Serce, S., Ovayolu, O., Pirbudak, L., & Ovayolu, N. (2018). The effect of acupressure on pain in cancer patients with bone metastasis: A nonrandomized controlled trial. Integrative Cancer Therapies, 17, 728–736.

To evaluate the effect of acupressure in managing pain experienced by patients with cancer with bone metastases

Study participants received a 10 minute acupressure session prior to each radiotherapy treatment for a total of eight sessions. Acupressure was applied for up to 10 seconds to 31 points on the body surface for approximately 5 minutes total. Acupressure is delivered by applying physical pressure and is believed to provide energy circulation and balance in the body.

• N = 60 
• AGE: Mean = 57.7 years (range = 20-60)
• MALES: 67%  
• FEMALES: 33%
• CURRENT TREATMENT: Radiation
• KEY DISEASE CHARACTERISTICS: Most frequent cancer type was respiratory (n = 21), followed by breast, urinary, reproductive, digestive, and leukemia.
• OTHER KEY SAMPLE CHARACTERISTICS: Only 31 participants had metastatic cancer, and it is unclear how many actually had bone metastases.

• SITE: Single site   
• SETTING TYPE: Outpatient    
• LOCATION: Radiotherapy unit of an institution in Turkey.

PHASE OF CARE: Active anti-tumor treatment

Non-randomized controlled trial

Pain level was measured using a visual analog scale at baseline and after the 8 acupressure sessions. In addition, participants completed a questionnaire at baseline which collected sociodemographic and disease-related information.

The difference in the intervention group’s mean pain score from baseline (7.6, SD = 1.9) and after acupressure (6.8, SD = 1.9) was statistically significant (p = 0.004) compared to the control group’s pain level (baseline = 8.2, SD = 1.7; after acupressure = 7.7, SD = 2.1; p = 0.056).

Although a statistically significant difference in pain level was found for the intervention group, it cannot be concluded that acupressure is effective in reducing pain in patients with cancer with bone metastases. Due to the limitations identified below and since only 31 of the 60 study participants had metastatic cancer, rigorous testing of this intervention needs to be conducted before acupressure can be recommended for practice in patients with bone metastases.

• Small sample (< 100)
• Risk of bias (no blinding) 
• Risk of bias (no random assignment)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Other limitations/explanation: Findings are not generalizable due to the small sample size, mixed sample of metastatic and non-metastatic cancers, and it is unclear if those with metastatic cancer actually have bone metastases. 
• The authors measured pain at the end of study rather than after each acupressure session. It would have been helpful to learn if acupressure has an immediate effect in this patient population.

Although this study did not provide scientific evidence for the use of acupressure in managing bone metastases, side effects are rare and the benefits of acupressure outweigh harms. If both the clinician and patient agree that this is an appropriate intervention for managing pain, nurses should know who to refer the patient to for acupressure treatment. In addition, acupressure appears to be an intervention which nurses could learn with brief training.