Review Article
The Effectiveness of
From the *Kaohsiung Medical
University College of Nursing,
Kaohsiung, Taiwan; †I-Shou
University Department of Nursing,
Kaohsiung, Taiwan.
Address correspondence to
Hsiu-Hung Wang, RN, PhD, FAAN,
Kaohsiung Medical University
College of Nursing, Taiwan, No. 100
Shih-Chuan 1st Road, San-Ming
District, Kaohsiung 80708, Taiwan.
E-mail: hhwang@kmu.edu.tw
Received May 15, 2012;
Revised December 13, 2012;
Accepted December 13, 2012.
1524-9042/$36.00
Ó 2014 by the American Society for
Pain Management Nursing
http://dx.doi.org/10.1016/
j.pmn.2012.12.005
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Acupressure on
Relieving Pain: A
Systematic Review
Ya-Wen Chen, RN, MSN,* ,†
---
and Hsiu-Hung Wang, RN, PhD, FAAN*
- ABSTRACT:
Acupressure is a complementary treatment that uses fingers and
hands to stimulate acupoints and maintains the balance of energy. The
objective of this study was to review the application of acupressure in
managing different pains and the effectiveness of acupressure on re-
lieving pain in various settings. A systematic review of English articles
using the databases of MEDLINE, PubMed, and Cumulative Index to
Nursing and Allied Health Literature (CINAHL) was performed using
the search terms of ‘‘acupressure’’ and ‘‘pain.’’ Studies during which
acupressure was applied as an intervention and assessed for its ef-
fectiveness on relieving pain were selected. The studies selected were
those published from January 1, 1996 to December 31, 2011 that met
the inclusion and exclusion criteria. The participants included
patients with dysmenorrhea, labor pain, low back pain, chronic
headache, and other traumatic pains. The Oxford 2011 Levels of Evi-
dence was used to appraise the literature. Fifteen studies were ex-
tracted for reducing dysmenorrhea (menstrual distress), labor pain,
low back pain, chronic headache, and other traumatic pain. These
papers were further reviewed for their study design, adequacy of
randomization and concealment of allocation, blinding of partici-
pants, interventions, and outcome measurements. Acupressure has
been shown to be effective for relieving a variety of pains in different
populations. The review begins to establish a credible evidence base
for the use of acupressure in pain relief. The implication for health
care providers would be incorporating acupressure into their practice
as an alternative therapy to facilitate patients who suffer from pain.
Ó 2014 by the American Society for Pain Management Nursing
Acupressure is a complementary treatment that uses fingers and applies pres-
sure to stimulate acupoints of the human body (McFadden & Hern
andez,
2010). This noninvasive therapy was originally developed from traditional Chi-
nese medicine, which focuses on the balance of yin and yang and maintains the
function of vital organs through circulation of blood and energy (chi) in the
body (Tsay, 2004).
Pain Management Nursing, Vol 15, No 2 (June), 2014: pp 539-550
540
There are 14 meridians connecting acupoints in our
bodies, and each meridian corresponds to and nourishes
different organs (World Health Organization, 1991). The
meridians are divided into Yin and Yang. The Yin merid-
ians communicate with the vital organs such as lung,
heart, spleen, kidney, and liver. The Yang meridians cor-
respond to gall bladder, intestines, stomach, and bladder
(World Health Organization, 1991).
Robinson, Lorenc, and Liao (2011) stated that acu-
pressure affects the balance of energy through acu-
points on the meridians by fingers and hands,
whereas acupuncture is an invasive therapy and ap-
plies needles or heat to acupoints. Acupressure applies
constant pressure to specific acupoints of selective an-
atomic sites in contrast to acupuncture, which uses
needles (Lee, Chang, & Kang, 2004; Hsieh, Liou, Lee,
Chen, & Yen, 2010). In addition, acupressure has
been shown to improve many clinical symptoms,
such as nausea and vomiting (Roscoe et al., 2010), fa-
