Written by Karen Pilkington, Vinjar Fønnebø and the CAM-Cancer Consortium.
Updated April 27, 2016

Acupuncture for chemotherapy-associated nausea and vomiting

Abstract and key points

  • The Pericardium 6 (P6) point is stimulated either with an acupuncture needle (acupuncture), or by a wristband or finger pressure (acupressure).
  • Acupuncture and acupressure of P6 were shown to reduce some aspects of chemotherapy-associated nausea and vomiting when given in conjunction with standard antiemetic treatments. More recent trials have produced mixed results so that overall effectiveness is currently unclear.
  • Trials of other points are too limited to draw any conclusions on effectiveness.
  • Serious complications of acupuncture exist but are probably very rare.

Acupuncture or acupressure stimulation of the Pericardium 6 (P6) acupoint is a popular treatment for nausea and vomiting associated with chemotherapy. Traditional Chinese medicine (TCM) claims that chemotherapy-induced nausea and vomiting are due to the reversal of the gastrointestinal flow of "qi" (flow of energy). Stimulation of P6 is claimed to cause the qi to flow in the right (downward) direction. The antiemetic effect is likely mediated via the central opioid pathway.

Two systematic reviews, as well as one narrative review reported that stimulation of acupoints (mainly P6) reduced some aspects of nausea and/or vomiting associated with chemotherapy when given in conjunction with standard antiemetic treatments. Subsequent reviews have reported similar findings but the limitations in the design of these reviews and in that of the original trials prevents firm conclusions on effectiveness. Similarly, RCTs published following the most recent review have reported mixed findings.

Mild adverse effects, e.g. pain or bleeding at the site of acupuncture can be expected in about 10% of all cases, and serious complications, such as pneumothorax and hepatitis, seem to be very rare.

Readabout the regulation, supervision and reimbursement of acupuncture at NAFKAMs website CAM Regulation.

Citation

Karen Pilkington, Vinjar Fønnebø, CAM-Cancer Consortium. Acupuncture for chemotherapy-associated nausea and vomiting [online document]. http://cam-cancer.org/The-Summaries/Mind-body-interventions/Acupuncture-for-chemotherapy-associated-nausea-and-vomiting. April 27, 2016.

Document history

Most recent update and revision in March 2016 by Karen Pilkington.
Fully revised and updated in August 2013 by Vinjar Fønnebø.
Fully revised and updated in February 2011 by Vinjar Fønnebø.
Fully revised and updated in June 2009 by Vinjar Fønnebø.
Summary first published in November 2005, authored by Vinjar Fønnebø.

