NAUSEA & VOMITING RESEARCH (© JCM Ltd)

ACUPUNCTURE FOR CHEMO INDUCED NAUSEA AND VOMITING IN CHILDREN
Researchers have investigated whether acupuncture can reduce the need for antiemetic medication during chemotherapy in paediatric oncology. A multicentre crossover study carried out at five hospitals in Germany enrolled 23 children, mean age 13.6 years, who were receiving highly emetogenic chemotherapy for the treatment of solid malignant tumours. Patients were randomly allocated to receive acupuncture treatment during either the second or third identical chemotherapy course together with standard antiemetic medication. Forty-six chemotherapy courses with or without acupuncture were compared. The need for rescue antiemetic medication was found to be significantly lower in acupuncture courses compared to control courses. Episodes of vomiting per course were also significantly lower with acupuncture. (Acupuncture to alleviate chemotherapy-induced nausea and vomiting in pediatric oncology - a randomized multicenter crossover pilot trial. Klin Padiatr. 2008 Nov-Dec;220(6):365-70. Epub 2008 Oct 23).

AURICULAR ACUPUNCTURE FOR NAUSEA AND VOMITING AFTER GALL BLADDER SURGERY
The efficacy of auricular acupuncture for the prevention of postoperative nausea and vomiting after cholecystectomy has been investigated by Iranian researchers. One hundred female patients undergoing transabdominal cholecystectomy were randomly allocated to an auricular acupuncture treatment group or a non-treatment group. A significant difference was found between the control and auricular acupuncture treatment groups in the incidence of vomiting 24 hours after surgery (66% and 0%, respectively). (Does Auricular Acupuncture Reduce Postoperative Vomiting After Cholecystectomy? J Altern Complement Med. 2008 Nov 25).

ACUPRESSURE FOR CHEMOTHERAPY SICKNESS
Self-applied acupressure for chemotherapy-induced nausea and vomiting has been found to compare favourably with placebo. A multicentre, longitudinal, randomised clinical trial enrolled 160 women undergoing chemotherapy for breast cancer. Subjects were randomised to one of three groups: acupressure at Neiguan P-6 point (active), acupressure to Houxi SI-3 point (placebo), or usual care only. Subjects completed a daily log for 21 days containing measures of nausea and vomiting and recording methods (including antiemetics and acupressure) used to control these symptoms. For delayed nausea and vomiting (occurring more than 24 hours following chemotherapy treatment), the acupressure group had a statistically significant reduction in the amount of vomiting and the intensity of nausea over time, compared with the placebo and usual-care groups. (Acupressure for chemotherapy-induced nausea and vomiting: a randomized clinical trial. Oncol Nurs Forum. 2007 Jul;34(4):813-20).

ACUPUNCTURE/PRESSURE FOR MORNING SICKNESS
A meta-analysis has examined the effects of various methods for stimulating acupuncture points (acustimulation, AS) for the prevention of nausea and vomiting in pregnant women (NVP). The authors identified 14 eligible trials published over the last 16 years, involving a total of 1615 women and using either acupressure, acupuncture or electrical stimulation (ETS) as a method of AS. After the treatment, compared with controls, AS (all methods) reduced the proportion of nausea by more than 50% and vomiting by around 40%. Acupressure applied by finger pressure or wristband reduced NVP, as did ETS. However, acupuncture did not show an effect on reducing NVP. The authors advise caution in interpreting the results, as the number of acupuncture trials included was limited. (Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women. Explore (NY). 2006 Sep-Oct;2(5):412-21).

CHINESE HERBS FOR CHEMOTHERAPY TOXICITY
Traditional Chinese herbal medicine (TCHM) does not reduce the toxic effects of chemotherapy on patients’ blood cell populations, however it does have a significant impact on control of nausea. One hundred and twenty patients with early-stage breast or colon cancer who required postoperative chemotherapy were enrolled. Participants were randomly assigned to receive either individualised TCHM prescriptions of herbal extract granules or placebo packages containing non-therapeutic herbs that smelled and tasted like a typical herbal tea. TCHM did not reduce chemotherapy toxicity as measured by any haematological parameters. Incidence of nausea was the only non-haematologic toxicity that was significantly reduced in the TCHM group (14.6% versus 35.7%). (A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol. 2007 Apr;18(4):768-74).

ACUPUNCTURE/ACUPRESSURE FOR CHEMOTHERAPY VOMITING
A systematic review published by the Cochrane Collaboration, an international organisation that evaluates medical research, pooled results from nine studies into the use of acupuncture for post-chemotherapy vomiting. Overall, 22% of patients who received acupuncture suffered vomiting the first day after chemotherapy, compared to 33% of those who did not receive acupuncture. When acupressure studies were evaluated, it was found that it was able to relieve nausea the day after chemotherapy (which acupuncture did not do) although it had no effect on vomiting. (Ezzo JM et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. The Cochrane Database of Systematic Reviews 2006, Issue 2).

