A randomized controlled trial of acupressure for the treatment of Raynaud's phenomenon: the difficulty of conducting a trial in Raynaud's phenomenon

Abstract

Objective To examine the effect of acupressure on Raynaud's phenomenon (RP) in a randomized controlled clinical trial (RCT) and to evaluate the difficulties of conducting a RP RCT. Methods A pilot single center RCT of acupressure vs. targeted patient education was conducted for the treatment of RP. Patients with either primary (N = 15) or secondary (N = 8) RP were randomized in an 8-week study. The primary endpoints included a decrease in the frequency and duration of RP. Secondary endpoints included several serum biomarkers including endothelial dysfunction, Raynaud's attack symptoms, Raynaud's Condition Score, and patient and physician global assessments of RP. Primary data analysis was conducted using the last observation carried forward and t-tests or a Wilcoxon rank test was used to compare the two groups. Results 23 patients were randomized and 7 discontinued prematurely. 78% of patients were female, 96% were Caucasian, and the mean age was 49.8 (SD=16) years. No statistically significant differences were detected between the acupressure vs. education groups in primary and secondary outcomes (p> 0.05). Frequency of attacks decreased by 6.7 attacks (SD=8.8) in the acupressure group vs. 7.2 (SD=12.8) in the education group (p=0.96), and the duration of attacks decreased by 11.4 (SD=19.9) minutes in the acupressure group vs. an increase of 0.8 minutes (SD=11.2) in the education group (p=0.14). There were no adverse events noted in the RCT. Conclusion This pilot study does not support efficacy of acupressure for RP.

Advances in nailfold capillaroscopic analysis in systemic sclerosis

“…Although various treatment options are available for the management of RP, these approaches at most are able to reduce the severity of the symptoms but do not resolve the clinical situation. 71–74 Microangiopathy evaluated by NVC (alone or with functional techniques) has also been used to evaluate the response to specific therapies in SSc patients. 75–84 Interestingly, some studies used NVC to detect the microvascular changes in terms of likely response markers to immunosuppressive/anti-fibrosing treatment and most of these studies considered endotelin-1 receptor antagonists effective therapeutical agents.…”

Innovations in the Assessment of Primary and Secondary Raynaud’s Phenomenon

“…Non-invasive assessment of the morphological and functional peripheral circulation may supplement the physical examination and provide a quick, accurately diagnosis, ultimately guiding the correct treatment for both PRP and SRP (Filaci et al, 1999, 2001; Faggioli et al, 2006; Pyrpasopoulou and Aslanidis, 2007; Aschwanden et al, 2008; Caramaschi et al, 2009; Miniati et al, 2009; Shah et al, 2011; Guiducci et al, 2012; Roustit et al, 2012; Cutolo et al, 2013, 2017b; Herrick, 2013, 2017; Cutolo and Sulli, 2015; Gladue et al, 2016; Smith et al, 2016b; Trombetta et al, 2016; Burmester et al, 2017; Kowal-Bielecka et al, 2017; Ruaro et al, 2017a; Rotondo et al, 2018).…”

“…Whilst other cases require pharmacological treatment like calcium channel blockers as first-line therapy (Herrick, 2013). Although various treatment options are available for the management of SSc-related SRP, these approaches at most reduce the severity of the symptoms but do not resolve the clinical situation (Herrick, 2013; Cutolo and Sulli, 2015; Gladue et al, 2016; Herrick, 2017; Kowal-Bielecka et al, 2017).…”

The role of the dermatologist in Raynaud's phenomenon: a clinical challenge

“…Moreover, temperature biofeedback is reported to be less efficacious than nifedipine in treating RP . Recently, a pilot single‐centre, randomized controlled trial of acupressure versus targeted patient education in primary and secondary RP did not show any efficacy for this technique . Recently, the use of ischaemic preconditioning, which was thought to help potentially patients with RP, reducing the number of attacks, was found ineffective …”