Nausea and vomiting caused by chemotherapy, often shortened to CINV, has been studied with acupuncture, electroacupuncture and acupressure at PC06 (Neiguan) and other points since at least 1987. Every trial in the Cochrane review gave acupuncture alongside anti-sickness drugs, so the question those trials ask is what the needles or pressure add to those drugs. The answers depend on which drugs were in use: the electroacupuncture trials behind the main guideline predate the drugs now standard for highly emetogenic chemotherapy, the regimens most likely to cause vomiting.
The Cochrane review and its withdrawal
A 2006 Cochrane review by Jeanette Ezzo and colleagues pooled 11 trials with 1,247 patients, using data supplied by the trials’ own investigators. All the trials gave anti-sickness drugs as well, and all except the electroacupuncture trials used what the authors called state-of-the-art drugs. Its findings, by method:
- All methods combined reduced the proportion of patients who vomited on the day of chemotherapy, called acute vomiting (risk ratio 0.82, 95% CI 0.69 to 0.99), but not the severity of acute or delayed nausea.
- Needle methods reduced acute vomiting (risk ratio 0.74). Within them, electroacupuncture reduced it (0.76) and manual acupuncture did not.
- Acupressure reduced the average severity of acute nausea by a small amount (standardised mean difference −0.19) but not vomiting or delayed symptoms, and the acupressure trials had no placebo control.
- Electrical stimulation through the skin without needles showed no benefit on any outcome.
Cochrane withdrew the review in November 2014. The notice says the authors had been unable to complete an update within the recommended two years, and that the review was correct at the date of publication.
The 2023 meta-analysis
A 2023 meta-analysis by Yan, Witt and colleagues at the University of Zurich searched English and Chinese databases and found 38 randomised trials with 2,503 patients that compared needle acupuncture with sham acupuncture or with usual care, meaning anti-sickness drugs alone. Its main outcome was complete control: no vomiting, no more than mild nausea, or both.
| Comparison | Finding | Certainty (GRADE) |
|---|---|---|
| Acupuncture plus usual care against usual care alone | Complete control of acute vomiting more likely (risk ratio 1.13, 95% CI 1.02 to 1.25; 10 trials); complete control of delayed vomiting more likely (1.47, 95% CI 1.07 to 2.00; 10 trials); no effect on other outcomes | Low to very low |
| Acupuncture plus usual care against sham acupuncture plus usual care | No effect on any outcome | Low to very low; few trials and patients |
Only 4 of the 38 trials used a sham control, and 14 provided data the authors could pool. In an exploratory analysis, trials that reported their planned rescue drugs adequately showed a smaller effect on acute vomiting. A 2025 study by Penati and colleagues at the University of Pavia checked 11 English-language trials from 1987 to 2019 that a systematic review of the subject had included: 4 had been registered, only 2 of them before recruitment began, and none reported all its outcomes as its protocol had planned.
Two trials
A 2000 trial in JAMA by Joannie Shen and colleagues randomised 104 women with high-risk breast cancer having high-dose chemotherapy to electroacupuncture once a day for 5 days, minimal needling at non-acupuncture points with mock electrical stimulation, or no needling. All three groups had triple anti-sickness drug therapy. Over the 5 days the median number of vomiting episodes was 5, 10 and 15 respectively, and the electroacupuncture group had fewer episodes than the minimal needling group. Over the following 9 days the groups did not differ. The Society for Integrative Oncology guideline, below, records that its electroacupuncture trials used PC06 and ST36 (Zusanli).
A trial reported in 2014 by Alex Molassiotis and colleagues in the north of England randomised 500 patients having chemotherapy to acupressure wristbands at PC6, sham wristbands or drugs alone, all with standard anti-sickness drugs. Nausea in the first cycle did not differ significantly between the three groups. After adjustment for sex, age and how emetogenic the chemotherapy was, the odds of a lower nausea experience were 1.18 with true bands and 1.42 with sham bands, and men and women responded differently. Vomiting, anxiety and quality of life did not differ.
What guidelines say
The Society for Integrative Oncology (SIO) published a guideline in 2017 on integrative therapies during and after breast cancer treatment, based on trials published from 1990 to 2015. It gives two grade B statements for CINV, grade B meaning the society recommends the modality with at least moderate certainty of moderate net benefit:
- Acupressure can be considered in addition to anti-sickness drugs, based on 3 trials reported between 2000 and 2007 with 17 to 160 participants each. One of the 3 tested pressure at PC06 and
SI03(Houxi) against sham pressure. - Electroacupuncture or acustimulation can be considered in addition to anti-sickness drugs, based on 2 trials from 2000 and 2012 and the 1997 NIH consensus conference. The guideline notes that the trials predate 5-HT3 and NK1 receptor antagonists, the drug classes now standard for highly emetogenic chemotherapy, and that it has no evidence on whether acupuncture adds to them.
The American Society of Clinical Oncology (ASCO) endorsed the guideline in 2018, summarising it as recommending acupressure and acupuncture for reducing CINV. Both documents concern breast cancer patients. Clinical guidelines sets out other bodies’ positions, and Electrical stimulation and implants covers the SIO’s caution about electroacupuncture near pacemakers and defibrillators.
What the reviews could not settle
The SIO guideline found no body of evidence on whether acupuncture adds anything to the current standard drugs for highly emetogenic chemotherapy. Against sham, the trials are few and their pooled estimates imprecise. The Cochrane review’s acupressure findings come from trials without a placebo control, and a sham-controlled acupressure trial of 500 patients found no clear difference. Trial registration and outcome reporting are incomplete across the English-language trials. Nausea after surgery reports the larger body of PC6 trials in a different setting, and Cancer-related fatigue the trials and the 2024 ASCO–SIO guideline on fatigue during and after treatment.
AcuiQ’s chemotherapy nausea and chemotherapy-induced vomiting pages list the protocols individual studies prescribed, each with its citation.