Published: May 22, 2013 | Updated: May 23, 2013

By  Nancy Walsh , Staff Writer, MedPage Today

ORLANDO — Diabetes patients with gastroparesis experienced significant relief of nausea with “needleless” acupuncture, which may have important implications for their glucose control, a small study suggests.

Treatment for 4 weeks with watch-sized electrical stimulators placed on gastrointestinal-specific acupuncture points led to a 30% decrease from baseline in nausea in a group of 12 patients (P=0.005), Richard W. McCallum, MD, of Texas Tech University in El Paso, reported at the annual Digestive Disease Week here.

The self-administered treatment also led to a 39% decrease in vomiting (P=0.055) and a 21% reduction in bloating (P=0.006).

“We currently have few options to stimulate motility in patients whose stomachs are slow in emptying and develop related symptoms, particularly nausea, which is a devastating symptom that’s underappreciated and certainly undertreated,” McCallum said during a press briefing.

“Acupuncture is a 4,000-year-old system in Chinese medicine in which stimulation of points on the skin that control the flow of ‘qi’ through channels known as meridians can influence pain and other symptoms, but controlled studies in patients with nausea and vomiting have been lacking,” he said.

To see if stimulating acupuncture points with electrical stimulation rather than needles could alleviate the symptoms of gastroparesis, which can be severe and can interfere with disease control in patients with diabetes, McCallum’s group enrolled 12 patients with refractory symptoms in a crossover study with 4 weeks of active and 4 weeks of sham treatments.

Participants’ mean age was 51, and eight were women.

They were instructed to apply the stimulators to acupuncture points p6, which is just above the wrist crease, and at ST36 on the leg for the active treatment.

“Those points, according to Chinese medicine, tap into control centers for nausea, heartburn, and regurgitation. They also are near nerves,” he said.

Sham control treatment involved placement of the stimulators on point S1 at the mid forearm and S2 on the lower leg, which are thought to have no effect on the central nausea control centers.

The stimulators were to be turned on for at least 2 hours after meals, and up to 300 minutes each day.

The electrical pulse width was 0.5 ms, frequency was 25 Hz, and the current was between 2 and 6 mAmp for both active and sham treatments.

At the end of 1 month of active treatment, frequency scores for heartburn and reflux were lower than after sham treatment (0.78 versus 1.13), though this did not reach statistical significance.

Other findings included reductions in abdominal fullness by 21% (P=0.0047) and retching by 31% (P=0.006).

Electrocardiograms were obtained at the end of each treatment period, measuring R-R wave variability in an attempt to measure the vagal sympathetic balance.

“This was intended to determine whether we actually stimulated the vagus nerve, and the R-R intervals showed a trend toward increased vagal activity after eating with the active treatment (P=0.09) but not with the sham,” McCallum explained.

“We believe the vagus nerve stimulation helps improve gastric emptying by contracting smooth muscle in the upper gut. The cutaneous stimulation also may encourage the release of pancreatic peptides,” he said.

Press conference moderator Jay Kuemmerle, MD, of Virginia Commonwealth University in Richmond commented that gaining control of the nausea and vomiting associated with gastroparesis is particularly important for patients with diabetes.

“One of the biggest challenges in patients who have diabetic gastroparesis is that symptoms can make it very difficult for them to adequately control their diabetes. Improving these symptoms allows them to consistently eat a more appropriate diet and have more predictable use of insulin and other medications,” Kuemmerle said.

McCallum agreed, and said, “That’s actually very important, because many of these patients ultimately become candidates for kidney or pancreatic transplants, and no transplant surgeon is interested in patients who are vomiting because they can’t keep their immunosuppressives down long enough to be effective.”

He concluded that he hopes to further test this treatment approach of neuromodulation of symptoms in patients with other disorders such as inflammatory bowel disease.