Acupressure

Preliminary clinical research in patients with chronic low back pain shows that acupressure alone or acupressure massage with aromatic essential oil in combination with usual care reduces pain, disability, and walking ability when compared with physical therapy or usual care alone (16220, 89032). A meta-analysis of clinical studies in patients with low back shows that acupressure improves response rate when compared with tuina massage, reduces pain when compared with tuina massage, physical therapy, or usual care, and improves functional ability when compared with usual care. Acupressure as an adjuvant to acupuncture also improves response rate, reduces pain, and improves functional ability when compared with acupuncture alone (107308). The validity of these findings is limited by the heterogeneity of the included studies, which persisted throughout some subgroup analyses, as well as unclear reporting.

Non-traditional methods of administering acupressure also seem to improve chronic low back pain. Preliminary clinical research shows that using an acupressure backrest during sedentary work for 1 month reduces pain and disability by at least 30% when compared with no intervention (98097). Ear (auricular) acupressure has also been studied for back pain. Preliminary clinical research shows that taping herbal seeds to the ear and applying pressure for 3 minutes three times daily for 5 days each week for 4 weeks reduces pain by about 40% when compared with performing the same procedure on incorrect acupoints (98105).

A meta-analysis of mostly small clinical studies in patients with cancer-related fatigue shows that various forms of acupressure, either self-administered or administered by a professional, reduces fatigue by a large amount when compared with usual care, sham acupressure, or acupuncture. Although substantial heterogeneity of the included studies was noted, a meta-regression and moderator analysis concluded that benefits for cancer-related fatigue were inversely proportional to the percentage of female patients, suggesting a potentially greater effect in males (107304).

The National Comprehensive Cancer Network (NCCN) guidelines for cancer-related fatigue list acupuncture, but not acupressure, as a potential nonpharmacologic treatment option for patients who have completed cancer treatment. Some of the evidence of benefit related to the use of acupuncture for improving fatigue in patients with cancer is combined with acupressure and other modalities involving acupoints (112413).

A small clinical study in young adults with primary dysmenorrhea shows that performing acupressure within 8 hours of the onset of menstruation reduces the severity of dysmenorrhea immediately after treatment and for up to 2 hours after treatment (16232). Another small study in adolescents with primary dysmenorrhea shows that receiving acupressure for 20 minutes decreases pain and anxiety (89078). Additionally, a small clinical study shows that wearing specific acupressure-administering pads (The Relief Brief) for up to 3 days, starting from the onset of menstrual flow, decreases pain by up to 50% in adults experiencing dysmenorrhea (89077).

Self-administration of acupressure also seems to help reduce pain in dysmenorrhea. One small clinical study in adolescents with primary dysmenorrhea shows that self-administering acupressure to acupoints is as effective as ibuprofen for improving pain and more effective than using sham acupoints (89079). Other clinical research in patients with moderate to severe primary dysmenorrhea shows that self-delivering acupressure daily as instructed by a smartphone application, starting 5 days prior to menstruation for six menstrual cycles, reduces days with pain by up to one day and modestly reduces pain intensity during the third to sixth cycles when compared with using the smartphone application without the acupressure feature (98088). Another small clinical study in young adults with primary dysmenorrhea shows that self-administered acupressure or sham acupressure once daily for days 1-3, repeated over 4 consecutive menstrual cycles, generally improves pain when compared with baseline (107310). However, it is unclear if the improvement from baseline differed between groups.

Auricular acupressure has also been evaluated. A meta-analysis of clinical research in adults with primary and secondary dysmenorrhea shows that auricular acupressure improves symptoms and reduces pain scores when compared with analgesics or no intervention, but not when compared with other traditional Chinese medicine therapies. However, it is unclear how often auricular acupressure was applied, when it was started in relation to the menstrual cycle, and whether it was self-administered. Additionally, many of the included studies were not blinded and were considered at high risk for bias (114087).

A meta-analysis of 10 small clinical trials in patients with hypertension and insomnia shows that auricular acupressure for 6-30 days improves sleep by 63% more than a control intervention or no intervention (103403). Some clinical research in patients with insomnia shows that the use of self-administered acupressure each night for 4 weeks modestly improves insomnia severity when compared with sleep hygiene education. Beneficial effects appear to last at least 4 weeks after treatment cessation (110311). A meta-analysis of 10 small clinical trials in elderly people shows that acupressure treatment for up to one year modestly improves sleep quality when compared with baseline or sham treatment. This analysis was limited by the inclusion of only studies published in English or Turkish (110302). In addition, preliminary clinical studies in older patients with sleep disturbances who are hospitalized or living in long-term care facilities show that administering acupressure improves sleep when compared with sham acupressure or no additional treatment (89026, 98092, 98093, 98100).

