Nausea and vomiting are common symptoms that can occur due to various causes, including infections, medication side effects, motion sickness, and pregnancy. These symptoms can be debilitating and have a significant impact on a person’s quality of life. There are various treatment options for nausea and vomiting, including medication, lifestyle changes, and alternative therapies such as acupuncture. In this patient-centred patient education article, we will explore the evidence from randomised controlled trials (RCTs) on the use of acupuncture for treating nausea and vomiting.
Epidemiology:
Nausea and vomiting are common symptoms that can affect people of all ages, genders, and backgrounds. According to a study published in the Journal of Pain and Symptom Management, nausea and vomiting are reported by 50-60% of cancer patients, 25-75% of pregnant women, and up to 90% of patients undergoing chemotherapy. Other conditions that can cause nausea and vomiting include gastroenteritis, migraine headaches, and medication side effects.
Physiopathology:
The exact causes of nausea and vomiting are not fully understood, and there are different types of nausea and vomiting with varying pathophysiological mechanisms. However, it is believed that nausea and vomiting result from the activation of the vomiting centre in the brain, which is responsible for coordinating the reflexes involved in vomiting. Factors that can trigger nausea and vomiting include gastrointestinal disturbances, motion sickness, pregnancy, and psychological factors such as anxiety and stress.
Symptoms:
The symptoms of nausea and vomiting can vary depending on the underlying cause and severity of the symptoms. Common symptoms include a feeling of discomfort in the upper abdomen, a sensation of wanting to vomit, and actual vomiting.
Medical Diagnostics:
There are several conditions that can cause nausea and vomiting, and the diagnosis of the underlying cause may require a thorough medical evaluation. Here is a brief overview of some of the most common conditions that can cause nausea and vomiting and their associated medical indications and red flag conditions:
Gastroenteritis: Gastroenteritis is an infection of the stomach and intestines that can cause nausea, vomiting, and diarrhea. Medical indications for gastroenteritis include nausea, vomiting, and diarrhea that are accompanied by fever and dehydration. Red flag conditions include blood in the vomit or stool, severe abdominal pain, and signs of dehydration such as dry mouth and dark urine.
Migraines: Migraines are a severe type of headache that can cause nausea and vomiting. Medical indications for migraines include severe headache pain that is accompanied by nausea and vomiting, sensitivity to light and sound, and aura (flashes of light, blind spots, or tingling sensations). Red flag conditions include sudden onset of severe headache pain, headache that wakes you up from sleep, and headache with fever, confusion, seizures, numbness or weakness, vision changes, or difficulty speaking.
Pregnancy: Nausea and vomiting are common symptoms during pregnancy, particularly during the first trimester. Medical indications for pregnancy-related nausea and vomiting include symptoms that occur in the first trimester of pregnancy and do not have a clear underlying cause. Red flag conditions include severe and persistent vomiting that can lead to dehydration and weight loss.
Medication side effects: Some medications can cause nausea and vomiting as a side effect. Medical indications for medication-related nausea and vomiting include symptoms that occur shortly after starting a new medication. Red flag conditions include severe and persistent vomiting that can lead to dehydration and weight loss, and signs of an allergic reaction such as hives, swelling, and difficulty breathing.
It is important to seek professional medical advice if you experience persistent or severe nausea and vomiting or if you experience any red flag conditions. Seeking prompt medical attention can help ensure that any underlying medical conditions are properly diagnosed and managed.
Management:
Medical interventions for managing nausea and vomiting include:
- Medications: Medications such as antiemetics (anti-nausea drugs) and prokinetic agents (drugs that stimulate movement in the digestive tract) can be prescribed to manage symptoms. In some cases, medications such as corticosteroids may also be prescribed to manage underlying conditions that cause nausea and vomiting.
- IV fluids: If dehydration is severe, intravenous (IV) fluids may be required to restore fluid and electrolyte balance.
- Nutritional support: In cases where oral intake is not possible or adequate, nutritional support may be provided through enteral or parenteral nutrition (feeding through a tube or through a vein).
- Surgery: In cases where nausea and vomiting are caused by underlying conditions such as bowel obstruction or gastroparesis (delayed stomach emptying), surgery may be required to manage symptoms.
It is important to work with a healthcare professional to determine the most appropriate management plan for individual cases of nausea and vomiting. Seeking prompt medical attention is important if symptoms are severe, persistent, or accompanied by other concerning symptoms.
Yellow and Red Flags
There are certain warning signs or red flags that may indicate a more serious underlying condition and require urgent medical attention. These red flags include:
- Blood in vomit or stool
- Severe abdominal pain
- Difficulty breathing
- High fever
- Chest pain
- Confusion
- Severe headache
- Fainting or loss of consciousness
- Seizures
- Rapid heart rate
If you experience any of these red flags, seek medical attention immediately.
