Acupressure for Pain Management and Fatigue Relief in Gulf War Veterans
Condition: Persian Gulf Syndrome; Chronic Fatigue Syndrome
MeSH terms: Fatigue Syndrome, Chronic; Syndrome; Fatigue; Persian Gulf Syndrome
Study type: Interventional

Summary: 
      This study will provide symptomatic veterans with acupressure treatment and determine its
      effectiveness in fatigue relief and pain management for Gulf War Illness (GWI). Investigators
      plan to recruit patients reporting symptoms of GWI through the Department of Veterans Affairs
      (VA), and randomize them into acupressure group (to receive acupressure treatment) and
      control group (to receive Reiki treatment). The acupressure treatment, twice per week for 6
      weeks, will be offered by a licensed acupressure practitioner. Evaluations will be made
      before and after treatment (at 6 weeks). Clinical outcomes will be compared between groups
      (acupressure group vs. control group) and between different timepoints (before treatment vs.
      after treatment) within the same group.

      The results of this study may provide useful information to develop more effective treatment
      for veterans with GWI disease. Since acupressure treatment is of Asian origin and has shown
      excellent promise within its Eastern traditions, if successful, this study has the potential
      to produce a paradigm shift in clinical practice to more effectively relieve the symptoms of
      veterans with GWI disease. Meanwhile, as a non-invasive therapeutic massage, acupressure may
      lend to better patient acceptance and ultimately, greater clinical accessibility.

      Hypotheses

        1. Acupressure besides routine clinical care will produce a more complete fatigue relief
           and pain alleviation in veterans with GWI versus routine clinical care plus reiki
           treatment.

        2. EEG measures will exhibit a positive change when fatigue is relieved and pain is
           alleviated for symptomatic veterans after effective treatment.
    

Detailed description: 
      Symptomatic veterans will receive standardized acupressure treatment, first with one-thumb
      pressing applied to the head at acupoints of GV-20 (Bai Hui), EX-HN-3 (Yin Tang), Du-24 (Shen
      Ting), ST-8 (Tou Wei), EX-HN-5 (Tai Yang). B-2 (Zan Zhu), M-HN-6 (Yu Yao), and SJ-23 (Si Zhu
      Kong) for ~5 s on each acupoint until the subject gets the sense of soreness and numbness,
      and the procedure will be repeated three times. The frequency of one-thumb pressing is 120±10
      times per minute and the force is 10±2 Newtons. Kneading massage will be applied around eyes
      and forehead, and face will be swabbed by palm for ~ 5 min. Manipulation of these acupoints
      is aimed at helping to calm and ease the subject, lighten headache and migraine, relieve
      fatigue, and alleviate insomnia. Finally, LI- 4 (He Gu), LI-11 (Qu Chi), HT-7(Shen Men),
      ST-32 (Fu Tu), SP-10 (Xue Hai), ST-36 (Zu San Li), and KI-3 (Tai Xi) acupoints will be
      one-thumb pressed for 10 min. Manipulations on these acupoints and meridians located on the
      limbs is to relax muscles, alleviate muscle and joint pain, and improve mobility. This
      protocol is based on our consultant's previous acupressure research and clinical practice,
      our pilot case study for CFS patient, and the basic rationale in traditional Chinese
      acupressure medicine (Yan, 2003; Cao, 2006).

      A matter of great concern in investigating oriental alternative and complementary
      interventions is standardizability and repeatability of experiments. In this proposed study
      the process of identifying the location of acupoints and underlying meridians for each
      subject will be carried out using Western anatomy and the World Health Organization's
      Standard Acupuncture Point Locations (Lim, 2009). The level of manipulation (force and
      frequency of pressing and kneading) will be monitored by the TN-II manipulation radiometer
      (Shangxin Medical Science & Technology Co. Ltd, Shanghai, China), which has been successfully
      used to normalize acupressure manipulation in previous research (Ma et al., 2006). In this
      manner, the whole treatment design would be standardized as much as possible and could be
      repeated in the future by our own and other groups.

      Reiki: Veterans in the control group will receive reiki treatment with the same dosage (40
      min/session, 12 sessions in 6 wks). The practitioner will place the hands on the recipient in
      various positions covering head, the back of the torso, and the 4 limbs with fixed set of 12
      hand positions. These covered areas will then be tapped and stroked, and practitioner will
      focus his/her gaze on these areas for 2-3 min, through which the healing energy is
      transferred to the subjects.
    

Intervention name(s): Acupressure treatment.; Reiki
Intervention type(s): Other; Other
Intervention description(s): Acupressure will be provided 40 min/day, 2 days/week for 6 weeks (total of 12 sessions). Symptomatic veterans will receive standardized acupressure treatment for ~5 s on each acupoint until the subject gets the sense of soreness and numbness, and the procedure will be repeated three times. Kneading massage will be applied around eyes and forehead, and face will be swabbed by palm for ~ 5 min. Manipulation of these acupoints is aimed at helping to calm and ease the subject, lighten headache and migraine, relieve fatigue, and alleviate insomnia.; Veterans in the control group will receive reiki treatment with the same dosage (40 min/session, 12 sessions in 6 wks). The practitioner will place his/her hands on the recipient in various positions covering head, the back of the torso, and the 4 limbs with fixed set of 12 hand positions. These covered areas will then be tapped and stroked, and practitioner will focus his/her gaze on these areas for 2-3 min, through which the healing energy is transferred to the subjects. In a format similar to acupressure treatment, it will be used as an inert control treatment to balance additional care the experimental group will receive.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Acupressure; Reiki; EEG; EMG; fatigue relief; veterans