MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Acupressure is the stimulation of specific points, called acupoints, on the body surface by pressure for therapeutic purposes. The required pressure can be applied manually of by a range of devices. Acupressure is based on the same tradition and assumptions as acupuncture. Like acupuncture, it is often promoted as a panacea, a ‘cure-all’.

Several systematic reviews of the clinical trials of acupressure have been published. An overview published in 2010 included 9 such papers and concluded that the effectiveness of this treatment has not been conclusively demonstrated for any condition.

But since 2010, more trials have become available.

Do they change the overall picture?

The objective of this study was to test the efficacy of acupressure on patient-reported postoperative recovery. The researchers conducted a single centre, three-group, blind, randomised controlled, pragmatic trial assessing acupressure therapy on the PC6, LI4 and HT7 acupoints. Postoperative patients expected to stay in hospital at least 2 days after surgery were included and randomised to three groups:

  1. In the acupressure group, pressure was applied for 6 min (2 min per acupoint), three times a day after surgery for a maximum of 2 postoperative days during the hospital stay.
  2. In the sham group, extremely light touch was applied to the acupoints.
  3. The third group did not receive any such intervention.

All patients also received the normal postoperative treatments.

The primary outcome was the change in the quality of recovery (QoR), using the QoR-15 questionnaire, between postoperative days 1 and 3. Key secondary outcomes included patients’ satisfaction, postoperative nausea and vomiting, pain score and opioid (morphine equivalent) consumption. Assessors for the primary and secondary endpoints were blind to the group allocation.

A total of 163 patients were randomised (acupressure n=55, sham n=53, no intervention n=55). The mean (SD) postoperative change in QoR-15 did not differ statistically (P = 0.27) between the acupressure, sham and no intervention groups: 15.2 (17.8), 14.2 (21.9), 9.2 (21.7), respectively. Patient satisfaction (on a 0 to 10 scale) was statistically different (P = 0.01) among these three groups: 9.1 (1.5), 8.4 (1.6) and 8.2 (2.2), respectively. Changes in pain score and morphine equivalent consumption were not significantly different between the groups.

The authors concluded that two days of postoperative acupressure therapy (up to six treatments) did not significantly improve patient QoR, postoperative nausea and vomiting, pain score or opioid consumption. Acupressure, however, was associated with improved patient satisfaction.

This study is a good example to show why it is so difficult (or even impossible) to use a clinical trial for demonstrating the ineffectiveness of a therapy for any given condition. The above trial fails to show that acupressure had a positive effect on the primary outcome measure. Acupressure fans will, however, claim that:

  • there was a positive effect on patient satisfaction,
  • the treatment was too intense/long,
  • the treatment was not intense/long enough,
  • the wrong points were used,
  • the sample size was too small,
  • the patients were too ill,
  • the patients were not ill enough,
  • etc., etc.

In the end, such discussions often turn out to be little more than a game of pigeon chess. Perhaps it is best to ask before planning such a trial:

IS THE ASSUMPTION THAT THE TREATMENT WORKS FOR THIS CONDITION PLAUSIBLE?

If the answer is no, why do the study in the first place?

28 Responses to No efficacy of acupressure on quality of recovery after surgery

  • Perhaps we should first address the question of surgery efficacy.

    “CONCLUSIONS
    In this controlled trial involving patients with osteoarthritis of the knee, the outcomes after arthroscopic lavage or arthroscopic débridement were no better than those after a placebo procedure.”

    Whatta sham, you need look no further than SBM to find your “quackery”

    https://www.nejm.org/doi/full/10.1056/NEJMoa013259

    • as always, a very daft comment!

    • @RG

      That’s from 2002.

      This is 2020.

      Further research has supported the findings.

      Because of this pioneering research, arthroscopic lavage is now used rarely, if ever, in the treatment of osteoarthritis of the knee.

      Perhaps we should first address the question of surgery efficacy.

      The question has been addressed. And reacted to.

      Show us where AltMed has done similarly.

      Oh

      You can’t.