A meta-analysis of 6 small clinical studies in patients with sleep disturbances and cancer shows that auricular acupressure administered up to 5 times daily for up to 6 weeks improves total Pittsburgh Sleep Quality Index (PSQI) scores by about 4 points when compared with routine care, sham acupressure, or no intervention (107301). A meta-analysis of nine clinical trials specifically investigating the effect of auricular acupressure on sleep in adults with lung cancer shows that sleep quality was improved by a modest to large amount when compared with usual care. The use of sleep medications was shown to be reduced in two clinical trials (110315). Additionally, a network meta-analysis of clinical research in adults with cancer shows that both auricular acupressure and general acupressure improve sleep quality when compared with sham acupressure, usual care, or a waitlist control (114071).

Further, small meta-analyses of clinical research in patients with sleep disturbance receiving maintenance hemodialysis show that auricular acupressure improves sleep disorders when compared with standard care or placebo and is similarly effective when compared with estazolam (107302, 107314). The studies included in the meta-analysis that compared auricular acupressure with estazolam had significant heterogeneity, which persisted throughout subgroup analyses. A more recent clinical trial in patients on hemodialysis shows that 55% of patients using auricular acupressure for 8 weeks reached a reduction of at least 3 points on the Pittsburgh Sleep Quality Index (PSQI) global score, when compared with 36% of those given sham acupressure. Also, there was some evidence of benefit on overall sleep quality in the 12 weeks after treatment. However, there was no difference between groups for most specific sleep outcome measurements during the treatment period (110313).

Most research in patients with osteoarthritis of the knee shows that self-administered acupressure alone for up to 16 weeks does not reduce knee pain intensity when compared with receiving sham acupressure, education on knee health, exercise, or no intervention (103404, 103411, 107305). Results from one of the larger studies show that both self-acupressure and sham acupressure improve pain and physical function by a small amount when compared with usual care, suggesting that any improvement is likely due to a placebo effect (103404).

Auricular acupressure has also been evaluated for osteoarthritis. A small clinical study in patients with osteoarthritis of the knee shows that auricular acupressure 4 times daily for 4 weeks is associated with reductions in pain, stiffness, and function on days 3 and 7, but not days 14, 21, or 28, when compared sham acupressure (107306).

Preliminary clinical research in adults with perennial allergic rhinitis shows that auricular acupressure 3 times daily for 8 weeks modestly reduces symptoms such as sneezing and eye irritation when compared with sham acupressure. Effects were sustained for an additional 12 weeks after treatment completion (103398). Another preliminary clinical trial in adults with seasonal allergic rhinitis shows that self-administered acupressure daily over 4 weeks modestly improves symptoms, mainly nasal symptoms, and quality of life when compared with no acupressure. A minimum clinically important difference in symptoms occurred in 82.4% of patients compared with 36.8% in the control group. The use of cetirizine as rescue medication was also reduced in patients using acupressure (110307). In children aged 6-15 years with allergic rhinitis, acupressure each evening for 4 weeks improved nasal and eye symptoms, as well as sleep quality, when compared with no treatment. However, the clinical significance of this finding is unclear, as the children in the acupressure group had more severe symptoms at baseline than those in the control group (103417).

Most clinical research, from individual clinical trials and a meta-analysis, shows that acupressure decreases situational anxiety. This benefit has been identified for situational anxiety related to academic studies, medical procedures, trauma, post-pregnancy, living in long-term care, having COVID-19, insomnia, cancer, and more. While most research has involved the use of a single acupressure treatment, other research has been conducted over a 2-to-4-week period. Sham acupressure or usual care are the most common controls (89068, 89069, 105118, 110296, 110301, 110304, 110311, 114082).

Auricular acupressure is commonly used for anxiety (89068, 105118, 110296, 110304). A meta-analysis of 27 clinical trials shows that acupressure has a large beneficial effect on symptoms of situational anxiety, with the strongest evidence in people experiencing anxiety related to upcoming medical procedures or hospital stays (110296). However, the heterogeneity between studies is high with respect to study design, number of treatments, and length of treatment.