References

  1. BAcC (British Acupuncture Council) website. Ten Top Things to Know. Available at: www.acupuncture.org.uk. Accessed 17th April 2015.
  2. Filshie, J., Cummings, M. Western medical acupuncture. In: Ernst E, White A.  (Eds). Acupuncture: A Scientific Appraisal. 1999. Oxford: Butterworth-Heinemann, 1999. pp 31-59.
  3. White A, Editorial Board of Acupuncture in Medicine. Western medical acupuncture: a definition. Acupunct Med 2009;27:33-5.
  4. White A, Ernst E. Introduction. In: Ernst E, White, A. (Eds). Acupuncture: A Scientific Appraisal. Oxford: Butterworth-Heinemann, 1999. pp1-10.
  5. Birch S, Kaptchuk T. History, nature and current practice of acupuncture: an East Asian perspective. InIn: Ernst E, White, A. (Eds). Acupuncture: A Scientific Appraisal. Oxford: Butterworth-Heinemann, 1999. pp 11-30.
  6. Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics 2008;29:245-56.
  7. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Prog Neurobiol 2008;84:355-375.
  8. Molassiotis A, Browall M, Milovics L, Panteli V, Patiraki E, Fernandez-Ortega P. Complementary and alternative medicine use in patients with gynecological cancers in Europe. Int J Gynecol Cancer. 2006 16 Suppl 1:219-24.
  9. Molassiotis A, Fernadez-Ortega P, Pud D, Ozden G, Scott JA, Panteli V, Margulies A, Browall M, Magri M, Selvekerova S, Madsen E, Milovics L, Bruyns I, Gudmundsdottir G, Hummerston S, Ahmad AM, Platin N, Kearney N, Patiraki E. Use of complementary and alternative medicine in cancer patients: a European survey. Ann Oncol 2005;16:655-63.
  10. Ezzo J, Vickers A, Richardson MA, Allen C, Dibble SL, Issell B et al. Acupuncture-point stimulation for chemotherapy-induced nausea and vomiting. J Clin Oncol 2005;23:7188-98.
  11. Chao LF, Zhang AL, Liu HE, Cheng HM et al. The efficacy of acupoint stimulation for the management of therapy related adverse events in patients with breast cancer: a systematic review. Breast Cancer Res Treat 2009;118:255-267.
  12. Chen HY, Li SG, Cho WC, Zhang ZJ. The role of acupoint stimulation as an adjunct therapy for lung cancer: a systematic review and meta-analysis. BMC Complement Altern Med;2013 13:362.
  13. Garcia MK, McQuade J, Lee R, Haddad R, Spano M, Cohen L. Acupuncture for symptom management in cancer care: an update. Curr Oncol Rep 2014;16:418.
  14. Cheon S, Zhang X, Lee IS, Cho SH, Chae Y, Lee H. harmacopuncture for cancer care: a systematic review. Evid Based Complement Alternat Med 2014;2014:804746.
  15. Song HJ, Seo HJ, Lee H, Son H, Choi SM, Lee S. Effect of self-acupressure for symptom management: a systematic review. Complement Ther Med 2015;23:68-78.
  16. Tan JY, Molassiotis A, Wang T, Suen LK. Current evidence on auricular therapy for chemotherapy-induced nausea and vomiting in cancer patients: a systematic review of randomized controlled trials. Evid Based Complement Alternat Med 2014;2014:430796.
  17. Genc A, Can G, Aydiner A. The efficiency of the acupressure in prevention of the chemotherapy-induced nausea and vomiting. Support Care Cancer 2013;21:253-61.
  18. Molassiotis A, Russel W, Hughes J, Breckons M, Lloyd-Williams M, Richardson J, Hulme C, Brearley S, Campbell M, Garrow A, Ryder W. The effectiveness and cost-effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: Assessment of Nausea in Chemotherapy Research (ANCHoR), a randomised controlled trial. Health Technol Assess 2013;17: 1-114.
  19. Molassiotis A, Russel W, Hughes J, Breckons M, Lloyd-Williams M, Richardson J, Hulme C, Brearley S, Campbell M, Garrow A, Ryder W. The effectiveness of acupressure for the control and management of chemotherapy-related acute and delayed nausea: a randomized controlled trial. J Pain Symptom Manage 2014;47:12-25.
  20. Suh EE. The effects of P6 acupressure and nurse-provided counseling on chemotherapy-induced nausea and vomiting in patients with breast cancer. Oncol Nurs Forum 2012;39:E1-9.
  21. Liu Y, Sun QS, Dong HJ, Zhai DX, Zhang DY, Shen W, Bai LL, Yu J, Zhou LH, Yu CQ. Wrist-ankle acupuncture and ginger moxibustion for preventing gastrointestinal reactions to chemotherapy: A randomized controlled trial. Chin J Integr Med 2015;21:697-702.
  22. Rithirangsriroj K, Manchana T, Akkayagorn L. Efficacy of acupuncture in prevention of delayed chemotherapy induced nausea and vomiting in gynecologic cancer patients. Gynecol Oncol 2015;136:82-6.
  23. Shen Y, Liu L, Chiang JS, Meng Z, Garcia MK, Chen Z, Peng H, Bei W, Zhao Q, Spelman AR, Cohen L. Randomized, placebo-controlled trial of K1 acupoint acustimulation to prevent cisplatin-induced or oxaliplatin-induced nausea. Cancer 2015; 121: 84-92.
  24. Zhang X, Jin HF, Fan YH, Lu B, Meng LN, Chen JD. Effects and mechanisms of transcutaneous electroacupuncture on chemotherapy-induced nausea and vomiting. Evid Based Complement Alternat Med 2014;2014:860631.
  25. White A, Hayhoe S, Ernst E. Survey of Adverse Events Following Acupuncture Acupunct Med 1997;15:67-70.
  26. Witt CM, Pach D, Brinkhaus B, Wruck K, Tag B, Mank S, Willich SN. Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form. Forsch Komplementmed 2009;16:91-7.
  27. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122-123.
  28. Ernst E. Deaths after acupuncture: a systematic review. Int J Risk Safety 2010;22:131-136.
  29. BMAS (British Medical Acupuncture Society). Code of Practice & Complaints Procedure. Version 9 December 2009. Available at: http://www.medical-acupuncture.co.uk. Accessed 21st July 2015.