      You really need to check that there’s water in the swimming pool first before jumping in, RG.

      • @Lenny

        “You really need to check that there’s water in the swimming pool first before jumping in, RG.”
        Lenny, perhaps you should pull your head out of your arse before you post.

        https://www.painscience.com/biblio/fascinating-landmark-study-of-placebo-surgery-for-knee-osteoarthritis.html
        “In 2008, these findings were fully supported by a Cochrane Collaboration review (Laupattarakasem) which concluded that “there is ‘gold’ level evidence that arthoscopic debridement has no benefit,” and by New England Journal of Medicine (Kirkley) which reported that “surgery for osteoarthritis of the knee provides no additional benefit to optimized physical and medical therapy.”

        This study inspired more comparisons of orthopedic surgeries to shams. By 2016, at least four more popular surgeries have been shown to have no benefit (Louw 2016).

        https://www.painscience.com/biblio/four-orthopedic-surgeries-no-better-than-placebo.html
        “This review of a half dozen good quality tests of four popular orthopedic (“carpentry”) surgeries found that none of them were more effective than a placebo. It’s an eyebrow-raiser that Louw et al could find only six good (controlled) trials of orthopedic surgeries, and all of them were bad news.

        Surgeries have always been surprisingly based on tradition, authority, and educated guessing rather than good scientific trials; as they are tested properly, compared to a placebo (a sham surgery), many are failing the test. This review introduction is excellent, and does a great job of explaining the problem. As of 2016, this is the best academic citation to support the claim that “sham surgery has shown to be just as effective as actual surgery in reducing pain and disability.” The need for placebo-controlled trials of surgeries (and the damning results) is explored in much greater detail — and more readably — in the excellent book, Surgery: The ultimate placebo, by Ian Harris.

        The surgeries that failed their tests were:

        vertebroplasty for osteoporotic compression fractures (stabilizing crushed verebtrae)
        intradiscal electrothermal therapy (burninating nerve fibres)
        arthroscopic debridement for osteoarthritis (“polishing” rough arthritic joint surfaces)
        open debridement of common extensor tendons for tennis elbow (scraping the tendon)

        • Yes, RG. I know. You’re just knocking more nails into the coffin that contains your argument.

          See also mammary artery ligation for angina, TMJ washouts and many more. When evidence has shown surgery to be ineffective, the procedure is discarded. Because that’s how proper medicine and surgery works.

          Now. As I asked. Show us any examples of AltMed changing in response to evidence.

          We’ll wait.

          (Oh and looking up your own arse really isn’t going to help. Best stop doing it)

          • @Lenny

            Sir, first of all, these procedures are supposed to be proven to be beneficial prior to being approved for use. The placebo findings were proposed and carried out far after FDA approval and the use of the treatments.
            Secondly, these procedures are still being performed…. Lenny.

          • @RG.
            It is always best to check if there is water in the pool before jumping in.
            You very definitely do not have the working knowledge of medicine or surgery required for discussing medicine or surgery. This you keep proving it with your lame, repetitive parroting of amateur arguments.
            If you know of anyone who is doing AML procedures, then you should report the surgeon to the regulatory healthcare authorities. I am not going into detail about its history, this you can easily find information about.
            Knee arthroscopies and lavage still have indications, just not as wide as before. Of course there are orthopedists still doing such procedures on doubtful or nonexistent indications, for profit. That is a problem with profit driven and privatised healthcare and/or poor regulatory oversight, not with the art and science of medicine/surgery. TMJ arthrocenthesis is not within my scope of knowledge but as far as I can see, it still has its indications, just like e.g. knee arthroscopies. The Mayo clinic seems to have them in their arsenal, they are not known for bad medicine: https://www.mayoclinic.org/diseases-conditions/tmj/diagnosis-treatment/drc-20350945

            Remember, this blog discusses So Called Alternative Medicine, not genuine health care. If you want to play medical maven, which you definitely are not, then you need to find another venue for your trolling. Here you are being laughed at for your sad attempts.

