Acupressure for Fatigue and Low Back Pain

Randomized Pilot Study of Self-Administered Acupressure for Patients With Low Back Pain

The purpose of this study is to compare two kinds of self-administered acupressure (relaxation acupressure and stimulating acupressure) to usual care for management of fatigue and pain in low back pain patients.

Hypothesis: Self-administered relaxation acupressure will result in improvements in fatigue and sleep quality, pain, and physical function compared to stimulating acupressure and usual care.

Study Overview

• Status: Completed
• Conditions: Fatigue; Chronic Low Back Pain
• Intervention / Treatment: Behavioral: Relaxation acupressure; Behavioral: Stimulating acupressure

Detailed Description

Acupressure is a Traditional Chinese Medicine (TCM) technique based on a philosophy similar to that of acupuncture. It involves the application of physical pressure on different acupuncture points (acupoints). One advantage of acupressure is the ability to self-administer the treatment. Acupressure is also a viable alternative to acupuncture in situations where patients: (1) cannot come to the clinic to receive an acupuncture treatment; (2) when a more frequent intervention is needed; or (3) where needle phobia or safety concerns are an issue.

The objective of this study is to evaluate the validity and feasibility of teaching acupressure interventions using an acupressure educator for the management of symptoms related to low back pain.

Specific aims:

1. To examine the effect of 6-weeks of relaxation acupressure (RA) compared to a regime of stimulating acupressure (SA) or wait-list control (WL) on fatigue and sleep quality as assessed by Brief Fatigue Inventory and wrist-worn accelerometry (sleep efficiency).
2. To explore the effect of 6-weeks of RA compared to a regime of SA or WL on for chronic low back pain in terms of reduced pain and improved function.

• Study Type: Interventional
• Enrollment (Actual): 51
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Michigan
    • Ann Arbor, Michigan, United States, 48109
      • University of Michigan

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 65 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Aged18-65 years
• Non-specific low back pain (either by self-report or via ICD-9 codes 724.2, 724.5, 846.0-846.9)
• Low back pain that has persisted for at least 3 months
• Minimum of 3/10 on the Pain Bothersome Scale
• Minimum of 3/10 fatigue severity
• Ambulatory with or without assistive device
• Ability to operate the accelerometer (Actiwatch-S)
• Stable medication regiment for the previous 2 months
• Report of a physician's visit during the previous 24 months
• English-speaking

Exclusion Criteria:

• Medically unstable (acute conditions or acute presentations of chronic conditions)
• Current pregnancy
• Radiculopathy or report of low back pain radiating to below the knee
• Reported history of spinal fracture, herniated lumbar disc, ankylosing spondylitis, and spinal stenosis.
• Report of back surgery within the preceding 12 months
• Participation in active litigation or compensation claims
• Conditions that might confound treatment effects or interpretation of results (for example, rheumatoid arthritis, lupus)
• Acupuncture or acupressure within the preceding 12 months
• Report of sleep apnea
• 2nd or 3rd shift workers or other non-traditional sleep schedules
• Use of anti-coagulant/platelet therapy within the preceding month

