Acupressure for Pain Management and Fatigue Relief in Gulf War Veterans
Acupressure for Pain Management and Fatigue Relief in Gulf War Veterans
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.
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.
Inclusion Criteria:

 -  Veterans with Gulf War Illness for more than 6 months

 -  Over 18 years old (male or female)

 -  Additional inclusion criteria:

 -  A score of 5 and above for severity and 5 and above for interference by BPI.

 -  A score of 3 and above by revised Piper Fatigue Scale.

 Exclusion Criteria:

 -  Pregnant woman;

 -  fatigue can be explained by existing causes (i.e., eating disorder);

 -  previous neuromuscular or mood disorders (i.e., bipolar disorder);

 -  previous cognitive problems (i.e., schizophrenia, dementia, delusional disorder);

 -  significant cardiovascular problems;

 -  under other rehabilitation treatment that can significantly differentiate the subject
 from others.