tigue (Tsay, 2004; Zick et al., 2011), insomnia (Sun,
Sung, Huang, Cheng, & Lin, 2010), anxiety (Agarwal
et al., 2005), depression (Wu, Lin, Wu, & Lin, 2007),
and other health problems.
Acupressure also has been applied to relieve differ-
ent types of pains that are often alleviated by using non-
steroid anti-inflammatory drugs or other analgesics. The
participants of this study included patients with dysmen-
orrhea, labor pain, low back pain, chronic headache,
and other traumatic pains. Acupressure was applied
as an intervention and compared with other control
groups. The outcomes were measured by using pain vi-
sual analog scales. Most of the study designs are random-
ized controlled trials. This process of review adheres to
the Preferred Reporting Items for Systematic Reviews
and Meta-Analyses (PRISMA) guideline (2009), which
is a well-respected and valuable guide to preparing sys-
tematic reviews that are complete and transparent.
METHODS
Research Question
Is acupressure effective in relieving pain in different
populations, such as populations with dysmenorrhea,
labor pain, low back pain, chronic headache, and other
traumatic pains?
Eligibility Criteria
The inclusion criteria included pilot studies, clinical tri-
als, and randomized controlled trials using human be-
ings. The exclusion criteria were literature irrelevant
to pain (n ¼ 193), qualitative studies (n ¼ 1), doctoral
dissertations (n ¼ 1), systematic reviews (n ¼ 3), and
case reports (n ¼ 8). In addition, the literature involv-
ing infants and children as participants (n ¼ 2) or
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Chen and Wang
animal studies were also excluded. Many studies com-
bining acupressure with other therapies, such as
acupuncture, aromatherapy, massage, and analgesic
medications (n ¼ 19) were eliminated, as shown in
Figure 1.
Information Sources
The computer-assisted search was performed by using
the databases of MEDLINE (n ¼ 107), PubMed (n ¼
120), and Cumulative Index to Nursing and Allied
Health Literature (CINAHL) (n ¼ 78) with the search
terms of ‘‘acupressure,’’ and ‘‘pain.’’ Harris et al.
(2005) had published a review of acupressure covering
the period from 1986 to 1995. Therefore, the screened
papers were published in medical and nursing peer-
review journals from January 1, 1996 to December
31, 2011. The literature review was limited to articles
in English.
Study Selection
Eligibility assessment was conducted independently in
an unblinded standardized manner by the two authors.
Disagreements between the authors were resolved by
consensus. The authors first eliminated the irrelevant
contents based on the literature’s abstracts, then scru-
tinized the full texts of the included papers. In the
final results, 15 studies were extracted and further
reviewed.
Data Items
The Levels of Evidence (OCEBM Levels of Evidence
Working Group, 2011) (Table 1) was used to appraise
the literature. The characteristics of study designs, par-
ticipants of experimental and control groups, acu-
points, key outcome measurements, and statistical
significances for treating a variety of pains are summa-
rized in Tables 2–5. Most of the studies are rated as 1b,
but non-randomized controlled trials (RCT) and pilot
studies are classified as 2b.
Risk of Bias
To ascertain the validity of eligible clinical trials, two
authors assessed the study designs, adequacy of ran-
domization and concealment of allocation, and blind-
ing of participants across the studies. In addition, the
frequency and duration of acupressure, the manual
techniques, and acupoints used are also reviewed.
Summary Measures
The primary outcome measurements for dysmenor-
rhea include the pain visual analog scale (VAS), Short-
Form Menstrual Distress Questionnaire (SF-MDQ),
and Short-Form McGill Pain Questionnaire (SF-MPQ).
To accurately evaluate the effectiveness of acupressure
 Effectiveness of Acupressure on Relieving Pain 541