          • @Bjorn

            “If you know of anyone who is doing AML procedures, then you should report the surgeon to the regulatory healthcare authorities.”

            I don’t know anyone doing AML procedures, but I KNOW they are still being preformed, because a friend and a brother-in-law both had them in the last three years. As for reporting them…. baah, I’ll leave that for you…. it’s none of my business.

            “Of course there are orthopedists still doing such procedures on doubtful or nonexistent indications, for profit. That is a problem with profit driven and privatised healthcare and/or poor regulatory oversight, not with the art and science of medicine/surgery.”

            Ahhh, so now when push comes to shove, SBM may be at fault only IF they are performing sham surgeries “for profit” …. as compared to CAM therapies for profit…. lol…. your guys are killing me. The double standards are staggering !

            There is a profit in most all medicine. Bjorn, are you being paid to be a surgeon ?

          • Tut-tut RG. Your ignorance of the subject you are trying to argue is shining through. I have to apologise for inadvertently using an inappropriate abbreviation for mammary artery ligation, which you claimed in response to Lenny, to know is still being performed. In my part of the world we call the mammary artery, ‘arteria mammaria’ so without thinkig I wrote AML when I should have written MAL as we are using english. If you were familiar with the field, you would have picked up my oversight and avoided jumping head first into yet another empty pool 😂
            Instead you reveal your total ignorance and ramble blindly on about people you know who had AML Firstly I don’t know any procedure abbreviated thus in english. asecondly, If the people you refer to really were operated with internal mammary aftery ligation for angina, they must have been victims of serious fraud and malpractice. Such procedures were proven useless in two trials sixty years ago. In my part of the world, the surgeon would promptly lose his/her license and probably be prosecuted.

            Why don’t you go play with your homeopathy set or something. You are making a fool of yourself trying to be smart and knowledgable.

          • @RG

            What do you understand an AML procedure to be?

          • @Bjorn

            Tut-tut to you too Bjorn
            You make a mistake, and I make a mistake. We both conveyed the wrong message.

            I clearly stated that “I did not know anyone performing AML procedures”.

            Then after I stated “I know they are still being performed”….. referring to the medical procedures stated in the link I provided that have been found to have no benefit.

          • When stuck in a hole – stop digging. 😀

          • @Bjorn

            I’ll never give up on exposing the lies perpetuated here.

          • so far, you have been exposing merely you lack of knowledge, understanding and ability to learn.

          • what is my medicine?
            enlighten me please.

          • @EE

            Play your word games with somebody else

          • RG

            In case you hadn’t noticed, this blog is about SCAM. Your ongoing exercise in demonstrating the tu quoque logical fallacy shows only your foolishness.

          • @Lenny

            That’s my point Lenny, the medicine supported by this blog is as much a SCAM as CAM

          • RG said:

            the medicine supported by this blog

            What medicine is ‘supported by this blog’? Please be specific.

          • @Alan Henness

            I’m not playing in your word games

          • RG said:

            @Alan Henness

            I’m not playing in your word games

            It’s not a word game. You were implying Prof Ernst was pushing some drugs or other or treatments of some sort on this blog. What medicine is supported by this blog?

  • thank you; that’s even more stupid

  • Dear RG,
    Two questions:
    Why are you anonymous?
    Why should we address “surgery efficacy” before addressing accupressure quackery?

    Tu quoque is a logical fallacy.

    • @Richard Rawlins

      I’m anonymous because I can be, many people choose not to be identified on the http://WWW…. no mystery here.

      Why should we address the efficacy of surgery ? Because you folks here want to hold EBM (as in surgery) as the standard by which all other therapies are measured. If the standard is not a reliable method of therapy, why should it be the standard ?

      I will address Lenny, with more evidence as to why not all surgeries performed show a benefit, but are still being used as a therapy.

  • llol… that’s you opinion, which is worth little.

    If nothing else, I’ve exposed that you know more about selling books than you know about medicine.

    • Erh, no.
      RG, you have only exposed your ignorance and dearth of critical thinking. I would remain anonymous too given the nonsense being constantly touted.

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