Preliminary clinical research in patients with chronic obstructive asthma shows that self-administering acupressure daily for 8 weeks in addition to standard care improves symptoms and quality of life when compared with standard care alone (89073).

One small clinical study in healthy males shows that auricular acupressure might reduce muscle fatigue, lactic acid levels, and oxygen uptake after vigorous exercise when compared with baseline (89084). The validity of these findings is limited by the lack of a control group.

Clinical research shows that self-administering an acupressure regimen at stimulation acupoints reduces sleepiness and improves alertness when compared with administering an acupressure regimen at relaxation acupoints (89072).

Preliminary clinical research in females with breast cancer shows that auricular acupressure applied weekly for 12 weeks does not improve most measures of quality of life or breast cancer-related quality of life when compared with no auricular acupressure. However, nausea, vomiting, arm symptoms, and breast symptoms were each improved at some time points (103407). It is unclear if these improvements indicate a true difference in benefit.

Preliminary clinical research in patients with bronchiectasis shows that self-administered acupressure improves some measures of quality of life when compared with control, but not when compared with sham acupressure. Also, neither self-administered acupressure nor sham acupressure affects other outcomes, such as daily sputum amounts, walking distance, or breathing difficulty (16225).

A meta-analysis of two preliminary clinical trials, as well as additional individual preliminary clinical research, show that auricular acupressure has a small to moderate effect on malignancy-related pain when compared with baseline or control (98104, 102628). When acupressure is used in addition to analgesics, it is more effective for pain reduction than analgesics alone (102628). The National Comprehensive Cancer Network (NCCN) guidelines for adult cancer pain highlight acupressure as a potential integrative treatment. This may be especially important for vulnerable populations, such as frail or elderly individuals who may not be able to tolerate pharmacological treatments (113680). The Society for Integrative Oncology-American Society of Clinical Oncology guideline indicates that acupressure may be offered to patients with pain during systemic cancer treatment. This recommendation is based on moderate evidence from intermediate-quality research suggesting that benefits outweigh harms (109161).

There are mixed findings about the effectiveness of manual acupressure for CINV. Meta-analyses of mostly low-quality clinical trials in adults receiving chemotherapy show that manual acupressure modestly reduces acute and delayed nausea, but not acute or delayed vomiting (89038, 98095).

There is also mixed evidence related to the use of acupressure wristbands for CINV. Some small clinical studies in adults undergoing chemotherapy for breast or stomach cancer who have a history of severe nausea with chemotherapy shows that using passive acupressure wristbands (Sea-Band, Sea-Band Ltd.) reduces nausea and vomiting when compared with usual care alone (16227, 89046, 89058). However, these benefits might not be significant when compared with sham acupressure. Clinical research in chemotherapy-naïve adults now receiving chemotherapy of varying emetogenicities shows that using passive acupressure wristbands does not reduce nausea and vomiting when compared with sham wristbands or standard care alone (98096). Also, a small clinical study in patients undergoing moderately or highly emetogenic chemotherapy shows that a combination of acupressure and acupuncture does not significantly decrease nausea and vomiting when compared with sham combination therapy (16233). The reasons for these mixed findings may be related to the type of cancer, the chemotherapy regimen used, or the severity of CINV.

One meta-analysis of moderate- to high-quality clinical studies evaluated both manual and wristband PC6 acupressure, showing that it reduces the occurrence and severity of both acute and delayed nausea and vomiting when compared with usual care or sham acupressure. A subgroup analysis suggests that administering acupressure with finger pressure may provide more consistent benefit than wristband compression (114078).

Auricular acupressure has also been evaluated for CINV. A meta-analysis of clinical studies in patients with cancer receiving chemotherapy shows that auricular acupressure with antiemetic medication reduces the risk of delayed, but not acute, nausea and vomiting by 32% and 9%, respectively, when compared with antiemetic medication alone (107303).

The Society for Integrative Oncology-American Society of Clinical Oncology guideline indicates that acupressure may be offered to patients with chemotherapy-induced peripheral neuropathy. This recommendation is based on weak evidence from low-quality research suggesting that benefits outweigh harms (109161).