FIGURE 1. - Schema for study selection.

on labor pain, the frequency and intensity of uterine

contractions were recorded by using an external fetal
monitor. The length of delivery time along with VAS TABLE 1.
was also observed to measure the effectiveness of Levels of Evidence
acupressure. Level Therapy/Prevention, Etiology/Harm
Among the studies for treating low back pain,
Suen, Wong, Chung, and Yip (2007) adopted a pain in- 1a Systemic review (with homogeneity) of RCTS
tensity verbal rating scale (Chinese version) to evaluate 1b Individual RCT (with narrow confidence interval)
the effects of auriculotherapy. Hsieh, Kuo, Yen and 1c All or none
2a Systemic review (with homogeneity) of cohort
Chen (2004) used the Short-Form Pain Questionnaire studies
(SF-PQ, Chinese version) to compare the effects be- 2b Individual cohort study (including low quality RCT;
tween the acupressure group and physical therapy <80% follow-up)
group. Later, the research group applied the Roland 2c Outcome research; ecological studies
and Morris Disability Questionnaire, Oswestry Disabil- 3a Systemic review (with homogeneity) of case-
control studies
ity Questionnaire, and pain VAS to measure more out- 3b Individual case-control study
comes in another study (Hsieh et al., 2006). 4 Case-series (and poor quality cohort and case-
However, VAS and SFPQ are the most commonly control studies)
used questionnaires with evidence for good reliability 5 Expert opinion without explicit critical appraisal, or
and validity in the reviewed studies, whereas some re- based on physiology, bench research or first
principles.
searchers do not delineate the psychometric proper-
ties of the instruments in the papers. Adapted from the OCEBM Levels of Evidence Working Group (2011).

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 542
TABLE 2.
Summary of Acupressure Studies Included for Treating Dysmenorrhea
Oxford
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Study design/ Experimental group Control group (sample Key outcome Level of
References # Participants (sample size) size) Acupoints measurements Statistical significance Evidence
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.

1. Chen, H. M., & Chen, Randomized single blind Acupressure groups: Control group: Hegu (LI 4), Pain Visual Analog Scale Acupressure at matched 1b
C. H. (2010). Journal of experimental study Zusanli (n ¼30), No intervention (n ¼35) Sanyingjao (Sp 6), and (VAS); VAS for Anxiety; points of Hegu and
Clinical Nursing, Adolescent girls with Hegu (n ¼33), and Hegu- Zusanli (St 36) Menstrual Distress Sanyinjiao reduced the
19(7–8), 998–1007. menstrual distress Sanyinjao matched Questionnaire Short pain, distress and
points (n ¼ 36) for Form; Short-Form anxiety. Acupressure
20 minutes McGill Pain at single point of Hegu
Questionnaire effectively reduced
menstrual pain during
six-month follow-up.
2. Jun, E., Chang, S., Non-randomized Experimental group: Placebo group: light Sanyingjao (SP6) Pain VAS; Skin There was a significant 2b
Kang, D., & Kim, S. controlled trial acupressure treatment touch (n ¼ 31) temperature changes difference in severity of
(2007). International Young college women within the first 8 hours in the Zhongwan (CV dysmenorrhea
Journal of Nursing with primary of menstruation 12) and Qugu (CV 2) between the two
Studies, 44(6), dysmenorrhea (n ¼ 30) acupoints groups immediately
973–981. and 2 hours after the

