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