For Hyperemesis Gravidarum (Morning Sickness), see the relevant section of our pregnancy page: There is also an interesting video from the British Acupuncture Council with a patient regarding hyperemesis gravidarum (severe morning sickness) and her use of acupuncture, showing a treatment and discussion with her acupuncturist: you can see it here
Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Research and Resources on Nausea, Vomiting and Acupuncture:
A scholarly search of the available research papers on the terms “acupuncture” + “nausea” yields over 36,300 papers, and narrowing this to “RCT” to identify Randomised Controlled Trials, gives over 5,930 results; of which 39% have been carried out since 2017 (Google Scholar). This suggests that acupuncture is being used traditionally and currently in this area, leading to a body of research being carried out, the pace of which has increased in recent years, indicating increased recognition that it is worthy of scientific appraisal regarding its potential role.
Interpreting the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
Post Operative Nausea and Vomiting (PONV)
In the hospital setting, acupuncture reduced postoperative nausea and vomiting (PONV) in children, particularly during the first 4 hours after surgery and was most effective when performed before anaesthesia (Veiga-Gil at al, 2017, systematic review of 16 RCT’s, n=1773).
Sun et al’s (2008) systematic review of 15 RCT’s (n=1166) in the British Journal of Anaesthesia examined post-operative pain but also found lower incidence of opioid side effects including post-operative nausea and vomiting (PONV) in acupuncture groups. They stated that further large and well-designed studies are needed to further examine this area including the most effective points and timings to use.
Fu et al (2020a) looked specifically at nausea and vomiting post abdominal surgery in a systematic review (20 studies, n=2862), finding positive results for acupuncture intervention groups, nausea being easier to control than was vomiting.
A further systematic review in this area is due soon, looking at comparing non-invasive and invasive acupuncture in the prevention of postoperative nausea and vomiting (protocol: Fu et al, 2020b), it will be good to have the more resent research included in this where methodology and quality allow, given this is an area of greatly increased research since 2017.
Chemotherapy and Radiotherapy Related Nausea and Vomiting
Five forthcoming systematic reviews are currently awaited from Ma et al, (protocol: 2020); Huang et al (protocol: 2020); Shi et al (protocol: 2020); Hu et al, (protocol, 2019); and Hou et al, (protocol: 2021) regarding acupuncture in chemotherapy-induced vomiting and nausea.
It will be of interest to see what these five systematics review add to the literature and evidence, given the large increase in RCT’s in this area since 2017. (Of 1,860 RCT’s for this, 638 were published since 2017 [search term “acupuncture” + “nausea” + “chemotherapy” +”RCT” on scholarly resource].
Further, a systematic review protocol has been published to investigate acupuncture in radiotherapy-induced nausea and vomiting (protocol: Shu et al, 2019).
EA is a safe and effective form of therapy, which studies and systematic reviews, have shown may benefit patients for the symptoms of a wide range of conditions, in particular nausea prevention: post chemotherapy (Zhang et al, 2014); post surgery nausea (Ho et al, 1990); in hyperemesis gravidarum (severe “morning sickness” of pregnancy) (Ezzo et al, 2006);
British Acupuncture Council evidence based factsheet about Nausea and Vomiting including specific research, trials and mechanisms of action for acupuncture in this condition.
Ezzo, J., Streitberger, K. and Schneider, A., 2006. Cochrane systematic reviews examine P6 acupuncture-point stimulation for nausea and vomiting. Journal of Alternative & Complementary Medicine, 12(5), pp.489-495.
Fu, C., Wu, T., Shu, Q., Song, A. and Jiao, Y., 2020a. Acupuncture therapy on postoperative nausea and vomiting in abdominal operation: A Bayesian network meta analysis. Medicine, 99(23).
Fu, C.W., Shu, Q., Jiao, Y., Wu, T., Song, A.Q., Zhu, Q.C. and Zhang, W.P., 2020b. A comparison of noninvasive and invasive acupuncture in preventing postoperative nausea and vomiting: A protocol for systematic review and Bayesian network meta-analysis. Medicine, 99(31).
Ho, R.T., Jawan, B., Fung, S.T., Cheung, H.K. and Lee, J.H., 1990. Electro‐acupuncture and postoperative emesis. Anaesthesia, 45(4), pp.327-329.
Hou, X.B., Chen, D.D., Cheng, T.F., Wang, D., Dai, X.J., Wang, Y., Cui, B.X., Wang, Y.Y., Xu, H. and Chen, H.Z., 2021. Acupuncture treatment for nausea and vomiting after chemotherapy: A protocol for systematic review. Medicine: Case Reports and Study Protocols, 2(5), p.e0084.
Hu, J., Shen, Y., Zhang, G., He, J., Sun, M., Zhang, H., Hua, B. and Zheng, H., 2019. Effect of acupoint therapies on chemotherapy-induced nausea and vomiting: A systematic review protocol. Medicine, 98(37).
Huang, Y., Zhang, R., Yao, Q., Liu, J., OuYang, X., Hui, X., Wang, H., He, R. and Zhao, B., 2020. Acupuncture treatment for chemotherapy-induced nausea and vomiting: A protocol for systematic review and meta-analysis. Medicine, 99(21).
Ma, T.T., Zhang, T., Zhang, G.L., Dai, C.F., Zhang, B.R., Wang, X.M. and Wang, L.P., 2020. Prevention of chemotherapy-induced nausea and vomiting with acupuncture: a protocol for systematic review and meta-analysis. Medicine, 99(3).
Shi, Y., Xu, T., Chen, Q., Wu, J., Zhong, Y., Song, S., Chen, Y., Gao, W. and Zhao, L., 2019. Acupuncture for radiotherapy-induced nausea and vomiting: A systematic review protocol. Medicine, 98(24).
Shi, K., He, F., Tang, Y., Xiao, X., Zhang, J., Jin, Y., Wang, Y. and Zhang, Q., 2020. Acupuncture PC6 for postoperative nausea and vomiting at different times: A protocol for systematic review and meta analysis. Medicine, 99(22), p.e20452.
Sun, Y., Gan, T.J., Dubose, J.W. and Habib, A.S., 2008. Acupuncture and related techniques for postoperative pain: a systematic review of randomized controlled trials. British journal of anaesthesia, 101(2), pp.151-160.
Veiga-Gil, L., Pueyo, J. and López-Olaondo, L., 2017. Postoperative nausea and vomiting: physiopathology, risk factors, prophylaxis and treatment. Revista Española de Anestesiología y Reanimación (English Edition), 64(4), pp.223-232.
Zhang, X., Jin, H.F., Fan, Y.H., Lu, B., Meng, L.N. and Chen, J.D., 2014. Effects and mechanisms of transcutaneous electroacupuncture on chemotherapy-induced nausea and vomiting. Evidence-Based Complementary and Alternative Medicine, 2014.