Preliminary clinical research in patients with cancer undergoing chemotherapy shows that self-administered acupressure can reduce general fatigue when compared with sham acupressure or usual care; however, acupuncture appears to be more effective than self-administered acupressure (16221, 98106). Additional preliminary clinical research in patients undergoing chemotherapy shows that receiving acupressure with essential oils improves sleep quality and functional status when compared with sham acupressure (98101).

Preliminary clinical research in patients with COPD shows that administering acupressure for 4-6 weeks improves dyspnea, oxygen saturation, physical capacity, and feelings of depression and anxiety when compared with sham acupressure or standard care alone (16224, 89074, 89075, 89080).

A network meta-analysis of clinical studies in older adults with mild cognitive impairment suggests that acupressure alone, or in combination with cognitive training, may improve cognitive function when compared with other non-pharmacological interventions or usual care (114086). Interpretation of these results is limited by the overall low quality of evidence and high risk of bias. A clinical study in older adults with amnestic mild cognitive impairment shows that self-acupressure for 6 months improves Mini-Mental State Examination (MMSE) scores by about 1 point at 3 months when compared with baseline, and an additional 1 point at 6 months. Self-acupressure also improves Montreal Cognitive Assessment (MoCA) scores by about 3 points at 3 months when compared with baseline and an additional 1 point at 6 months. However, there was no difference in scores when compared with group-based cognitive training (107309). The lack of statistical comparison between groups limits the validity of these findings.

A small clinical study in adults with functional constipation shows that adding perineal self-acupressure to standard care moderately improves bowel function and self-assessment of discomfort and satisfaction when compared with standard care alone (103396). However, it is unclear how this intervention compares with performing self-massage of the perineum. In addition, a meta-analysis of preliminary clinical trials in adults with post-stroke constipation shows that using various forms of massage, but most commonly acupressure massage, for 3-14 days is approximately 4 times more likely to reduce symptoms of constipation when compared with dietary or lifestyle treatments. Use of massage also had a large effect on the incidence of constipation (104747). High-quality research is needed to determine the long-term effects of acupressure massage.

Auricular acupressure has also been evaluated. A meta-analysis of clinical studies in adults with constipation, mostly located in China, shows that auricular acupressure improves Bristol stool form rating, constipation symptoms, and constipation-related quality of life scores when compared with control (114084). However, the overall quality of the evidence was rated low to very low.

Some research has evaluated acupressure for opioid-related constipation. A small clinical study in adults taking opioids for the treatment of cancer-related pain shows that daily acupressure for 4 weeks modestly improves stool consistency and defecation frequency, as well as feelings of straining, incomplete evacuation, pain, and gas, when compared with routine care (110303). The validity of these findings is limited by the lack of blinding.

An observational study conducted in China in adults with a mild COVID-19 infection has found that twice daily self-administered acupressure, in conjunction with usual care, is associated with a shortened time to resolution of most symptoms and higher clinical cure rate by day 7 when compared with usual care alone. Although the patients in this study were described as having only mild symptoms, all patients were admitted to the hospital (114090).

Preliminary clinical research in patients with dementia shows that acupressure administered 15 minutes twice daily for 5 days each week for 4 weeks reduces agitation when compared with no treatment (16230).

Meta-analyses of clinical research and individual clinical trials in adults with mild to moderate symptoms of depression shows that acupressure modestly improves feelings of depression and anxiety when compared with sham acupressure or usual care. These studies have included older adults, people diagnosed with depression, and people with comorbid illnesses such as stroke or cancer. However, many studies are heterogeneous with respect to treatment frequency, duration, and acupoint location(s). Also, some clinical trials have had a large dropout rate. Some research, including research which has found similar benefits with acupressure and sham acupressure, suggests that any observed benefit of acupressure may be due to a placebo effect (103412, 105118, 110301, 110304, 110308, 110311, 114072, 114082).

Preliminary clinical research in patients with type 2 diabetes shows that a single self-acupressure session at 4 bilateral points modestly decreases fasting blood glucose levels when compared with no intervention (103401). Another small clinical study in patients with type 2 diabetes shows that self-administered acupressure twice daily for 1 month improves fasting blood glucose levels by 38 mg/dL, compared with an increase of 4 mg/dL in those receiving sham acupressure. Changes in glycated hemoglobin (HbA1c) levels did not differ between groups (107317). Another small clinical study of a longer duration in this same population shows that acupressure, either self- or caregiver-administered, 3 times weekly for 12 weeks improves HbA1c levels by 0.5% when compared with baseline. Fasting blood glucose and HbA1c levels were similar when compared with usual care or usual care in combination with sham acupressure (107316). It is unclear if the changes from baseline differed between groups.

