Resumo

Houve avanços recentes no tratamento medicamentoso da náusea e mal-estar após quimioterapia, como o uso de inibidores de 5-HT₃ e dexametasona. No entanto, muitos ainda relatam esses sintomas, e especialistas recomendam o uso de métodos adicionais na redução desses sintomas.

Objetivos

O objetivo deste estudo foi de analisar a eficácia da acupuntura nas náuseas e vômitos causados pela quimioterapia, em pacientes com câncer.

Métodos

Foram selecionados artigos no MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, e resumos de congressos.

Critérios de seleção

Selecionamos artigos randomizados, em que havia estimulação de pontos de acupuntura, quaisquer eram os métodos (por agulhas, estimulação elétrica, acupressão), e náuseas ou vômitos induzidos por quimioterapia.

Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting

1. Jeanette Ezzo^1,*,
2. Mary Ann Richardson²,
3. Andrew Vickers³,
4. Claire Allen⁴,
5. Suzanne Dibble⁵,
6. Brian F Issell⁶,
7. Lixing Lao⁷,
8. Michael Pearl⁸,
9. Gilbert Ramirez⁹,
10. Joseph A Roscoe¹⁰,
11. Joannie Shen¹¹,
12. Jane C Shivnan¹²,
13. Konrad Streitberger¹³,
14. Imad Treish¹⁴,
15. Grant Zhang¹⁵

Editorial Group: Cochrane Pain, Palliative and Supportive Care Group

Published Online: 19 APR 2006

Assessed as up-to-date: 21 FEB 2006

DOI: 10.1002/14651858.CD002285.pub2

There have been recent advances in chemotherapy-induced nausea and vomiting using 5-HT₃ inhibitors and dexamethasone. However, many still experience these symptoms, and expert panels encourage additional methods to reduce these symptoms.

The objective was to assess the effectiveness of acupuncture-point stimulation on acute and delayed chemotherapy-induced nausea and vomiting in cancer patients.

We searched MEDLINE, EMBASE, PsycLIT, MANTIS, Science Citation Index, CCTR (Cochrane Controlled Trials Registry), Cochrane Complementary Medicine Field Trials Register, Cochrane Pain, Palliative Care and Supportive Care Specialized Register, Cochrane Cancer Specialized Register, and conference abstracts.

Randomized trials of acupuncture-point stimulation by any method (needles, electrical stimulation, magnets, or acupressure) and assessing chemotherapy-induced nausea or vomiting, or both.

Data were provided by investigators of the original trials and pooled using a fixed effect model. Relative risks were calculated on dichotomous data. Standardized mean differences were calculated for nausea severity. Weighted mean differences were calculated for number of emetic episodes.

Eleven studies (N = 1247) were pooled. Overall, acupuncture-point stimulation of all methods combined reduced the incidence of acute vomiting (RR = 0.82; 95% confidence interval (CI) 0.69 to 0.99; P = 0.04), but not acute or delayed nausea severity compared to control. By modality, stimulation with needles reduced proportion of acute vomiting (RR = 0.74; 95% CI 0.58 to 0.94; P = 0.01), but not acute nausea severity. Electroacupuncture reduced the proportion of acute vomiting (RR = 0.76; 95% CI 0.60 to 0.97; P = 0.02), but manual acupuncture did not; delayed symptoms for acupuncture were not reported. Acupressure reduced mean acute nausea severity (SMD = -0.19; 95% CI -0.37 to -0.01; P = 0.04) but not acute vomiting or delayed symptoms. Noninvasive electrostimulation showed no benefit for any outcome. All trials used concomitant pharmacologic antiemetics, and all, except electroacupuncture trials, used state-of-the-art antiemetics.

This review complements data on post-operative nausea and vomiting suggesting a biologic effect of acupuncture-point stimulation. Electroacupuncture has demonstrated benefit for chemotherapy-induced acute vomiting, but studies combining electroacupuncture with state-of-the-art antiemetics and in patients with refractory symptoms are needed to determine clinical relevance. Self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients though studies did not involve placebo control. Noninvasive electrostimulation appears unlikely to have a clinically relevant impact when patients are given state-of-the-art pharmacologic antiemetic therapy.