Acupoint Stimulation for Morning Sickness
By Carmen Tamayo, MD
Almost one-third of pregnant women use complementary and alternative medicine (CAM) therapies during pregnancy, according to a recent survey among 463 postpartum patients conducted at the St. Peter’s University Hospital in New Jersey.1 The most frequent reasons for CAM use included lower GI problems (73, 25.1%), anxiety (36, 12.6%), nausea/vomiting (34, 12.6%), and urinary tract problems (20, 7.0%). In this population (median age 28 years, range 15-39 years; 57% were college graduates), 13 (2.8%) used acupuncture/pressure.
Physicians, nurses, and midwives acknowledge and use acupuncture for a variety of conditions. A comprehensive literature search identified 25 surveys conducted between 1982 and 1995 that examined the practices and beliefs of conventional physicians with regard to five prominent CAM therapies including acupuncture, chiropractic, homeopathy, herbal medicine, and massage. Approximately half of the surveyed physicians believed in the efficacy of acupuncture (51%) and acupressure (52.4%).2 A recent survey of certified nurse-midwives in North Carolina found that 19.5% recommend acupuncture for their pregnant or postpartum patients.3
One of the difficulties with drawing conclusions from the existing literature is that the term acupuncture is used to describe a variety of treatments that differ in many important aspects, both theoretical and technical.4,5 The issue is further complicated by inherent difficulties in the design of adequate clinical trials that must include selection of appropriate controls, adequate sample size, single- vs. double-blind design, and application of relevant outcome measures. Blinding and controls are particular problems in acupuncture trials.
Double-blinding an acupuncture trial is difficult to achieve if a professional acupuncturist is administering the treatment, and one wouldn’t want someone who wasn’t trained in the technique administering acupuncture. And although sham acupuncture often is used as a control, debate rages about whether shallow acupuncture at appropriate points, acupuncture at accepted acupuncture points inappropriate to the patient’s condition, acupuncture at sites not accepted to be real acupuncture points, and prodding the patient with sticks or tubes are appropriate controls.
The variability of acupuncture techniques, difficulties of standardizing acupuncture treatments, variability of response to treatments, and practitioner’s experience are other factors that contribute to the complexity of acupuncture research.
Acupoint stimulation trials have been performed under double-blind conditions, however, primarily by utilizing acupressure or electrical stimulation. Acupuncture points may be stimulated by needles, focused pressure, heat, or electricity, via Transcutaneous Electrical Nerve Stimulation (TENS) or Sensory Afferent Stimulation (SAS) units.
Acupressure is a non-invasive variation of acupuncture; acupressure bracelets (sea bands) are elastic strips with a button that presses on a single point. Acupressure also includes applying pressure with the thumb or a button to one or several acupressure points at the same time. The treatment can last from 3 to 15 minutes. Acupressure trials are easier and cheaper to carry out than classical acupuncture trials, and are particularly popular for treating nausea and vomiting of various etiologies, because treatment can involve stimulation of a single, easily identified wrist point, obviating the need for a professional acupuncturist.
The most popular acupoint for nausea and vomiting is the Neiguan (P6) point located two cun (approximately three finger-breadths) below the distal wrist crease on the anterior surface (palmar side) of the wrist. The stimulation usually is bilateral but also can be unilateral. Acupuncture at the P6 point to treat nausea and vomiting has been practiced in China for many years.
Nausea and Vomiting During Pregnancy
Nausea and vomiting during pregnancy affect approximately 50-70% of all pregnant women. Although most cases of nausea and vomiting in pregnancy resolve spontaneously, a small percentage of cases progress to hyperemesis gravidarum. Acupuncture and acupressure may offer an effective therapeutic alternative for treating nausea and vomiting in early pregnancy.
Clinical Trials
Fifteen randomized controlled clinical trials, with more than 1,500 women, were identified. Eleven of 15 trials found a positive effect of acupoint stimulation on at least one measure (Click here to see Table 1 and Table 2). Twelve trials utilized acupressure bands, three used acupuncture (two used P6 acupuncture, one included an individualized treatment group, one included a semi-individualized treatment group; acupuncturists could choose one of three sets of points), one used self-applied finger acupressure, and one used TENS units. Acupressure may be more successful than acupuncture for this indication; two of three of the acupuncture trials found no benefit of real acupuncture over sham treatment. Some trials did not separate nausea and vomiting in assessments; the trials that did separate the two generally indicate that the technique is more effective for nausea than vomiting.