A meta-analysis of 7 low-quality clinical studies in adults with dry eye disease shows that auricular acupressure, alone or in combination with artificial tears, for 2-8 weeks improves tear-film stability, tear secretion, and some dry eye symptoms, when compared with artificial tears alone (114081). The validity of these findings is limited by the low to very low quality of the evidence.

Some clinical research shows that auricular or body acupressure reduces pain and anxiety during transportation to the hospital after hip fracture or distal radial fracture when compared with sham acupressure (89033, 89034).

Preliminary clinical research in patients with glaucoma shows that auricular acupressure twice daily for 4 weeks reduces intraocular pressure by approximately 17%, compared with about 3% in those using sham acupressure. Improvements occurred as soon as 10 minutes after the first treatment. There was also a slight improvement in uncorrected visual acuity after the 4-week intervention (103400).

A meta-analysis of 10 preliminary clinical trials in patients with hypertension and insomnia shows that auricular acupressure for 6-30 days reduces systolic and diastolic blood pressure by 15 and 8 mmHg, respectively, when compared with a control intervention or no intervention (103403).

Preliminary clinical research in patients with kidney failure shows that manual acupressure modestly improves depression, fatigue, and sleep when compared with usual care or sham acupressure (89022, 89023, 89024, 98091, 110301). A clinical study in patients receiving hemodialysis shows that acupressure at 4 points immediately prior to dialysis 3 times weekly for one month reduces the severity of pruritus by a large amount when compared with sham acupressure points or routine care (103405). In patients with constipation related to hemodialysis, a similar acupressure treatment schedule increased the mean number of weekly bowel movements by 1.3 when compared with sham acupressure (103406).

Auricular acupressure has also been evaluated in patients with kidney failure. A meta-analysis of mostly low-quality small studies in patients receiving maintenance hemodialysis shows that auricular acupressure improves sleep disorders, pruritis, and daily net weight gain when compared with usual care or placebo (107314). Similarly, another small meta-analysis of clinical studies in patients with sleep disturbance who are receiving maintenance hemodialysis shows that auricular acupressure is similarly effective when compared with estazolam (107302). The validity of these findings is limited by the heterogeneity of the included studies, which persisted throughout subgroup analyses.

Meta-analyses of preliminary clinical research show that applying acupressure during contractions has a small effect on pain and the use of analgesics during labor when compared with sham acupressure, no treatment, or usual care (98099, 102641, 103408, 110310). Benefits seem to last up to about an hour after each treatment (103408); however, high-quality research is still needed to confirm these results (102641, 103408).

Preliminary clinical research in adults with migraines shows that receiving acupressure daily for 8 weeks in addition to valproate prophylaxis does not reduce pain and frequency of migraine attacks, consumption of analgesics, or quality of life when compared with valproate alone (98103).

Some clinical research shows that acupressure does not reduce motion sickness in elderly patients, females, or male college students (89042, 89043, 89044, 89060). However, other research in experimentally-induced motion sickness shows that acupressure at the P6 point reduces nausea when compared with sham acupressure (89050). A similar preliminary research study shows that wearing an acupressure wrist band decreases experimentally-induced motion sickness when compared with baseline, but not when compared with sham acupressure (89061).

Preliminary clinical research in females with multiple sclerosis-related fatigue shows that acupressure at 3 points daily for 4 weeks improves fatigue by a moderate amount when compared with sham acupressure. Improvement occurred immediately after the first treatment (103397).

Preliminary clinical research in patients receiving activated charcoal for overdose shows that wearing acupressure wristbands on both wrists decreases vomiting when compared with not wearing them (89056). However, wristband acupressure does not seem to reduce nausea and vomiting immediately after myocardial infarction when compared with sham acupressure (89059).