ACUPUNCTURE & NAUSEA
A systematic review of 26 acupuncture trials into the use of Neiguan P-6 for post-operative nausea has found that it is as successful as routine anti-sickness medication and is both cheaper and has fewer side effects. (http://www.cochrane.org//cochrane/revabstr/ab003281.htm).

 ACUPUNCTURE & MORNING SICKNESS
A study of 593 women at the Women’s and Children’s Hospital, Adelaide, Australia, who were less than 14 weeks pregnant and suffered from symptoms of nausea or vomiting, compared traditional acupuncture, simple acupuncture at Neiguan P-6 only, sham acupuncture and no acupuncture. The acupuncture patients received two 20-minute sessions of acupuncture in the first week followed by one weekly treatment for four weeks. Traditional acupuncture consisted of the insertion of a maximum of 6 needles at a mixture of abdominal points and points selected according to pattern differentiation. Abdominal points were Burong ST-19, Chengman ST-20, Liangmen ST-21, Youmen KID-21, Futonggu KID 20, Juque REN-14, Shangwan REN-13, Zhongwan REN-12, Jianli REN-11 and Xiawan REN-10. Points selected according to differentiation were Liver qi stagnation: Taichong LIV-3, Neiguan P-6, Yanglingquan GB 34, Shangwan REN-13, Youmen KID-21, Liangqiu ST-34, Zusanli ST-36; Stomach or Spleen deficiency: Zusanli ST 36, Neiguan P-6, Zhongwan REN 12; Stomach heat: Neiting ST-44, Jianli REN-11, Liangqiu ST 34, Liangmen ST-21, Neiguan P-6, Quze P-3; Phlegm: Fenglong ST-40, Yinlingquan SP-9, Burong ST-19, Pishu BL-20, Youmen KID-21; Heart qi deficency: Tongli HE-5, Neiguan P-6, Zusanli ST-36, Juque REN-14; Heart fire: Neiguan P-6, Juque REN-14, Xinshu BL-15. Deqi was obtained and needles were left for 20 minutes. The sham acupuncture group were needled at points close to, but not on, acupuncture points. All three acupuncture groups reported less nausea and dry retching, with traditional acupuncture having the fastest effect. Patients receiving traditional acupuncture reported improvement in five aspects of general health status (vitality, social function, physical function, mental health and emotional role function) compared with improvement in 2 aspects in the other acupuncture groups, and 1 aspect in the no acupuncture group. Although no kind of acupuncture was able to reduce vomiting, the authors speculate that more frequent treatments might have produced greater benefit. (Birth 29:1 March 2002).

ACUPUNCTURE & VOMITING
Patients given cyclophosphamide infusion for rheumatic diseases, suffer from nausea and vomiting as a side-effect. To assess the potential benefits of acupuncture in reducing these symptoms, a Swedish study compared the use of ondansetron (an anti-emetic) alone, or ondansetron in combination with needling of Neiguan P-6 and/or ear points. Compared with ondansetron treatment alone, the combined acupuncture-ondansetron treatment significantly decreased both the severity of nausea and the number of bouts of vomiting 24 and 48 hours after the subjects had received acupuncture at the first treatment session. Nearly the same results were seen 48 and 72 hours after the subjects had had their last acupuncture treatment. The results clearly indicate that combined treatment with acupuncture and ondansetron reduces the severity and the duration of chemotherapy-induced nausea as well as the number of bouts of vomiting as compared with ondansetron therapy alone, in patients with rheumatic diseases. (Rheumatology, October, 2003, vol. 42, no. 10, p. 1149- 1154).

ELECTROACUPUNCTURE AND NAUSEA/VOMITING
In a study carried out at the University of Texas Southwestern Medical Center, a sham-controlled, double-blinded study was designed to examine the antiemetic efficacy of transcutaneous acupoint electrical stimulation (TAES) in a surgical population (laparoscopic cholecystectomy) at high risk of developing nausea and vomiting. 221 outpatients undergoing laparoscopic cholecystectomy with a standardised general anaesthetic technique were selected for this randomised, multicentre trial and divided into two groups. In the experimental group, an active ReliefBand device was placed at Neiguan P-6, whilst in the sham and placebo groups, an inactive device was applied at Neiguan P-6 and at the dorsal aspect of the wrist, respectively. The TAES group showed a significantly decreased incidence of moderate-to-severe nausea compared to the sham and placebo groups, although there were no statistically significant differences among the three groups with regard to incidence of vomiting or the need for rescue antiemetic drugs [Anesth Analg 2001 Mar;92(3):629-35)].

ACUPRESSURE & MORNING SICKNESS
In a study to assess the benefits of acupressure at Neiguan P-6 in the treatment of nausea and vomiting of pregnancy, researches at Lund University in Sweden asked 60 pregnant women suffering from symptoms to a) wear a wrist band at Neiguan P-6, b) wear a wristband at a placebo point, and c) wear no wrist band. Both the Neiguan P-6 and the placebo groups showed a reduction in nausea and vomiting, however the effect lasted only 6 days in the placebo group, whilst the Neiguan P-6 group still experienced significant relief after 14 days (J Reprod Med 2001;46:835-839).

