To assess the effectiveness and safety of acupuncture for hiccups following stroke.
Methods
Medline, Embase, CENTRAL, CINAHL, and four Chinese medical databases were searched from their inception to 1 June 2015. The dataset included randomised controlled trials (RCTs) with no language restrictions that compared acupuncture as an adjunct to medical treatment (effectiveness) or acupuncture versus medical treatment (comparative effectiveness) in stroke patients with hiccups. The Cochrane risk of bias tool was used to assess the methodological quality of the trials.
Results
Out of 436 potentially relevant studies, five met the inclusion criteria. When acupuncture was compared with other interventions (as sole or adjunctive treatment), meta-analysis revealed a significant difference in favour of cessation of hiccups within a specified time period (CHWST) following intervention when used as an adjunct (risk ratio (RR) 1.59, 95% CI 1.16 to 2.19, I2=0%), but not when used alone (RR 1.40, 95% CI 0.79 to 2.47, I2=65%, ie, high heterogeneity). No safety information was reported in these studies.
Conclusions
Our systematic review and meta-analysis suggests that acupuncture may be an effective treatment for patients suffering from hiccups following stroke when used as an adjunct to medical treatment. However, due to the limited number of RCTs and poor methodology quality, we cannot reach a definitive conclusion, hence further large, rigorously designed trials are needed.
FriedmanNL. Hiccups. A treatment review. Pharmacotherapy1996;16:986–95.
2.
BeckerDE. Nausea, vomiting, and hiccups: a review of mechanisms and treatment. Anesth Prog2010;57:150–6.
3.
HowardRS. Persistent hiccups. BMJ1992;305:1237–8.
4.
ArishimaH, KikutaKI. Disseminated metastatic tumor at dorsal surface of medulla oblongata presenting intractable hiccups. A case report. Clin Neurol2011;51:279–81.
5.
LewisJH. Hiccups: causes and cures. J Clin Gastroenterol1985;7:539–52.
6.
HillipsRA. The management of hiccups in terminally ill patients. Nursing Times2005;101:32–3.
7.
WilcockA, TwycrossR.Midazolam for intractable hiccup. J Pain Symptom Manage1996;12:59–61.
8.
MadanagopolanN.Metoclopramide in hiccup. Curr Med Res Opin1975;3:371–4.
9.
FriedgoodCE, RipsteinCB. Chlorpromazine (thorazine) in the treatment of intractable hiccups. JAMA1955;157:309–10.
10.
JacobsonPL, MessenheimerJA, FarmerTW. Treatment of intractable hiccups with valproic acid. Neurology1981;31:1458–60.
11.
MukhopadhyayP, OsmanMR, WajimaT, Nifedipine for intractable hiccups. N Engl J Med1986;314:1256.
12.
LiuM, WuB, WangWZ, Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol2007;6:456–64.
13.
LeeS, ShafeAC, CowieMR. UK stroke incidence, mortality and cardiovascular risk management 1999-2008: time-trend analysis from the General Practice Research Database. BMJ Open2011;1:e000269.
14.
Centers for Disease Control and Prevention (CDC). Prevalence of stroke–United States, 2006-2010. MMWR Morb Mortal Wkly Rep2012;61:379–82.
15.
XieXL, CaoXM, HuangSZ, Acupuncture and cupping for treatment of hiccup in cases of cerebrovascular accident. J Tradit Chin Med2006;26:175–6.
16.
BaoF, LiangZ, WangF.Clinical observation on treatment of stubborn hiccup by acupuncture with different needle retaining time. World J Acupunct Moxibustion2003;13:50–4.
17.
ChoiTY, LeeMS, ErnstE.Acupuncture for cancer patients suffering from hiccups: a systematic review and meta-analysis. Complement Ther Med2012;20:447–55.
18.
MorettoEN, WeeB, WiffenPJ, Interventions for treating persistent and intractable hiccups in adults. Cochrane Database Syst Rev2013;1:CD008768.
