Acupressure for Cancer-related Fatigue: A Quick Pick-me Up Routine (Part 1)

Cancer-related fatigue (CRF); a kind description would be a pervasive and disruptive feeling of lethargy associated with cancer treatment…my patient compared CRF this week, however, to a female dog! Fatigue has been found to be even more troublesome that cancer-related pain (1).  Prospective longitudinal studies have shown that between 73.8-90.5% of chemotherapy and 44-80.8% of patients receiving radiation experience fatigue (2,3). Do not make the mistake of assuming that because treatment ends the symptom of fatigue disperses along with it; approximately 40% of survivors continue to experience decreased energy levels years later (4,5). I know that exercise is one of the only research supported interventions to alleviate fatigue, but I have recently discovered that acupressure may be a legitimate solution as well!

Molassiotis and colleagues performed a randomized controlled trial in 2007 assessing the benefits of acupuncture and acupressure in 47 patients recently completing chemotherapy with moderate to severe levels of fatigue. 15 patients received 6 sessions of 20 minute acupuncture treatments over a period of 2 weeks. 16 patients were taught how to stimulate the same points for one minute with daily self-acupressure for 2 weeks. 16 patients were given a sham or fake acupuncture treatment. At the end of 2 weeks a validated outcome measure called the Multidimensional Fatigue Inventory showed a 36% improvement in acupuncture patients, 19% improvement in acupressure patients and .6% improvement in patients in the sham control group. This research demonstrates a significant improvement in cancer-related fatigue by stimulating acupuncture points with both needle and hand!

Acupuncturist Lisa Sherman and I will present a 3-week series on acupressure treatments for cancer-related fatigue based on a 2011 study by Zick and colleagues. The purpose of their study was to determine the most effective acupressure treatment formulas and appropriate dosage. They compared the effects of 3 acupressure treatment groups that they called low-dose stimulatory acupuncture (LIS), high-dose stimulatory acupressure (HIS) and relaxation acupressure (RA). The stimulatory acupressure points were chosen based on their ability to reduce fatigue and sleepiness in Traditional Chinese Medical (TCM) theory.

Both the low-dose (LIS) and high-dose (HIS) stimulatory acupressure points used the following acupressure points in their study:

– Governing Vessel 20, GV 20 aka DU 20 (Unilaterally)
– Conception Vessel 6, CV 6 aka REN 6 (Unilaterally)
– Large Intestine 4 (LI4) (bilaterally)
– Stomach 36 (ST36) (bilaterally)
– Spleen 6 (SP6)(bilaterally)
– Kidney 3 (K3) (bilaterally)

Zick suggested that participants stimulate these points by making small clockwise circles with their index finger, thumb, or a pencil eraser for three minutes per point. Sufficient pressure would evoke a “de qi” sensation (i.e., dull ache, tingling, and soreness).

Results of the Zick paper concluded that all 3 groups experienced significant improvements in fatigue from baseline, with the RA group experiencing the biggest improvement. As far as the stimulatory points are concerned the mean decrease of fatigue from baseline was 49.5% in the LIS group and 44.8% in the HIS group.

Assessing dose, this study concluded that stimulating these points once a day is effective and that more is better.  Zick et al state, “We observed that at least four weeks were needed to achieve significant effects and seven weeks of treatment to reach a maximum effect. Thus, to have the maximum effect on fatigue participants in our study, needed to perform a minimum of 21 to 49 acupressure treatments over seven weeks (three times per week to one time per day, depending on study arm). In fact, we found that fatigue continued to significantly decrease the more acupressure was performed, regardless of the study group” (6).

In this first video, entitled “A Quick Pick-Me-Up,” Lisa Sherman, ATc is going to share 2 acupressure points from the list of stimulatory points above as well as pranayama technique called ‘Shining Skull Breath.’ The short energy burst points are:

• Large Intestine 4 (LI4)‘Hegu’ (bilaterally), = gentle ‘karate chop’ on point between index finger and thumb (please take precaution for those at risk of lymphedema; see disclaimer below)

• Governing Vessel 20, (GV20 or DU 20)‘Bai Hui’ (Unilaterally), = crown of head

Cancer patient or not, the techniques Lisa Sherman, ATc shares in this vlog (video blog) routine are beneficial for almost anyone needing an immediate boost in energy! These points are a quick, easy, cost-effective compliment to help my patients get into their exercise routine on the way to feeling better! I can’t wait to teach these points to my cancer patients which will hopefully give us both a boost in energy and a little giggle too!

-Susannah Haarmann, PT, WCs, CLT

Lisa Sherman, LAc practices at Asheville Integrated Acupuncture and can be reached here. She also is an instructor for Light A Path, a non-profit group serving breast cancer survivors, the unhoused, incarcerated individuals and low-income school systems in the greater Asheville area. To learn more or donate to Light a Path click here. 

References:

1. Stone P, Richards M, Hardy J. Fatigue in patients with cancer. Eur J Cancer 1998;34:1670—6.
2. Molassiotis A, Chan CWH. Fatigue patterns in Chinese patients receiving radiotherapy. Eur J Oncol Nurs2004;8:334—40.
3. Servaes P, Verhagen S, Bleijenberg G. Determinants of chronic fatigue in disease-free breast cancer patients: a cross-sectional study. Ann Oncol 2002;13:589—98.
4. Bower JE, Ganz PA, Desmond KA, Bernaards C, Rowland JH, Meyerowitz BE, et al. Fatigue in long-term breast carcinoma survivors: a longitudinal investigation. Cancer 2006;106(4):751—8.
5. Molassiotis A, Sylt P, Diggins, H, The management of cancer-related fatigue after chemotherapy with acupuncture and acupressure: A randomised controlled trial. Complementary Therapies in Medicine 2007, 15, 228-237.
6. Zick SM et al, Relaxation Acupressure Reduces Persistent Cancer-Related Fatigue. Evidence-Based Complementary and Alternative Medicine 2011. Article ID 142913, 10 pages

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