# Abstract

 Acupressure on local and distal acupuncture points might result in sedation and relaxation, thereby reducing chronic neck pain. The aim was to investigate the effect of acupressure at local (LP) and distal acupuncture points (DP) in females with chronic neck pain. Thirty-three females were assigned to three groups: the control group did not receive any stimuli, the LP group received acupressure at local acupuncture points, GB 21, SI 14 and SI 15, and the DP group received acupressure at distal acupuncture points, LI 4, LI 10 and LI 11. Verbal rating scale (VRS), Neck Disability Index (NDI), State-Trait Anxiety Inventory (STAI), muscle hardness (MH), salivary alpha-amylase (sAA) activity, heart rate (HR), heart rate variability (HRV) values and satisfaction due to acupressure were assessed. VRS, NDI, STAI and MH values decreased after acupressure in the LP and the DP group. HR decreased and the power of high frequency (HF) component of HRV increased after acupressure in only the LP group. Although acupressure on not only the LP but also the DP significantly improved pain conditions, acupressure on only the LP affected the autonomic nervous system while acupuncture points per se have different physical effects according to location. # 3. Results [Table 1](#) shows the demographic data of the three groups. There were no significant differences in age, weight, and pre-treatment values regarding pain conditions among the three groups ([Table 1](#)). There were no significant differences in all parameters in the control group. VRS ([Figure 3](#)), STAI-I ([Figure 4](#)), and MH ([Figure 5](#)) values significantly decreased immediately after treatment, and NDI ([Figure 6](#)) was lower at 1 day following treatment compared with pre-treatment in the LP and the DP groups. HR ([Figure 7](#)) significantly decreased and the HF component of HRV ([Figure 9](#)) significantly increased after treatment in the LP group only. There were no differences on the sAA and the LF components ([Figure 8](#)) and the LF/HF ratio ([Figure 10](#)) of HRV among the three groups. Satisfaction due to acupressure continued to 1 day after the treatment in the LP and the DP groups ([Figure 11](#)). <figure> <p><img src="" /></p> <figcaption>Changes in pain intensity (VRS: verbal rating scale). ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. * significantly different from pre-treatment in the DP group (<em>P</em> < .05). \*\* significantly different from pretreatment in the LP group (<em>P</em> < .01). † significantly different from control group in the DP group (<em>P</em> < .05).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in pain-associated anxiety (STAI-I: State-Trait Anxiety Inventory-I). ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. \*\* significantly different from pre-treatment in the LP and the DP groups (<em>P</em> < .01).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in muscle hardness (MH). ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. * significantly different from pre-treatment in the DP group (<em>P</em> < .05). \*\* significantly different from pre-treatment in the LP group (<em>P</em> < .01).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in pain-associated disability (NDI:Neck Disability Index). ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. * significantly different from pre-treatment in the DP group (<em>P</em> < .05). \*\* significantly different from pre-treatment in the LP group (<em>p</em> < .01). † significantly different from control group in the DP group (<em>P</em> < .05).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in heart rate (HR). ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. * significantly different from pre-treatment in the LP group (<em>P</em> < .05).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in the low-frequency (LF) component of heart rate variability. ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups.</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in the high-frequency (HF) component of heart rate variability. ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups. * significantly different from pre-treatment in the LP group (<em>P</em> < .05).</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in the LF/HF ratio (LF/HF) of heart rate variability. ○: control group. ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups.</figcaption> </figure> <figure> <p><img src="" /></p> <figcaption>Changes in satisfaction due to treatment (VRS: verbal rating scale). ■: local acupuncture point (LP) group. □: distal acupuncture point (DP) group. Values are presented as mean. SD represented with error bars in the LP and the DP groups.</figcaption> </figure> ::::table-wrap

::: caption
Age, weight, VRS, NDI, STAI, MH, sAA, HR, and HRV values at pretreatment
for each group.
:::

```
            C group (*n* = 11)   LP group (*n* = 11)   DP group (*n* = 11)   *P* value
```

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Age (yr) 34.8 (4.0) 35.5 (6.4) 37.2 (7.0) .637
Weight (kg) 50.4 (6.8) 52.3 (10.1) 52.2 (4.8) .643
VRS 1.8 (0.6) 2.1 (0.5) 1.7 (0.8) .413
NDI 7.9 (3.8) 9.4 (4.4) 7.6 (4.6) .430
STAI 39.2 (9.5) 44.5 (8.0) 43.2 (6.8) .772
MH (N) 56.9 (5.0) 57.4 (4.5) 56.2 (5.3) .507
sAA (kU/l) 38.2 (20.1) 20.0 (9.0) 36.8 (27.9) .079
HR (bpm) 65.4 (8.7) 65.8 (6.7) 62.3 (14.1) .941
LF (ms^2^) 490.7(409.2) 274.2 (253.3) 494.1 (1050.7) .084
HF (ms^2^) 381.8(338.3) 212.8 (186.7) 764.8 (1045.2) .587
LF/HF 1.7(1.4) 1.4 (0.8) 1.0 (0.6) .399

Values expressed as mean (SD).VRS: verbal rating scale. NDI: Neck
Disability Index. STAI: State-Trait Anxiety Inventory-I. MH: muscle
hardness. sAA: salivary alpha-amylase. HR: heart rate. LF: the power of
low-frequency (0.04--0.15 Hz, LF) component of heart rate variability
(HRV). HF: the power of high-frequency (0.15--0.4 Hz, HF) component of
HRV. LF/HF: LF/HF ratio of HRV.::::


Extracted trial result:
Outcome: Verbal rating scale pain intensity (continuous)
Intervention: Acupressure at local points
Comparator: Control
Intervention group size: 11
Comparator group size: 11
Notes: Numerical values in figure.