Preliminary clinical research shows that acupressure reduces neck pain when compared with baseline or a non-acupressure control group. However, when compared with sham acupressure, benefits are unclear (89030, 103414, 104750, 105120). One clinical study in patients with sub-acute nonspecific neck pain shows that acupressure massage with lavender oil improves neck pain, stiffness, flexibility, and stress levels when compared with baseline (89030). In patients with chronic neck pain, acupressure treatment twice weekly for 4 weeks around the neck and shoulders reduces pain and disability and improves flexibility by moderate to large amounts when compared with no treatment (104750). In patients with acute or chronic neck pain, self-applied acupressure over 90 days in addition to standard treatment reduces pain by a small amount more than standard treatment alone, although there was no effect on function (105120). When compared with sham acupressure in patients with chronic neck pain, auricular acupressure seems to modestly improve the pain threshold, disability, and some measures of flexion, but does not reduce pain scores (103414). Further well-designed studies are needed.

One small clinical study in children shows that acupressure might decrease nocturnal enuresis when compared with oxybutynin (89081).

Although some individual preliminary clinical research disagrees (89017), a meta-analysis of small clinical studies shows that auricular acupressure with or without diet and exercise for 4-12 weeks reduces body weight by approximately 2 kg and fat mass by approximately 0.9 kg when compared with no treatment or sham treatment, with or without diet and exercise. Waist circumference and body mass index (BMI) were also reduced (103402). In addition, one small clinical study shows that patients receiving a specific acupressure technique (Tapas Acupressure Technique) maintained greater weight loss after 24 weeks when compared with patients participating in a support group or qi gong therapy (16229).

Meta-analyses of clinical studies and a number of individual clinical studies show that acupressure modestly reduces pain when compared with usual care, sham acupressure, or no treatment (89069, 89071, 103410, 107313, 110306, 110316, 114076, 114089). Studies have been conducted in patients during transport to the hospital for minor trauma, such as small fractures, wounds, or contusions (89069), in healthy adults, in adults with mild dementia and acute pain (110316), and in neonates undergoing needle insertions such as intramuscular injections and heel lance procedures (89071, 107313, 110306, 114076, 114089). In young athletes with an acute musculoskeletal injury, a small clinical study shows that acupressure administered in the medical clinic to an area near the thumb for 3 minutes on the day of injury modestly reduces pain when compared with sham acupressure or no treatment. However, there was no difference in anxiety between groups (103410).

A meta-analysis of the available clinical research shows that acupressure does not decrease the rate of caesarean delivery when compared with either sham acupressure or no additional treatment (98098). Acupressure also does not seem to help spontaneous labor initiation when compared with sham acupressure or no additional treatment (98102). However, one meta-analysis of preliminary clinical research shows that receiving acupressure decreases time in labor by about 1.3 hours when compared with sham acupressure or no treatment (98094). The validity of these findings is limited by the high heterogeneity and low quality of the included studies.

Acupressure has also been evaluated for use in the conversion of breech to cephalic presentation. A clinical study in patients at 32-35 weeks' gestation of a singleton pregnancy with ultrasound-confirmed breech presentation shows that self-administration of acupressure daily for 2 weeks is associated with conversion to cephalic presentation in 83% of patients, compared with 17% of patients receiving no intervention. Presentation at birth was similar and caesarean delivery occurred mostly in those receiving no intervention (107311).

A clinical study in patients undergoing first trimester vacuum aspiration abortion shows that there is no difference in pain and anxiety scores among those receiving auricular acupressure or acupuncture when compared with placebo (107312).

A small clinical study in adults undergoing hysterectomy shows that administering postoperative acupressure might improve gastrointestinal motility when compared with sham acupressure (89036). Another small clinical study in patients undergoing total knee arthroplasty shows that 67% of patients receiving postoperative acupressure have a bowel movement on postoperative day 1, compared with only 26% in the control group (107307).

Meta-analyses of clinical research in adults and children show that acupressure applied to the wrist modestly reduces PONV and the use of rescue antiemetics when compared with a control group (29628, 88601, 110309). However, the validity of these findings is limited by the inclusion of generally low quality studies with high heterogeneity. Some individual preliminary clinical studies in patients undergoing gynecological procedures and middle-ear surgeries also show that passive acupressure using wristbands (Sea-Band, Sea-Band Ltd.) reduces PONV when compared with control (16231), while one study shows no difference (107315).

