Sports Medicine Research: In the Lab & In the Field: Pain? Just Apply a Little Pressure (Sports Med Res)


Wednesday, August 16, 2017

Pain? Just Apply a Little Pressure

Does Acupressure Hit the Mark? A Three-Arm Randomized Placebo-Controlled Trial of Acupressure for Pain and Anxiety Relief in Athletes With Acute Musculoskeletal Sports Injuries

Macznik AK, Schneiders AG, Athens J, & Sullivan SJ. Clin J Sport Med. 2017;27(4):338-343.  

Take Home Message: Acupressure for 3 minutes reduced acute musculoskeletal pain, but not anxiety, after an acute injury. 

Acupressure is a treatment that was founded from traditional Chinese medicine principles and combines pressure points and acupuncture theories without the use of needles.  Clinically there has been a reemergence of alternative medicine techniques for reducing pain and anxiety associated with minor bruises, headaches, cancer, and other chronic conditions.  Acupressure may also be effective at decreasing symptoms of musculoskeletal injury; but it is unknown if it can help reduce symptoms after an acute injury. These authors conducted a randomized trial to investigate the effectiveness of acupressure compared with a sham acupressure treatment or no treatment among people who had an acute musculoskeletal injury on the same day they were treated. The authors randomized 29 patients to the acupressure group, 27 people to a sham acupressure treatment, and 23 people to no treatment.  Acupressure treatment was for 3 minutes on an active point along the long intestine meridian on the dorsum of the hand. The sham treatment similarly involved 3 minutes of treatment on a non-active point on the palm of the hand, while control had no pressure provided.  Pain and anxiety intensity were assessed immediate before and after the treatment using a visual analogue scale.  Participants also reported their perceptions of pain relief, anxiety relief, satisfaction with the treatment, willingness to have treatment done again, and belief that it works immediately after treatment with a Likert-type scale.  The authors found that acupressure reduced pain by ~19% compared with the sham and control treatments when participants ranked their pain 0 to 100 on a visual analog scale. There was no difference between groups regarding anxiety. The authors found no differences among the groups in any of the secondary outcomes: participant perceptions of pain relief or anxiety relief, willingness to repeat or recommend treatment, belief that the treatment would work for symptoms related to an acute injury, or satisfaction with treatment.

Acupressure was relatively successful at reducing pain in acute musculoskeletal injuries.  Given the lack of invasiveness or adverse outcomes, it is an easy tool that clinicians can add into their possible treatment options.  These findings should be interpreted with caution because it remains unknown as to whether these findings were clinically meaningful and how long the pain relief lasted.  It was interesting see that when the authors assessed pain with a visual analog scale they could detect a treatment effect but not when they asked participants if they thought their pain relief was moderately improved or better (using a Likert-style assessment).  The authors explained that this discrepancy may be due to patient expectations of quick pain reductions but it may also be associated with statistical issues of using a Likert type scale, which is a less sensitive pain assessment scale.  There are also so many factors associated with acute musculoskeletal injury that may influence the results. It would be interesting to see if the treatment could be focused on certain injuries, rather than including all acute musculoskeletal injuries.  For example, if a sprain is severe enough for time to be missed – this may create more anxiety than if it is a minor sprain where someone will not miss any time.  There is also research that links athletic identity to depression/anxiety, so it would be interesting to collect this information at baseline to help to identify individuals who may respond more favorably to this type of a treatment.  Finally, it would be interesting to see if patients could be taught to do this treatment so we could determine if this may be a good skill to teach patients and after an injury. Ultimately, there is some positive evidence to support pain reduction with acupressure and it may be something to consider adding into your clinical treatment options since it does not take long to perform and does not pose significant risk to a patient.

Questions for Discussion:  What is your personally clinical experience with acupressure?  Are there any other complementary or alternative treatments that you like to clinically use?

Written by: Nicole Cattano
Reviewed by: Jeffrey Driban

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