ACUPUNCTURE AND SICKNESS
Pregnant women who experience exceptionally severe morning sickness may benefit from acupuncture in addition to standard treatment, researchers in Sweden report. In a study of 33 pregnant women, only 7 of 17 women were still vomiting 3 days after acupuncture compared with 12 of 16 women who received a sham acupuncture treatment, according to findings published in the October issue of the Journal of Pain and Symptom Management. While 50% to 80% of women experience nausea or some vomiting in pregnancy, 1% to 2% of women have sickness so severe - often around the clock - that they end up losing weight, becoming dehydrated and being hospitalised. In the study, the active acupuncture treatment consisted of deep needle insertion about 2 inches above the wrist on both arms at Neiguan P-6. Women who received the sham treatment had a superficial needle insertion 4 inches above the wrist on both forearms. Both groups of women had 2 days of the experimental treatments at the beginning or the end of a week in hospital in addition to traditional treatments, which include bedrest, antinausea drugs and intravenous fluids. The severity of nausea and the frequency of vomiting decreased more quickly with active acupuncture than with the sham treatment, regardless of when standard medical treatment was received, the report indicates. The effects of active acupuncture could be seen "often within minutes of stimulation" the authors add (Carlsson CPO, Axermo P, Bodin A, et al.  Manual acupuncture reduces hyperemesis gravidarum: a placebo-controlled, randomized, single-blind, crossover study.  J Pain Symptom Manage). In another study published in The Journal of the American Medical Association, 104 women with breast cancer receiving chemotherapy that resulted in severe nausea and vomiting were assigned to one of three groups. All received concurrent triple antiemetic pharmacotherapy and high-dose  cyclophosphamide, cisplatin, and carmustine). One group further received electroacupuncture at classic antiemetic acupuncture points, a second group received minimal needling at control points with mock electrostimulation, and the third group received only the medication. Over a five-day treatment period, both needling groups experienced less incidents of vomiting than the medication-only group, with the electroacupuncture group showing the lowest incidence (JAMA. 2000;284:2755-2761).

ACUPUNCTURE & STRABISMUS SURGERY
The effect of stimulating Tianzhu BL-10, Dazhu BL-11 and Yanglingquan GB-34 by needeless acuplasters to control vomiting in children (age 3 to 14) after strabismus surgery was evaluated by comparing them with a group who received placebo treatment. The overall postoperative vomiting incidence in the acuplaster patients in a 24 hour period was 29.4% as opposed 64.5% in the placebo group (Acta Anaesthesiol Sin 1998 Mar;36(1):11-6).

ACUPUNCTURE AND POSTOPERATIVE NAUSEA AND VOMITING<br>
A double-blind randomised controlled study of acupuncture versus a placebo was carried out on 81 patients scheduled for day case gynaecological laparoscopic surgery. The acupuncture patients who received treatment at Neiguan P-6 showed a 65% reduction in postoperative nausea and vomiting  in hospital compared to 35%  in the placebo group and a 69% compared to 31% reduction after discharge. Anaesthesia 1997 Jul;52(7):658-61.

NEIGUAN P-6 AND NAUSEA
In this single-blind randomised study, two groups of patients suffering post-operative nausea and vomiting lasting longer than ten minutes were respectively treated by i. needling at bilateral Neiguan P-6, and ii. needling of a 'dummy' point near the elbow. In both groups, needling attempted to obtain deqi, i.e. tingling, heaviness or numbness which occasionally radiated from the site of needling, and the needles were rotated manually for 2 minutes. In the Neiguan P-6 group all patients showed an improvement of 20% or more in nausea while only one third of the control group showed such improvement. 100% of patients in the control group required orthodox antiemetc treatment compared with only 47% of patients in the Neiguan P-6 group. There was no significant reduction in either group in the number of patients who vomited following treatment, indicating that Neiguan P-6 is more effective at reducing nausea than in controlling vomiting (Acupuncture in Medicine, May 1996, Vol XIV, No1, pp2-4).

ACUPUNCTURE AS AN ANTI-EMETIC
A review of 33 controlled trials into the use of acupuncture as an anti-emetic in pregnancy and following chemotherapy and surgery shows its effectiveness. In four trials where acupuncture was given under anaesthesia it was found to be equal to or inferior to controls. In the other 29 trials it was statistically superior to controls in 27 cases. The review was carried out by the UK's Research Council for Complementary Medicine (Journal of the Royal Society of Medicine, June 1996, pp303).

NEIGUAN P-6 FOR MOTION SICKNESS
A study on the effects of acupressure at the point Neiguan P-6, placed subjects in an optokinetic drum for a twelve minute rotation period. The subjects in the P-6 acupressure group reported significantly less nausea than those in dummy-point acupressure, sham P-6 acupressure and control groups. They also showed significantly less abnormal gastric myoelectric activity. (Aviation Space & Environmental Medicine, 1995; 66(7):631-634.