However, it is unclear whether acupressure is more effective than sham acupressure. A meta-analysis of clinical research in patients undergoing laparoscopic surgery shows that acupressure, usually applied to the wrist, modestly reduces postoperative nausea, vomiting, and antiemetic use when compared with sham acupressure (110309). In addition, one preliminary clinical study shows that applying an acupressure bead patch perioperatively reduces postoperative nausea in females when compared with a control patch (98090). This study did not report the frequency or severity of vomiting. Another clinical trial shows that acupressure using wristbands (Sea-Band, Sea-Band Ltd.) modestly reduces the incidence and severity of postoperative nausea in the first 6 hours when compared with placebo wristbands or no treatment. However, there was no effect on vomiting (110314). Other individual preliminary clinical studies in patients undergoing gynecologic, plastic, otolaryngologic, or urologic surgeries show that acupressure wristbands or magnet patches on the P6 acupoint do not improve symptoms of PONV when compared with incorrectly positioned wristbands (89048, 89062, 98089). The reasons for these discrepancies are not clear but may involve the heterogenous populations, the timing of stimulation, the timing of symptom measurements, and the generally small size of most individual clinical trials.

Meta-analyses of clinical research, as well as individual clinical trials, show that auricular acupressure modestly improves most postoperative pain (89029, 103409, 114075, 114088). One meta-analysis shows that acupressure produces a 25% greater reduction in pain when compared with control groups, including usual care, no treatment, or sham acupressure (103409). Pain relief seems to be most significant 72 hours after surgery or when abdominal surgery was performed (103409). Another meta-analysis of clinical studies in patients with recent surgery for hip fracture shows that auricular acupressure, in combination with conventional treatment, reduces pain scores in the first 72 hours after surgery, reduces analgesic use, and improves hip function when compared with conventional treatment alone (114088). In addition, postoperative acupressure at other points after a caesarean section or in children after a tonsillectomy reduces pain by a moderate amount when compared with sham acupressure (103416, 103418). In contrast, a small clinical study shows that adding acupressure to standard anesthesia does not decrease pain or opioid use after abdominal surgery (89028). Also, auricular acupressure does not seem to improve pain following ear, nose, or throat (ENT) surgery (103409). The validity of these findings is limited by the low quality of many of the studies.

Acupressure using a wristband has also been investigated. One small clinical study shows that acupressure using wristbands (Sea-Band, Sea-Band Ltd.) modestly reduces pain 12 hours after surgery, but not before 12 hours or between 12-24 hours after surgery, when compared with placebo wristbands or no treatment. However, there was no effect on pain-related vomiting (110314).

The Society for Integrative Oncology-American Society of Clinical Oncology guideline indicates that acupressure may be offered to patients with cancer-related postoperative or post-procedural pain. This recommendation is based on weak evidence from low-quality research suggesting that benefits outweigh harms (109161).

One preliminary clinical trial shows that acupressure using wristbands (Sea-Band, Sea-Band Ltd.) modestly improves sleep quality in the 24 hours after surgery, when compared with placebo wristbands or no treatment (110314).

A network meta-analysis of clinical studies in adults with postpartum urinary incontinence living in China shows that acupressure in combination with pelvic floor training reduces urinary incontinence when compared with pelvic floor training alone, other acupoint modalities, or biofeedback therapies (114074).

Two meta-analyses of clinical studies show that auricular acupressure and P6 acupressure applied with fingers or a wristband reduce nausea and vomiting during pregnancy when compared with baseline, sham acupressure, or control treatments (88592, 114077). Another meta-analysis of clinical studies shows that acupressure may reduce the need for prescription antiemetics. It may also reduce nausea and vomiting when compared with metoclopramide with or without vitamin B6 (pyridoxine), but not when compared with placebo (114080). Most of these studies were considered low-quality and at high risk of bias.

However, not all research has been positive. Other small clinical studies show that passive acupressure wristbands (Sea-Band, Sea-Band Ltd.) do not reduce nausea and vomiting when compared with vitamin B6 or with a wristband applied to a sham acupoint (16228, 89049). In addition, applying auricular acupressure during pregnancy does not reduce nausea or vomiting when compared with sham auricular acupressure (89052). Finally, in patients who are hospitalized for severe nausea and vomiting, adding wristband acupressure to usual care does not decrease the length of hospital stay or the need for antiemetic medication or intravenous fluids (16234). Although the reasons for these discrepancies are unclear, studies differ by acupressure type, included age groups, duration of intervention, and the specific tools used to measure the severity of nausea and vomiting (103413). More research is needed to determine if certain patients may be more likely to benefit, or if certain forms of acupressure are more beneficial than others.