19.
GeAX, RyanME, GiacconeG, Acupuncture treatment for persistent hiccups in patients with cancer. J Altern Complement Med2010;16:811–16.
20.
JiangHX. Clinical research of Jiaji electroacupuncture for post-stroke patients with intractable hiccups [Master thesis]. Heilongjiang University of Chinese Medicine, 2010 (in Chinese).
21.
WeiQ, GaoY.30 Cases of post-stroke hiccup treated with acupuncture and medicine. J Zhejiang Chin Med Univ2014;38:82–3 (in Chinese).
22.
YanXR. Clinical study of Xing Nao Kai Qiao acupuncture method for persistent hiccups after stroke. Guangming J Chin Med2012;27:97–8 (in Chinese).
23.
ZhangXT. Clinical observation of acupuncture for persistent hiccup after cerebral infarction with 63 cases. J Sichuan Tradit Chin Med2006;24:105 (in Chinese).
24.
ZongF, ZengXQ, LinX.Clinical study of acupuncture plus drugs for hiccups after stroke. Shanghai J Acupunct Moxibustion2009;28:287 (in Chinese).
YueJ, LiJ, LiuM, Acupuncture for the treatment of hiccups following stroke: a protocol for a systematic review. Eur J Bio Med Res2015;1:23–7.
27.
LiberatiA, AltmanDG, TetzlaffJ, The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med2009;151: W-65-94.
28.
HigginsJPT, AltmanDG, SterneJAC, on behalf of the Cochrane Statistical Methods Group and the Cochrane Bias Methods Group (editors). Chapter 8: Assessing risk of bias in included studies. In: HigginsJPT, GreenS, ed. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011: http://www.cochrane-handbook.org (accessed 25 Jul 2015).
29.
DeeksJJ, HigginsJPT, AltmanDG. Chapter 9: analysing data and undertaking meta-analyses. In: Higgins JPT, Green S. eds. Cochrane handbook for systematic reviews of interventions version 5.1.0 (updated March 2011). The Cochrane Collaboration. 2011. http://www.cochrane-handbook.org
30.
EggerM, Davey SmithG, SchneiderM, Bias in meta-analysis detected by a simple, graphical test. BMJ1997;315:629–34.
31.
CarrD.Raising the bar on the ethical standards of acupuncture research. Acupunct Med2015;33:178–9.
32.
MooreA, McQuayH.Bandolier's little book of making sense of the medical evidence Oxford. UK: Oxford University Press, 2006.
33.
TangJL, ZhanSY, ErnstE.Review of randomised controlled trials of traditional Chinese medicine. BMJ1999;319:160–1.
34.
LiJ, ShiHH. Acupuncture at DU 26 combined with breath-holding for treating the intractable hiccups. Chin Acupunct Moxibustion2002;3:193–4.
35.
LonghurstJ.Acupuncture's cardiovascular actions: a mechanistic perspective. Med Acupunct2013;25:101–13.
36.
ChangFY, LuCL. Hiccup: mystery, nature and treatment. J Neurogastroenterol Motil2012;18:123–30.
37.
KorpelainenJT, SotaniemiKA, MyllyläVV. Autonomic nervous system disorders in stroke. Clin Auton Res1999;9:325–33.
38.
VickersA, GoyalN, HarlandR, Do certain countries produce only positive results? A systematic review of controlled trials. Control Clin Trials1998;19:159–6.
39.
LuoJ, XuH, LiuBY. Real world research: a complementary method to establish the effectiveness of acupuncture. BMC Complement Altern Med2015;15:153.
40.
LangevinHM, WaynePM, MacphersonH, Paradoxes in acupuncture research: strategies for moving forward. Evid Based Complement Alternat Med2011;2011:180805.
41.
MacPhersonH, AltmanDG, HammerschlagR, , STRICTA Revision Group. Revised STandards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement. J Evid Based Med2010;3:140–55.
