Band was then switched; in the four subjects who switched to the placebo position, symptoms worsened (1.0 +/- 0.2 to 4.0 +/- 1.4); whereas, in the five subjects where the device was switched to the P6 position, symptoms improved in each subject (3.4 +/- 1.1 to 1.0 +/- 0.7) (p < 0.01).

CONCLUSIONS

Motion sickness symptoms were suppressed by portable acustimulation in field studies of seasickness. The Relief Band may be an alternative to drug treatments of the nausea and vomiting of seasickness.

A randomised placebo-controlled clinical trial of an acupressure device for weight loss

OBJECTIVE

To provide a randomized placebo-controlled trial to determine the efficacy of an auricular acupressure device.

DESIGN

Subjects were randomly assigned to either treatment or placebo. The treatment group received the acupressure device and were instructed to use the device in their dominant ear. The placebo group received an acupressure device for their wrist. Participants were followed for 12 weeks.

SETTING

Outpatient core of the New York Obesity Research Center.

SUBJECTS

96 obese adult volunteers, 80 females and 16 males, between 19 and 70 years of age.

MEASUREMENTS

Weight, body fat, and blood pressure measured every two weeks.

RESULTS

All subjects combined lost, on average, 0.96 kg. There was no significant difference between the two groups on weight loss (mean wt loss = 1.28 [s.d. = 2.74] kg for treatment and 0.63 [s.d. = 3.26] kg for placebo) regardless of whether all subjects were examined or only the most compliant subjects were examined. Similarly, there were no significant differences between the two groups regarding fat loss or blood pressure reduction.

CONCLUSION

The acupressure device appears to be a safe device (did not cause any harmful side effects). However, it did not promote significantly greater weight or fat loss, or declines in blood pressure than placebo.