Alternative and Integrative Therapies for Nausea And Vomiting

Good Scientific Evidence:

Acupressure, Shiatsu: Shiatsu technique involves finger pressure at acupoints and along body meridians. It can incorporate palm pressure, stretching, massaging, and other manual techniques. Numerous scientific studies support the use of wrist acupressure at the P6 acupoint (also known as Neiguan) in the prevention and treatment of nausea after surgery, intra-operative nausea (during spinal anesthesia), nausea from chemotherapy, as well as pregnancy related nausea/vomiting and morning sickness. However, results from studies are conflicting. Effects have been noted in children as well as adults. Better quality research is needed.

Acupuncture: The practice of acupuncture originated in China 5,000 years ago. Today, acupuncture is widely used throughout the world and is one of the main pillars of traditional Chinese medicine (TCM). Evidence from several small studies supports the use of acupuncture at a specific point on the wrist (P6) to help chemotherapy patients reduce nausea and vomiting. Also, several well-designed studies support the use of acupuncture at the P6 wrist point for control of pregnancy-related nausea and vomiting. Evidence supports acupuncture at the wrist P6 point for the relief of post-operative nausea and vomiting in adults.

Acustimulation: Acustimulation is the mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting. A low-intensity electrical current is used to penetrate just slightly below the surface of the skin. There is evidence from small but well-designed studies of seasickness and artificially-induced motion sickness (using laboratory equipment) indicating that acustimulation can reduce symptoms of nausea and vomiting. It may slow down, but not necessarily prevent, the development of motion sickness.

There is good evidence that wearing the ReliefBand ® helps reduce post-operative nausea and vomiting. The effect may be comparable to anti-nausea medications (dimenhyrinate) and may be enhanced when combined with medication. The ReliefBand ® is worn like a wristwatch on the inside of the wrist. It stimulates the nerves in the wrist with gentle electrical signals, which are believed to interfere with nausea-inducing messages between the brain and the stomach.

Ginger: Preliminary studies suggest that ginger (Zingiber officinale) may be safe and effective for nausea and vomiting in pregnancy when used at recommended doses for short periods of time (less than five days). Some publications discourage large doses of ginger during pregnancy due to concerns about mutations or abortion. Additional research is needed to determine the safety and effectiveness of ginger during pregnancy. Ginger may increase bleeding in sensitive individuals, including those taking blood thinning medications such as warfarin (Coumadin ®).

Music therapy: Music is used to influence physical, emotional, cognitive, and social well-being and improve the quality of life for healthy people, as well as those who are disabled or ill. It may involve either listening to or performing music, with or without the presence of a music therapist. Music therapy helps in a wide range of pain conditions, primarily by its ability to improve mood, encourage relaxation, and elevate pain threshold. Music therapy may reduce levels of nausea and episodes of vomiting in bone marrow transplant patients during the preparatory period when they are receiving high-dose chemotherapy with cyclophosphamide (Cytoxan ®).

Unclear or Conflicting Scientific Evidence:

Acupuncture: Several attempts have been made to document benefits of stimulation of the P6 wrist point to reduce post-operative nausea and vomiting. Both acupuncture and acupressure wrist bands have been tried. Study results conflict. More trials are needed to make any firm conclusion regarding the use of acupuncture in adults and children.

Acustimulation: Transcutaneous acupoint electrical stimulation has been tested in one small study of patients receiving electroshock therapy for mental illness, to determine whether it might reduce nausea and vomiting after this procedure. The design of the study makes interpretation difficult, and more studies are needed to determine benefits in this use.

The evidence on the use of acustimulation wristbands for chemotherapy nausea and vomiting is mixed. Some studies suggest no benefit and that simple acupressure massage may be more effective. Other studies have found benefit that when acustimulation is combined with anti-nausea medications: the bands may reduce the amount of medication needed and they may help with more severely nauseous patients. More studies are needed to clarify the relationships between patient responses, types of cancer, and types of chemotherapy.

There is a lack of solid evidence on the effects of acustimulation for nausea associated with pregnancy. Although experts express a general opinion that it is likely beneficial, well-designed studies are needed to document the benefits.

Aromatherapy: Aromatherapy is a technique in which essential oils from plants are used with the intention of preventing or treating illness, reducing stress, or enhancing well-being. There is preliminary evidence from one small study suggesting that there may be no effect on nausea post-surgery other than might be attributable to simple breathing or placebo effects. More studies are needed to determine whether or not aromatherapy may contribute to well-being in post-operative patients.

Ginger: There is mixed evidence in this area, with some studies reporting that ginger has no effect on motion sickness, and other research noting that ginger may reduce vomiting (but not nausea). More studies are needed comparing ginger to other drugs used for this purpose.

Initial human research reports that ginger may reduce the severity and length of time that a patient feels nausea after chemotherapy. Other studies show no significant effects. Additional studies are needed to confirm these results and to determine safety and dosing. Numerous prescription drugs, such as 5HT3 inhibitors, are highly effective at controlling nausea in cancer patients undergoing chemotherapy, and the available options should be discussed with the patient's medical oncologist.

Some human studies report improvement in nausea or vomiting after surgery if patients take ginger before surgery. However, other research shows no difference. Additional studies are needed.

Hypnosis: Several studies report on the use of hypnotherapy in people with nausea/vomiting related to cancer chemotherapy, pregnancy (hyperemesis gravidarum), and surgical recovery. Results are mixed and there is no reliable comparison to anti-nausea medications or other relaxation techniques. Better research is needed before a firm conclusion can be drawn.

TENS: Transcutaneous electrical nerve stimulation (TENS) is a non-invasive technique in which a low-voltage electrical current is delivered through wires from a small power unit to electrodes located on the skin. TENS is usually performed in conjunction with acupuncture treatments. Electrodes are temporarily attached with paste in various patterns, depending on the specific condition and treatment goals. Although a study found positive results with post-operative nausea when using TENS, more research is needed.

Traditional or theoretical uses that lack sufficient evidence:

Integrative therapies traditionally used in nausea and related conditions, but which lack sufficient scientific evidence include African wild potato (Hypoxis hemerocallidea), alpinia (Alpinia galanga), bael fruit (Aegle marmelos), homeopathic belladonna (Atropa belladonna), black horehound (Ballota nigra), blue flag (Iris versicolor), calendula (Calendula officinalis), carob (Ceratonia siliqua), chamomile (Matricaria recutita, Chamaemelum nobile), clay, ginseng (Panax ginseng), globe artichoke (Cynara scolymus), guided imagery, lavender essential oil (Lavandula angustifolia), lemongrass (Cymbopogon spp.), marshmallow (Althaea officinalis), niacin (vitamin B3, nicotinic acid), niacinamide, peppermint oil (Mentha piperita), polarity therapy, raspberry (Rubus idaeus), tamarind (Tamarindus indica), and Traditional Chinese medicine (TCM).

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