The American College of Obstetrics and Gynecology (ACOG) lists P6 acupressure, applied via wristbands, as a first-line nonpharmacological treatment option for pregnancy-induced nausea and vomiting. This recommendation is based on limited evidence and acknowledges that any benefits may be limited (111601).

Some preliminary clinical research, as reported in a meta-analysis, shows that acupressure at points near the thumb or at the top of the foot reduces the number of patients with moderate to severe PMS symptoms by approximately 36% when compared with sham acupressure. Quality of life was also improved (100769). Another preliminary clinical trial shows that acupressure moderately improves PMS pain and symptoms when compared with baseline, although yoga produced greater effects (104749).

A meta-analysis of 9 clinical trials shows that acupressure has a large beneficial effect on symptoms of pre-procedural anxiety when compared with usual care or sham acupressure (110296). Additionally, a meta-analysis of clinical studies shows that acupressure reduces pre-operative anxiety, heart rate, blood pressure, and serum cortisol levels in adults scheduled for elective surgery when compared with usual care or sham acupressure (114079). In adults undergoing abdominal surgery and in children undergoing tonsillectomy, acupressure between the eyebrows, with or without auricular acupressure, modestly reduces preoperative anxiety when compared with acupressure at sham acupoints (103399, 103415). Small clinical studies in other populations, such as children undergoing endoscopic procedures and adults undergoing open heart surgery, shows that acupressure reduces anxiety when compared with sham acupressure (89067, 104748). In adults undergoing caesarean section under spinal anesthesia, acupressure on the wrist modestly reduces feelings of anxiety when compared with normal hospital protocols involving no treatment (105119). However, one small study shows that acupressure applied to the face for 10 minutes reduces anxiety in adults undergoing elective surgical procedures when compared with baseline, but not when compared with sham acupressure (89065).

Some research has evaluated acupressure for anxiety in the parents of children undergoing procedures. One small clinical study in parents of children who are undergoing surgical procedures shows that acupressure between the eyebrows reduces anxiety within 20 minutes when compared with sham acupressure (89066).

Preliminary clinical research in females with a history of sexual problems shows that a vaginal acupressure massage decreases pain and discomfort during intercourse and improves sexual insufficiency and quality of life when compared with baseline (89027). The validity of these findings is limited by the lack of a control group.

Preliminary clinical research in stroke patients shows that acupressure and aromatherapy acupressure twice daily for 2 weeks reduces shoulder pain when compared with baseline (16223). The validity of this finding is limited by the lack of a control group.

Preliminary clinical research in patients wishing to quit smoking shows that auricular acupressure along with nicotine replacement does not reduce nicotine withdrawal symptoms when compared with nicotine replacement alone (16226). However, other preliminary clinical research in adolescents shows that adding 1 minute of auricular acupressure 3-5 times daily for 4 weeks to an internet smoking cessation program results in better quit rates when compared with the internet cessation program alone (89019).

A small clinical study in healthy volunteers shows that applying acupressure to an acupoint for 10 minutes decreases stress when compared with sham acupressure (89070).

Preliminary clinical research in patients with stroke-related hemiplegia shows that full-body acupressure treatment every 1 or 2 days for less than 6 months reduces symptoms when compared with baseline (89018). However, the validity of these findings is limited by the lack of a control group. In addition, in patients with post-stroke constipation, a meta-analysis of preliminary clinical trials shows that using various forms of massage, but most commonly acupressure massage, for 3-14 days is approximately 4 times more likely to be effective for reducing symptoms of constipation when compared with dietary or lifestyle treatments. Use of massage also had a large effect on the incidence of constipation (104747).

Preliminary clinical research in patients with acute vertigo and those undergoing labyrinth stimulation shows that using passive acupressure wristbands (Sea-Band, Sea-Band Ltd.) reduces nausea, vomiting, and sweating associated with spontaneous or provoked vertigo in up to 85% of patients, compared with only 11% of patients wearing a sham wristband (18239).

Preliminary clinical research in patients receiving spinal anesthesia for caesarean delivery shows that applying acupressure wristbands (Sea-Band, Sea-Band Ltd.) prior to anesthesia does not reduce nausea and vomiting when compared with placebo wristbands (16235, 89055).