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  1. Adrian White
  1. Correspondence to Dr Adrian White, Primary Care Group, Plymouth University Peninsula Schools of Medicine and Dentistry, N21 ITTC Building, Tamar Science Park, Plymouth, Devon PL6 8BX, UK; Adrian.white{at}plymouth.ac.uk

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Clinical effectiveness trials

Chemotherapy induced nausea and vomiting

▸ 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.

Acupuncture compared with ondansetron (n=70).

Methods

Seventy patients were randomised to receive either (1) acupuncture at PC6 bilaterally for 30 min, with manipulation initially, or (2) ondansetron 8 mg intravenously, both 30 min before chemotherapy infusion in their first cycle. Patients crossed over to the other treatment for the consecutive cycle. All patients received dexamethasone 5 mg orally twice a day for 3 days. Patients were given additional doses of ondansetron 4 mg orally every 12 h if they experienced emesis.

Outcome measures were episodes of vomiting, severity of nausea score of 0–10 and adverse events. Complete response was defined as no nausea, no vomiting and not requiring additional antiemetic drugs. FACT-G scale was used to evaluate quality of life (QOL) 7 days after each cycle of chemotherapy.

Results

The acupuncture group had a significantly higher rate of complete response (see figure 1) in prevention of delayed nausea and vomiting (p=0.02), and the acupuncture group reported significantly lower delayed nausea (45.7% and 65.7%, p=0.004), nausea score (p<0.001) and fewer dosages of additional oral ondansetron (p=0.002).

Figure 1

Numbers with no nausea or vomiting. Based on Gynecol Oncol 2014. pii: S0090-8258(14)01409-7.

Adverse effects were also significantly lower in the acupuncture group with less frequent constipation (p=0.02) and insomnia (p=0.01). Overall FACT-G scores were significantly higher in the acupuncture group.

Comment

There seems to be increasing evidence of the value of acupuncture in preventing delayed chemotherapy induced nausea and vomiting, and the effect is large enough to show in such a small study.

Peroperative and postoperative pain

▸ Iacobone M, Citton M, Zanella S, et al. The effects of acupuncture after thyroid surgery: a randomized, controlled trial. Surgery 2014;156:1605–13.

Methods

We randomised 121 patients to a control group (undergoing only standard analgesia during and after …

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