Chen and Wang

treatment.
3. Kashefi, F. Ziyadlou, S., Single-blind clinical trial Acupressure group: Control group: Sham Sanyingjao (SP6) Pain VAS; Short-Form The decline of the severity 1b
Khajehei, M., Ashraf, A. Female students suffering acupressure on the acupressure (n ¼ 43) McGill Pain of dysmenorrhea in
R., & Fadaee, A. R. primary dysmenorrhea SP6 acupoint (n ¼ 43) Questionnaire acupressure group
Complementary (SF-MPQ) greater than control
Therapies in Clinical group at 30 minutes, 1,
Practice, 16(4), 2, and 3-hour after the
198–202. intervention.
4. Mirbagher-Ajorpaz, N., Randomized Controlled Intervention group: Control group: light touch Sanyingjao (SP6) Pain VAS The significant
Adib-Hajbaghery, M., Trial acupressure on the on the SP6 acupoint differences were
& Mosaebi, F. (2011). Young college female SP6 acupoint during (n ¼ 15) observed in pain
Complementary students with primary menstruation cycle scores between the
Therapies in Clinical dysmenorrhea (n ¼ 15) two groups
Practice, 17(1), 33–36. immediately and
3-hour after treatment.
5. Wang, M., Hsu, M., Randomized clinical trial Acupressure group: Control group: received Three auricular Short-Form Menstrual The menstrual symptoms 1b
Chien, L., Kao, C., & Young college females received auricular a plain adhesive patch acupressure Points: Distress Questionnaire decreased significantly
Liu, C. (2009). Journal with primary acupressure by seed- with no seed attached Liver (CO12), Kidney (MDQ); Blood sample after auricular
of Alternative & dysmenorrhea pressure method placed on the same (CO10), and Endocrine of NO (nitric oxide) acupressure by seed-
Complementary (n ¼ 36) acupoints (n ¼ 35) (CO18) pressure method. NO
Medicine, 15(3), level increased in the
235–242. acupressure group.
6. Wong, C. L., Lai, K. Y., Randomized clinical trial Acupressure group: Control group: rest only Sanyingjao (SP6) Pain VAS; Short-Form There was a statistically 1b
& Tse, H. M. (2010). Young college female acupressure on the (n ¼ 21) McGill Pain significant decrease in
Complementary students with SP6 during the initial Questionnaire pain VAS and SF-MPQ
Therapies in Clinical dysmenorrhea session for 20 minutes (SF-MPQ); Short-Form immediately after the
Practice, 16, 64–69. (n ¼ 19) Menstrual Distress treatment.
Questionnaire A significant reduction of
(SF-MDQ) Pain VAS, SF-MPQ,
and SF-MDQ scores
was noted at 3-month
after the treatment.
 TABLE 3.
Summary of Acupressure Studies Included for Labor Pain
Experimental Oxford
Study design/ group (sample Control group Key outcome Statistical Level of
References # Participants size) (sample size) Acupoints measurements significance Evidence
Downloaded for Anonymous User (n/a) at University of Indonesia from ClinicalKey.com/nursing by Elsevier on February 14,

1. Chung, U., Hung, Randomized Group 1: Group 2: Light skin Hegu (LI4), Visual Analog Scale A significant 1b
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.

L., Kuo, S., & controlled trial Acupressure stroking Chihying (BL67) (VAS); External difference in the
Huang, C. (2003). The parturient (n ¼ 43) (effleurage) fetal monitoring acupressure
Journal of women with (n ¼ 42) strips group was found
Nursing 37–42 weeks of Group 3: No in lessening labor
Research, 11(4), gestational age treatment/ pain during the
251–260. conversation only active phase of
(n ¼ 42)

Effectiveness of Acupressure on Relieving Pain

the first stage of
labor.
2. Hjelmstedt, A., Randomized Acupressure group Light touch group Sanyingjao (SP 6) Labor pain intensity A reduction of in- 1b
Shenoy, S. T., controlled trial (n ¼ 71) (n ¼ 71) was rated on labor pain was
Stener-Victorin, The nulliparous Standard care a 100-mm VAS found in the
E., Lekander, M., women in active group (n ¼ 70) acupressure
Bhat, M., labor group and was
Balakumaran, L., most noticeable
& Waldenstrom, immediately after
U. (2010). treatment.
Acta Obstetricia et
Gynecologica
Scandinavica 89,
1453–1459.
3. Lee, M. K., Randomized clinical SP 6 Acupressure SP6 Touch control Sanyingjao (SP 6) VAS; The length of There were 1b
Chang, S. B., & trial (n ¼ 36) (n ¼ 39) delivery time significant
Kang, D. H. The women were differences
(2004). Journal of more than 37 between the two
Alternative & weeks of groups in labor
Complementary pregnancy pain scores
Medicine, 10(6), without any immediately after
959–965. specific the intervention,
diagnosed and at 30, 60, and
diseases 120 minutes
follow-up.
3. Lee, M. K., Randomized clinical SP 6 Acupressure SP6 Touch control Sanyingjao (SP 6) VAS; The length of There were 1b
Chang, S. B., & trial (n ¼ 36) (n ¼ 39) delivery time significant
Kang, D. H. The women were differences
(2004). Journal of more than 37 between the two
Alternative & weeks of groups in labor
Complementary pregnancy pain scores
without any immediately after

543
(Continued )
544 Chen and Wang

Evidence
RESULTS
Level of
Oxford
Study Selection
Of the 15 research studies extracted, six conveyed the
use of acupressure to diminish the symptoms of dys-
and at 30, 60, and
the intervention,
menorrhea. Three of the remaining nine RCTs studied
significance
Statistical