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Wait-list control
Experimental: Relaxation acupressure	Behavioral: Relaxation acupressure; The relaxation acupressure protocol will use a set of nine fixed acupoints: forehead, twixt the eyebrows (unilateral); posterior neck, behind the ears (bilateral); palmer side of hand at wrist (bilateral); inside of lower leg (bilateral); top of foot (bilateral). A trained acupressure educator will meet with each participant and demonstrate the sites and techniques for self-administered acupressure. Additionally, each participant will receive a demonstration DVD and a laminated handout detailing the locations of each acupoint. Participants will be asked to perform daily acupressure sessions using the assigned sites. Each site is stimulated for 3 minutes, and the entire session can be completed in approximately 30 minutes.
Active Comparator: Stimulating acupressure	Behavioral: Stimulating acupressure; The stimulating acupressure protocol will use a set of ten fixed acupoints: top of the head (unilateral); below the navel (unilateral); back of the hand (bilateral); outside of lower leg (bilateral); inside of lower leg (bilateral); inside of ankle (bilateral). A trained acupressure educator will meet with each participant and demonstrate the sites and techniques for self-administered acupressure. Additionally, each participant will receive a demonstration DVD and a laminated handout detailing the locations of each acupoint. Participants will be asked to perform daily acupressure sessions using the assigned sites. Each site is stimulated for 3 minutes, and the entire session can be completed in approximately 30 minutes.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Fatigue severity and interference in daily activities	Fatigue severity and interference in daily activities will be measured using the Brief Fatigue Inventory. Subjects will answer the BFI at both baseline and follow-up. To investigate a change from baseline in fatigue, the difference between the post-assessment outcomes and baseline measures will be calculated. Analyses on these differences will be performed using independent samples t-tests between treatment groups. We will also evaluate all continuous outcomes by ANCOVA, adjusting for baseline value and treatment group.	Week 0 (baseline) and approximately 9 weeks (follow-up)
Sleep quality via objectively measured sleep efficiency	We will use wrist-worn accelerometry to assess sleep efficiency. Subjects will wear a wrist-worn accelerometer for 7 consecutive days (at baseline and follow-up) that collects in vivo sleep quality data; an accompanying logbook will be used to enhance objective data. To investigate a change from baseline in sleep efficiency, the difference between the post-assessment outcomes and baseline measures will be calculated. Analyses on these differences will be performed using independent samples t-tests between treatment groups. We will also evaluate all continuous outcomes by ANCOVA, adjusting for baseline value and treatment group.	Week 0 (baseline) and approximately 9 weeks (follow-up)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain severity and interference in daily activities	Pain severity and interference in daily activities will be measured using the Brief Pain Inventory. Subjects will answer the BPI at both baseline and follow-up. To investigate a change from baseline in pain, the difference between the post-assessment outcomes and baseline measures will be calculated. Analyses on these differences will be performed using independent samples t-tests between treatment groups. We will also evaluate all continuous outcomes by ANCOVA, adjusting for baseline value and treatment group.	Week 0 (baseline) and approximately 9 weeks (follow-up)
Level of physical functioning as measured by the Roland-Morris Disability Questionnaire.	Subjects will answer the Roland-Morris Disability Questionnaire at both baseline and follow-up. To investigate a change from baseline in physical function, the difference between the post-assessment outcomes and baseline measures will be calculated. Analyses on these differences will be performed using independent samples t-tests between treatment groups. We will also evaluate all continuous outcomes by ANCOVA, adjusting for baseline value and treatment group.	Week 0 (baseline) and approximately 9 weeks (follow-up)

Collaborators and Investigators

• Sponsor: University of Michigan
• Investigators: Principal Investigator: Susan L Murphy, ScD, OTR, University of Michigan

Publications and helpful links

General Publications

• Murphy SL, Harris RE, Keshavarzi NR, Zick SM. Self-Administered Acupressure for Chronic Low Back Pain: A Randomized Controlled Pilot Trial. Pain Med. 2019 Dec 1;20(12):2588-2597. doi: 10.1093/pm/pnz138.

Study record dates

Study Major Dates

• Study Start: May 1, 2013
• Primary Completion (Actual): May 1, 2016
• Study Completion (Actual): May 1, 2016

Study Registration Dates

• First Submitted: March 31, 2014
• First Submitted That Met QC Criteria: April 3, 2014
• First Posted (Estimate): April 8, 2014

Study Record Updates

• Last Update Posted (Estimate): October 25, 2016
• Last Update Submitted That Met QC Criteria: October 24, 2016
• Last Verified: August 1, 2015

More Information

Terms related to this study

• Keywords: Pain; Fatigue; Acupressure; Symptoms; Self-administered
• Additional Relevant MeSH Terms: Pain; Neurologic Manifestations; Fatigue; Back Pain; Low Back Pain
• Other Study ID Numbers: BAK