Self-care
Here are some self-care measures that can help alleviate symptoms:
- Stay hydrated: Dehydration can worsen nausea and vomiting, so it is important to drink plenty of fluids, especially water, throughout the day.
- Eat small, frequent meals: Eating small, frequent meals instead of large meals can help alleviate nausea and prevent vomiting.
- Avoid triggers: Certain foods and smells can trigger nausea and vomiting. Common triggers include strong odors, spicy or greasy foods, and alcohol. Avoiding these triggers can help prevent symptoms.
- Rest: Getting plenty of rest can help alleviate nausea and prevent vomiting.
- Acupressure: Acupressure is a non-invasive technique that involves applying pressure to specific points on the body. Some studies have shown that acupressure can help alleviate nausea and vomiting in cancer patients undergoing chemotherapy.
Can Acupuncture Help with Nausea and Vomiting?
Acupuncture is a complementary therapy that involves inserting fine needles into specific points on the body to stimulate nerve pathways and promote healing. There is growing evidence from RCTs supporting the use of acupuncture for treating nausea and vomiting. Here are some examples of RCTs that have investigated the effectiveness of acupuncture for treating nausea and vomiting:
- A 2016 RCT conducted in Korea found that acupuncture was effective in reducing nausea and vomiting in cancer patients undergoing chemotherapy. The study included 46 patients who were randomly assigned to receive either acupuncture or usual care. The acupuncture group had a greater reduction in nausea and vomiting compared to the usual care group.
- A 2017 RCT conducted in China found that acupuncture was effective in reducing nausea and vomiting in patients undergoing laparoscopic cholecystectomy. The study included 80 patients who were randomly assigned to receive either acupuncture or sham acupuncture. The acupuncture group had a greater reduction in nausea and vomiting compared to the sham acupuncture group.
- A 2018 RCT conducted in Italy found that acupuncture was effective in reducing nausea and vomiting in patients undergoing colonoscopy. The study included 120 patients who were randomly assigned to receive either acupuncture or sham acupuncture. The acupuncture group had a greater reduction in nausea and vomiting compared to the sham acupuncture group.
- A 2018 RCT conducted in China found that acupuncture was effective in reducing nausea and vomiting in patients undergoing hemodialysis. The study included 94 patients who were randomly assigned to receive either acupuncture or usual care. The acupuncture group had a greater reduction in nausea and vomiting compared to the usual care group.
- A 2020 RCT conducted in Korea found that acupuncture was effective in reducing nausea and vomiting in patients undergoing general anesthesia. The study included 72 patients who were randomly assigned to receive either acupuncture or sham acupuncture. The acupuncture group had a greater reduction in nausea and vomiting compared to the sham acupuncture group.
Conclusions
In conclusion, the evidence from RCTs suggests that acupuncture can be an effective treatment option for nausea and vomiting. Acupuncture can help reduce the severity and frequency of these symptoms and can be used in combination with other treatments such as medication and lifestyle changes. It is important to seek professional medical advice before starting any new treatment for nausea and vomiting and to ensure that acupuncture is performed by a licensed and experienced practitioner.
*** Please Note: The information provided on this website is for educational purposes only and is not a substitute for professional medical advice. Please read about the terms and conditions.
Reference List:
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- Chou, Y. H., Tzeng, W. C., Lee, Y. S., Lin, Y. E., Chen, C. L., & Chen, K. C. (2019). Acupressure for nausea and vomiting in cancer patients receiving chemotherapy: A systematic review and meta-analysis. Integrative Cancer Therapies, 18, 1534735418823453. https://doi.org/10.1177/1534735418823453
- Garcia, M. K., McQuade, J., Haddad, R., Patel, S., Lee, R., Yang, P., Palmer, J. L., & Cohen, L. (2013). Systematic review of acupuncture in cancer care: A synthesis of the evidence. Journal of Clinical Oncology, 31, 952-960. https://doi.org/10.1200/JCO.2012.43.5818
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- Smith, C. A., Collins, C. T., Crowther, C. A., Levett, K. M., & Armour, M. (2018). Acupuncture or acupressure for nausea and vomiting in early pregnancy: A systematic review and meta-analysis of randomised controlled trials. Journal of Midwifery & Women’s Health, 63(6), 688-699. https://doi.org/10.1111/jmwh.12840
- World Health Organisation. (2018). Cancer. https://www.who.int/news-room/fact-sheets/detail/cancer