120 minutes
follow-up.
the effectiveness of acupressure in relieving labor pain,
especially during the active phase of the first stage of
labor. Another three RCTs investigated the effects of
acupressure for treatment of low back pain, and the
other three are clinical trials for reducing tension head-
ache and minor traumatic pains.
The Effectiveness of Acupressure on Dysmenor-
measurements
Key outcome

rhea. Six studies were retrieved for alleviating pri-

mary dysmenorrhea and menstrual distress, including
five RCTs and one non-RCT, as shown in Table 2. Men-
struation, which increases intrauterine pressure and
decreases blood flow to the uterus, would result in is-
chemia of the uterine arteries and dysmenorrhea (Jun,
Chang, Kang, & Kim, 2007). Mirbagher-Ajorpaz, Adib-
Acupoints

Hajbaghery, and Mosaebi (2011) used acupressure on

30 young college students with primary dysmenor-
rhea. The severity of menstrual pain was measured us-
ing a visual analog scale before acupressure and again
immediately, 30 minutes, and 1, 2, and 3 hours after
treatment. Kashefi et al. (2010) in Iran and Wong,
Lai, and Tse (2010) in Hong Kong also conducted sim-
Control group
(sample size)

ilar studies among female students to assess the effects

of acupressure on primary dysmenorrhea. The acu-
point of relieving menstrual distress in most research
was Sanyingjao (Spleen 6, SP 6). The Sanyingjao is
on the junction point of the liver, spleen, and kidney
meridians, which is located 4 fingerbreadths above
the inner malleolus (Jun et al., 2007; Wong et al.,
group (sample
Experimental

2010).
Chen and Chen (2010) examined the effects of
size)

acupressure on menstrual distress in 134 adolescents

and compared the effects on three different acupoints
(Hegu-Sanyinjao matched points and Hegu, Zusanli sin-
gle point) in Taiwan. The researchers found that acu-
pressure at match points of Hegu and Sanyinjao and
Study design/

Hegu single point can effectively reduce menstrual

Participants

pain during the six-month follow-up. In terms of the lo-

diagnosed
diseases

cation of acupoints, Hegu (Large intestine 4, LI 4) is

specific

‘‘situated on the dorsum of the hand, between the first

and second metacarpal bones, at the mid-point of the
second metacarpal bone and close to its radial border’’
(Chen & Chen, 2010, p. 1000). The location of Zusanli
Medicine, 10(6),

(Stomach 36, ST 36) is three cuns below lower edge of

References #

the kneecap and one cun to the outside of the shin-

Continued

bone (Chen & Chen, 2010). The ‘‘cun’’ is the standard

959–965.
TABLE 3.

unit of the measurement for the body used in acupunc-

ture, and one cun equals 1 thumb width or 2.5 cm
(Lang et al., 2007).

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 TABLE 4.
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Summary of Acupressure Studies Included for Treating Low Back Pain

2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.

Experimental Oxford
Study design/ group (sample Control group Key outcome Statistical Level of
References # Participants size) (sample size) Acupoints measurements significance Evidence

1. Hsieh, L. L., Kuo, Randomized Acupressure group Physical therapy Not mentioned The Roland and The Roland and 1b
C., Lee, L. H., controlled clinical (n ¼ 64) group (n ¼ 65) Morris disability Morris disability
Yen, A. M., Chien, trial questionnaire at questionnaire