Safety
No adverse events have been reported following acupressure; adverse events following acupuncture are rare. A prospective survey of 78 acupuncturists (32,000 consultations) in the United Kingdom found a "significant" adverse event rate (defined as "unusual, novel, dangerous, significantly inconvenient, or requiring further information") of 14/10,000 (95% confidence interval [CI] 8-20).6 The most serious events were a case of cellulitis after treatment of an edematous leg and a seizure; headache, anxiety, and exacerbation of symptoms also were reported. The minor adverse event rate (defined as "any ill-effect, no matter how small, that is unintended and non-therapeutic, even if not unexpected"), primarily bleeding or needling pain, was 671/10,000 treatments (95% CI 42-1013). Another prospective mail survey, also in the United Kingdom, found no serious adverse events after 34,407 acupuncture treatments by 574 acupuncturists.7
Practitioners in a clinic in Australia experienced an average of one adverse event every 8-9 months of full-time practice, or one adverse event for every 633 consultations. The mean adverse event rate of non-medical practitioners was less than half the mean adverse event rate of medical practitioners. The most common adverse events associated with acupuncture were: fainting, nausea and vomiting, and increased pain.8
A prospective survey of Japanese acupuncture practitioners recorded only 94 minor adverse events related to 65,000 treatments. The most common events were forgotten needles and faintness; no serious adverse events occurred.9
Conclusion
Evidence supports the use of acupuncture and acupressure at the P6 point to reduce nausea and vomiting during early pregnancy. It is possible, but has not been established, that increasing the frequency of treatments may reduce the frequency and severity of vomiting. There is more evidence on acupressure than acupuncture. Most studies have examined mild-to-moderate nausea; few studies have evaluated the effectiveness of either method in severe nausea and (particularly) vomiting during pregnancy. Two acupressure trials found a significant reduction in vomiting. The only study that evaluated hyperemesis gravidarum reported significantly better improvement from acupuncture than sham.10
Acupressure is easier than acupuncture to evaluate in randomized controlled clinical trials. Acupressure bands are a non-invasive, inexpensive, safe, and effective treatment for nausea and vomiting. Both methods appear to be safe and effective and can be considered a good alternative for nausea and vomiting during pregnancy.
Dr. Tamayo is Director, Division of Complementary and Alternative Medicine, Foresight Links Corp. in London, Ontario, Canada.
References
1. Ranzini A, et al. Use of complementary medicines and therapies among obstetric patients. Obstet Gynecol 2001;97(4 Suppl 1):S46.
2. Astin JA, et al. A review of the incorporation of complementary and alternative medicine by mainstream physicians. Arch Intern Med 1998;158:2303-2310.
3. Allaire AD, et al. Complementary and alternative medicine in pregnancy: A survey of North Carolina certified nurse-midwives. Obstet Gynecol 2000;95: 19-23.
4. Langevin HM, Vaillancourt PD. Acupuncture: Does it work and, if so, how? Semin Clin Neuropsychiatry 1999;4:167-175.
5. Langevin HM, et al. Biomechanical response to acupuncture needling in humans. J Appl Physiol 2001;91:2471-2478.
6. White A, et al. Adverse events following acupuncture: Prospective survey of 32,000 consultations with doctors and physiotherapists. BMJ 2001;323:485-486.
7. MacPherson H, et al. The York acupuncture safety study: Prospective survey of 34,000 treatments by traditional acupuncturists. BMJ 2001;323:486-487.
8. Bensoussan A, et al. Risks associated with the practice of traditional Chinese medicine: An Australian study. Arch Fam Med 2000;9:1071-1078.
9. Yamashita H, et al. Adverse events in acupuncture and moxibustion treatment: A six-year survey at a national clinic in Japan. J Altern Complement Med 1999;5:229-236.
10. Carlsson CP, et al. Manual acupuncture reduces hyperemesis gravidarum: A placebo-controlled, randomized, single-blind, crossover study. J Pain Symptom Manage 2000;20:273-279.
11. Smith C, et al. Acupuncture to treat nausea and vomiting in early pregnancy: A randomized controlled trial. Birth 2002;29:1-9.
12. Knight B, et al. Effect of acupuncture on nausea of pregnancy: A randomized, controlled trial. Obstet Gynecol 2001;97:184-188.
13. Norheim AJ, et al. Acupressure treatment of morning sickness in pregnancy. A randomised, double-blind, placebo-controlled study. Scand J Prim Health Care 2001;19:43-47.
14. Slotnick RN. Safe, successful nausea suppression in early pregnancy with P-6 acustimulation. J Reprod Med 2001;46:811-814.
15. Steele NM, et al. Effect of acupressure by Sea-Bands on nausea and vomiting of pregnancy. J Obstet Gynecol Neonatal Nurs 2001;30:61-70.
16. Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy. A randomized, placebo-controlled, pilot study. J Reprod Med 2001; 46:835-839.
17. O’Brien B, et al. Efficacy P6 acupressure in the treatment of nausea and vomiting during pregnancy. Am J Obstet Gynecol 1996;174:708-715.
18. Belluomini J, et al. Acupressure for nausea and vomiting of pregnancy: A randomized, blinded study. Obstet Gynecol 1994; 84:245-248.
19. Bayreuther J, et al. A double-blind cross-over study to evaluate the effectiveness of acupressure at pericardium 6 (P6) in the treatment of early morning sickness (EMS). Complement Ther Med 1994;2:70-76.
20. Evans AT, et al. Suppression of pregnancy-induced nausea and vomiting with sensory afferent stimulation. J Reprod Med 1993;38:603-606.
21. Stone CL. Acupressure wristbands for the nausea of pregnancy. Nurse Pract 1993;18:15, 18, 23.
22. de Aloysio D, Penacchioni P. Morning sickness control in early pregnancy by Neiguan point acupressure. Obstet Gynecol 1992;80:852-854.
23. Hyde E. Acupressure therapy for morning sickness. A controlled clinical trial. J Nurse Midwifery 1989;34: 171-178.
24. Dundee JW, et al. P6 acupressure reduces morning sickness. J R Soc Med 1988;81:456-457.
Tamayo C. Acupoint stimulation for morning sickness. Altern Ther Women's Health 2002;4:49-53.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content