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Does acupressure help reduce nausea and vomiting in palliative care patients? Pilot study

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Does acupressure help reduce nausea and vomiting in palliative care patients? Pilot study

Auteurs : Paul Perkins ; Sarah L. Vowler

Source :

Palliative Medicine [ 0269-2163 ] ; 2008-03.

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https://api.istex.fr/document/3CEC9F3D71F5C79E926F3EDB52EBF4A828F39375/fulltext/pdf

DOI: 10.1177/0269216307087144

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         <contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Perkins</surname>
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<meta-value>pmjPalliative Medicine0269-216310.1177/026921630708714407087144Letter to the             EditorDoes acupressure help reduce nausea and vomiting in palliative care patients?             Pilot studyLetter to the EditorPerkinsPaulConsultant in Palliative Medicine1VowlerSarah             LMedical Statistician21Sue Ryder Care Leckhampton Court Hospice Church Road Leckhampton             Cheltenham GL53 0QJ UK. E-mail: paul.perkins@suerydercare.org2Department of Public             Health and Primary Care Centre for Applied Medical Statistics University of             CambridgeCambridge22008222193194SAGE Publications2008There is little evidence of for the             anti-emetics used in palliative medicine.1 Cochrane reviews examined stimulation of the             acupuncture point P6 (Pericardium 6) for emesis in pregnancy2 and surgery.3 There are             two published trials examining acupoint stimulation for nausea and vomiting in             palliative care.4,5 One enrolled six patients in a crossover design comparing             acupressure, placebo wrist band and no band. Results presented for four patients with             follow-up between 16 hours and four days were interpreted as revealing that acupressure             did not help. The second observational study (33 patients) had no comparator and a             median follow-up of 45 minutes (range 15 minutes to one week); 29/33 patients             responded.We wished to evaluate acupressure at the P6 site for terminal cancer patients             with nausea and vomiting. Approval was obtained from the Bedfordshire Local Research             Ethics Committee. The study was conducted in a specialist palliative care unit.Pairs of             active or sham wristbands (Sea-Band Ltd) were placed in sealed, numbered envelopes             according to a random allocation derived from a randomization programme. Active bands             have a bead to stimulate the acupressure point, sham bands appear identical but have no             bead.Inclusion criteria:(1)adults with cancer and estimated prognosis of between three             days and one year;(2)at least moderate nausea on a likert scale or one vomit per day for             the last three days;(3)underlying cause thought irreversible or patient chose not to             proceed with treatment for potentially reversible cause;(4)if taking corticosteroids,             dosage should be stable for three days prior to and during the trial.Exclusion             criteria:(1)arm lymphoedema;(2)weakness, fatigue or confusion preventing             participation;(3)previous acupressure/acupuncture;(4)Parkinsonism;(5)sharing a room with             another participant.Following consent patient was asked to score nausea on a visual             analogue scale (VAS). Lowest numbered envelope was opened and wristbands supplied. Their             use was explained, patients were provided a diagram to illustrate positioning and told             they could wear bands for as long as desired.Patients were asked six-hourly to score             nausea, duration of nausea and length of time they had worn bands. At trial endpoint             (day three), patients were asked to score how much they thought the bands had helped.             Patients were not woken overnight. Staff were blinded to intervention as bands were             placed by investigator.Anti-emetics prescribed prior to participation were continued.             PRN medication could be administered and regular anti-emetics escalated if patients felt             symptom control inadequate on daily review.The non-parametric Mann–Whitney U             test was used to compare outcomes.The probability that an observation in one group is             less than one in the other was calculated from the U statistic, by dividing, in turn by             the two group sizes.Ten patients were approached and all agreed to participate (four             male, six female). Median age was 61 (range 48–74). Eight completed the trial.             Two active and one placebo patient were unable to complete VASs after day one.Active             patients required fewer PRN doses, had fewer vomits and fewer instances of escalation of             regular anti-emetics. There was no evidence of differences between the two groups.Three             out of three active patients able to answer the question ‘Do you think the             acupressure wristbands helped you to feel better?’ scored the question as             greater than 50/100 compared with only one out of five placebo patients.One patient             complained of mild swelling and scored this as 2/100.Three power calculations were             carried out. For the change from baseline number of vomits, total number of PRN doses             and the VAS for ‘did they help?’ sample sizes of 23, 15 and 15 in             each group would be required. Allowing for a 20% dropout, a study with 29 per group             would give at least 80% power for all three comparisons.This is the largest randomized             controlled study examining acupressure in this area. It was unlikely that this small             pilot study would reveal any evidence of differences between the groups – it             was conducted to confirm feasibility and to allow formal power calculations for a larger             trial.We believe it unethical to deprive patients of anti-emetics and differences             between the groups may have been greater without concomitant medication. Bands are             inexpensive and acceptable to patients, and their use should be considered alongside             anti-emetics.We are about to conduct a formal trial in this area.AcknowledgementsWe             would like to thank the patients and staff of Sue Ryder Care St. John’s             Hospice, Moggerhanger, especially Dr Penny McNamara (Consultant) and Mrs Pauline Panter             (Palliative Care Services Manager) for their support. Special thanks to Dr Swati Negi             for enthusiastically enrolling patients. We are also grateful to Sea-Band Ltd for             providing active and placebo acupressure             bands.References1GlarePPereiraGKristjansonLStocklerMTattersallM. Systematic review of             the efficacy of antiemetics in the treatment of nausea in patients with far-advanced             cancer. Support Care Cancer 2004; 12: 432–440.2JewellDYoungG. Interventions             for nausea and vomiting in early pregnancy (Cochrane Review). The Cochrane Library,             Issue 3, 2004. Chichester: John Wiley & Sons, Ltd.3LeeADoneML. Stimulation of             the wrist acupuncture point P6 for preventing postoperative nausea and vomiting             (Cochrane Review). The Cochrane Library, Issue 3, 2004. Chichester: John Wiley &             Sons, Ltd.4BrownSNorthDMarvelFKFonsR. Acupressure wrist bands to relieve nausea and             vomiting in hospice patients: do they work? Am J Hosp Palliat Care 1992; 9:             26–29.5WrightL. The use of motion sickness bands to control nausea and             vomiting in a group of hospice patients. Am J Hosp Palliat Care 2005; 1:             49–53.</meta-value>
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Does acupressure help reduce nausea and vomiting in palliative care patients? Pilot study

Does acupressure help reduce nausea and vomiting in palliative care patients? Pilot study

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