Effectiveness of Acupressure on Relieving Pain

K., & Chen, T. H. The patients with baseline, after after treatment
(2006). BMJ: chronic low back treatment, and at was significantly
British Medical pain six month follow- lower in the
Journal up; Modified acupressure
(International Oswestry group than in the
Edition), Disability physical therapy
332(7543): Questionnaire; group.
696–698. Pain VAS
2. Hsieh, L. L., Kuo,Randomized Acupressure group Physical therapy Not mentioned Chinese version of The pain score after 1b
C., Yen, M., & controlled clinical (n ¼ 69) group (n ¼ 77) Short-Form Pain a 4-week
Chen, T. H. trial Questionnaire treatment in the
(2004). PreventiveThe patients with (SF-PQ) acupressure
Medicine, 39(1), chronic low back group was
168–176. pain significantly lower
than that in the
physical therapy
group.
3. Suen, L. K., RCT Experimental group Control group using Seven auricular Chinese pain A significant 1b
Wong, E. M., & Pilot study using magnetic semen vaccariae points: Shenmen, intensity Verbal improvement in
Chung, J. Y. The elderly suffering pellets (n ¼ 30) (n ¼ 30) kidney, urinary Rating Scale pain relief in the
(2007). from low back bladder, (VRS) experimental
Complementary pain lumbosacral group when
Therapies in vertebrae, compared with
Clinical Practice buttock, liver and the control group;
(2007) 13, 63–69. spleen. The therapeutic
effects were
sustained at 2-
and 4-week
follow-up.

545
 546
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TABLE 5.
Summary of Acupressure Studies Included for Treating Headache and Other Pains
2023. For personal use only. No other uses without permission. Copyright ©2023. Elsevier Inc. All rights reserved.

Experimental Oxford
Study design/ group (sample Control group Key outcome Statistical Level of
References # Participants size) (sample size) Acupoints measurements significance Evidence

1. Hsieh, L. L., Liou, Randomized Acupressure group Muscle relaxant The acupoints used Pain Visual The mean scores on 1b
H., Lee, L., Chen, controlled trial (n ¼ 14) medication are different Analogue Scale the VAS at post-
T. H., & Yen, A. M. The patients with (n ¼ 14) depending on (VAS); Headache treatment
(2010). chronic headache pain areas Quality of Life assessment were
American Journal of complained by Questionnaire significantly lower
Chinese each patient. was recorded at in the acupressure
Medicine, 38(1), baseline, 1 month group (32.9 
1–14. after treatment, 26.0) than in the

Chen and Wang

and at a 6-month muscle relaxant
follow-up. medication group.
2. Kober, A., Randomized, Group 1: True Group 2: Sham Group 1: Hegu (LI 4), VAS scores for pain Significant 1b
Scheck, T., double-blind trial acupressure acupressure Zhongchong (KS and anxiety reductions of
Greher, M., Lieba, The patients with (n ¼ 19) (n ¼ 20) 9), Neiguan (P 6), scores before and pain, anxiety, and
F., Fleischhackl, minor trauma Group 3: No Kunlun (BL 60), & after treatment; heart rates in
R., Fleischhackl, acupressure Baihui (GV 20). Heart rates and group 1.
S., & Hoerauf, K. (n ¼ 21) blood pressure
(2002).
Anesthesia and
Analgesia, 95(3),
1328–1332.
3. Lang, T., Hager, Randomized, Acupressure group Sham acupressure Acupressure group: VAS scores for pain The patients in the 1b
H., Funovits, V., double-blind trial (n ¼ 15) (n ¼ 16) Baihui (GV 20), and anxiety acupressure
Barker, R., The patients with Hegu (LI 4); group had
Steinlechner, B., isolated distal Sham group: Geshu significantly lower
Hoerauf, K., & radial fractures (BL17), Jianliao pain VAS and
Kober, A. (2007). (TE14) anxiety scores.
American Journal
of Emergency
Medicine, 25(8),
887–893.
 Effectiveness of Acupressure on Relieving Pain
Wang, Hsu, Chien, Kao, and Liu (2009) postu-
lated that dysmenorrhea may be associated with nitric
oxide (NO) and tested the effects of auricular acu-
pressure on relieving menstrual distress and reducing
NO for 90 females with primary dysmenorrhea in Tai-
wan. They provided evidence that the auricular acu-
pressure by the seed-pressure method on liver
(CO12), kidney (CO10), and endocrine (CO18) acu-
points can significantly improve menstrual symptoms.
The location of each auricular point is shown in
Figure 2.
Jun et al. (2007) conducted a non-RCT to evaluate
the efficacy of acupressure on Sanyinjao (SP 6) acupoint
for dysmenorrhea and the changes of skin temperature
in 58 college students. They found a significant differ-
ence in the severity of dysmenorrhea between experi-
mental group and control group immediately after and
for up to 2 hours post-treatment. The changes of abdom-
inal skin temperature were measured as an objective in-
dicator of blood flow to the uterus (Jun et al., 2007). The
temperature in the acupoints of Zhongwan (Conception
vessel 12, CV 12) and Qugu (Conception vessel 2, CV 2)
increased at 30 minutes after acupressure was imple-
mented in the experiment group, which indicated an in-
crease of blood flow to the uterus and a decrease of
menstrual pain. The location of Zhongwan (CV 12) is
at the middle of gastric cavity, between the solar plexus
and umbilical ring (Jun et al., 2007). In addition, the acu-
point of Qugu (CV2) is at the midpoint of pubic symphy-
sis, corresponding to the organ of uterus (Jun et al.,
2007).
FIGURE 2.
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547
The Effectiveness of Acupressure on Labor Pain.
Three randomized clinical trials showed that acupres-
sure can effectively reduce the intensity of labor pain
(Table 3). The stimulation of Sanyingjao (SP 6) acu-
point has strongly improved gynecological symptoms
and facilitates women to induce labor (Lee, Chang, &
Kang, 2004). Lee et al. (2004) studied the effects of
SP6 acupressure on labor pain and delivery time in Ko-
rea. The ratings of labor pain were measured by VAS at
baseline before intervention, immediately after the in-
tervention, and at 30 and 60 minutes after the interven-
tion. The study showed that the pain scores were
significantly different at all time points after the inter-
vention between the groups. In addition, the labor
time (from 3 cm cervical dilatation to delivery) was
also significantly shorter in the acupressure group
than in the control group.
Hjelmstedt et al. (2010) conducted a similar study
to investigate the effect of acupressure at SP 6 acupoint
during the active phase of labor on 142 nulliparous
women in India. The results showed that labor pain
was reduced immediately after the treatment in the
acupressure group. Chung, Hung, Kuo, and Huang
(2003) applied acupressure on Hegu (Large Intestine
4, LI 4), and Chihying (Bladder 67, BL 67) acupoints
among 127 women and evaluated the effect of acupres-
sure on labor pain and uterine contractions in the first
stage of labor in Taiwan. The study showed that the la-
bor pain during the initial stage of labor was signifi-
cantly decreased, but no significant effects were
found on uterine contractions. The stimulation of
- Auricular acupoints.
548
Chih-ying (BL 67) point, which is located approxi-
mately 0.1 inch behind the lateral corner of the fifth
toe nail, is believed to relieve labor pain (Perinatal
Education Associates, Inc., n.d.).
The Effectiveness of Acupressure on Low Back
Pain. Three RCTs for treatment of low back pain
were extracted in Table 4. Hsieh et al. (2006) indicated
the efficacy of acupressure for patients with low back
pain related to disability, pain scores, and functional
status as compared with physical therapy after treat-
ment and at six month follow-up in Taiwan. Hsieh
et al. (2004) applied acupressure to 146 participants
with chronic low back pain and reported that the
pain scores were significantly lower in the acupressure
group after a 4-week treatment compared to those in
physical therapy group.
Suen et al. (2007), in Hong Kong, investigated the
effectiveness of acupressure by using magnetic pellets
on a three-week basis for older adults suffering from
low back pain. The researchers selected 7 auricular
acupoints that are believed to be effective in treating
low back pain and used either magnetic pellets (exper-
imental group) or semen vaccariae (control group) for
auriculotherapy. A significant improvement in pain re-
lief was found in the experimental group when com-
pared with the control group. The three clinical trials
have clearly described the randomization, allocation
concealment, and blinding of participants and inter-
veners in the papers, but the acupoints used for treat-
ing low back pain were not mentioned in the two
studies (Hsieh et al. 2006; Hsieh et al., 2004).
The Effectiveness of Acupressure on Tension
Headache and Other Pains. Acupressure was also
utilized for reducing chronic headache and other trau-
matic pains (Table 5). Hsieh, Liou. Lee, Chen, and Yen
(2010) compared the effectiveness of acupressure
with muscle relaxants for treating chronic headache
among 28 patients in Taiwan. The acupressure group
showed a significant decrease in pain VAS scores,
more than the control group using muscle relaxants
at post-treatment and at a six-month follow-up. The
quality of life related to headache also showed signifi-
cant differences between the two groups. The acu-
points used in the acupressure group are different
depending on pain areas reported by each patient.
Kober et al. (2002) examined the analgesic effects
of acupressure on 60 victims of minor trauma. The par-
ticipants were divided into three groups. The group of
true acupressure was stimulated on the acupoints of
Hegu (LI 4), Zhongchong (Pericardium 9, PC 9), Neiguan
(Pericardium 6, PC 6), Kunlun (Urinary bladder 60, UB
60 or Bladder 60, BL 60), and Baihui (GV 20). The Zhong-
chong point is located at the center of the tip of the mid-
dle finger (TCM Discovery, 2003). The Neiguan (PC 6)
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Chen and Wang
acupoint is ‘ located on the surface of the forearm ap-
proximately 4.5 cm above the wrist between the flexor
and palmaris longus medialis tendons.’’ (G€ urkan &
Arslan, 2008, p. 47). The Baihui (GV 20) acupoint is lo-
cated 5 cuns directly above the midpoint of the anterior
hairline on the head and at the midpoint of the line con-
nection the apexes of both ears (TCM Discovery, 2003;
Lang et al., 2007). In addition, the acupoint of Kunlun
(UB or BL 60) is located behind the outer anklebone of
either foot (Scholasticus, 2012). The results showed sig-
nificant reductions on pain, anxiety, and heart rates in
the true acupressure group. The researchers indicated
that acupressure is a fast, practical, and effective treat-
ment for reducing pain in emergent situations and also
improves the quality of care during the process of para-
medic transport.
Lang et al. (2007) conducted a prospective, ran-
domized, double-blind study and applied acupressure
to pre-hospitalized patients with distal radial fracture in
Australia. The acupoints used in the treatment group in-
clude Baihui (GV 20) and Hegu (LI 4), whereas the sham
acupressure was applied on Geshu (Bladder 17, BL 17)
and Jianliao (TE 14). The location of Geshu (BL 17) point
is ‘ at the crossing of 2 lines; one runs horizontally
through the inferior angle of the scapula, and the other
runs parallel to the spine at a distance of 1.5 cuns’’ (Lang
et al., 2007, p. 889). The Jianliao (TE 14) point is located
‘ in the midst of the deltoid muscle at its proximal site of
insertion’’ (Lang et al., 2007, p. 890). The results showed
that significant decreases on pain and anxiety scores
were found in the treatment group.
DISCUSSION
From the results of the fifteen studies, acupressure is
shown to reduce various pains, including dysmenor-
rhea, labor pain, low back pain, chronic headache,
and other traumatic pains in different countries. The
clinical trials showed that acupressure can be effi-
ciently conducted by health care professionals as an ad-
juvant therapy in general practice for pain relief. The
intervention is implemented through pressing and rub-
bing acupoints with fingers and hands by using a force
approximately 3 to 5 kilograms once per second for 5
seconds and then releasing for 1 second (Cho & Tsay,
2004). Patients must feel soreness, numbness, heavi-
ness, distention, and warmth to confirm the accurate
location of each acupoint (Chung et al., 2003). How-
ever, a lack of standard procedure or clinical protocol
of acupressure treatment apparently exists, such as
the frequency, duration of time, and precise selection
of acupoints differing by the diagnoses and symptoms.
Although the nonpharmacological and simple-to-
learn treatment can be practiced by health care
 Effectiveness of Acupressure on Relieving Pain
providers through appropriate teaching and training,
many factors could confound the outcome measure-
ments. Therefore, further research should be conduct-
ed on the consistency of administrating techniques,
which would facilitate the establishment of evidence-
based practice and the comparison of the results for
pain management in a broader population. In addition,
two limitations were found in part of the reviewed ar-
ticles, including a lack of power calculation for sample
size and no CONSORT checklists presented in the con-
tents of the papers.
CONCLUSIONS
The systematic review begins to establish a credible ev-
idence base for the use of acupressure in relieving
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