Acupuncture Treatment for Persistent Hiccups in Patients with Cancer

This retrospective study evaluated the efficacy of acupuncture in the treatment of persistent hiccups in 16 male patients with cancer, aged between 27 and 71 years, treated at the Clinical Research Center of the National Institutes of Health between 2002 and 2008. Persistent hiccups are defined as lasting more than 48 hours and can have a significant impact on quality of life, interfering with sleep, eating, and speech, and causing pain, anxiety, and depression. In oncology patients, these symptoms can be related to chemotherapy, anesthetics, or other treatments. The acupuncture protocol was based on traditional Chinese medicine and used eight specific points: BL-17 (Geshu), GV-14 (Dazhui), CV-12 (Zhongwan), PC-6 (Neiguan), ST-36 (Zusanli), BL-20 (Pishu), BL-21 (Weishu), and LR-14 (Qimen).

Sessions lasted 30 minutes, using 32-gauge needles with moderate manual manipulation until de qi (needling sensation) was obtained. Patients received 1 to 3 treatments over a period of up to 7 days. For assessment, the Hiccup Assessment Instrument (HAI) was developed, a 0-10 scale where 0 means 'no hiccups' and 10 means 'worst possible hiccup'. Hiccups rated 1-3 were considered mild, 4-6 moderate, and 7-10 severe.

The HAI was administered before and after each treatment, with follow-up of 1-3 days. The results were notable: 13 of the 16 patients (81.3%) experienced complete remission of hiccups, with a statistically significant difference (p < 0.0001). Of the patients who experienced complete remission, 8 reached this outcome after just one session, 2 required two sessions, and 3 required three sessions. The remaining 3 patients had a reduction in severity but were not able to complete the study because of medical conditions.

In addition to hiccup resolution, significant improvement was observed in discomfort (62.8% reduction, p < 0.0001), distress (62.7% reduction, p < 0.0001), and fatigue (12.6% reduction, p = 0.0078). Hiccup-related symptoms such as difficulty swallowing, sleeping, breathing, and speaking also improved. It is interesting to note that 10 of the 16 patients did not know whether the treatment would be effective, but all agreed after treatment that acupuncture had been helpful and would recommend it to others. No adverse events were reported, confirming the safety of the treatment.

The mechanism of action of acupuncture for hiccups is not yet fully understood but may involve modulation of the hiccup reflex arc through changes in blood perfusion, activation of the autonomic nervous system, regulation of inflammatory mediators, or alteration of axonal excitability. Previous studies have suggested that points such as ST-36 and PC-6 may activate neurons in the nucleus of the solitary tract, an area important for autonomic control. Limitations of the study include the retrospective design, the absence of a control group, the small sample, and the predominance of male patients. Despite these limitations, this is the first study to use a standardized instrument to measure hiccups and to systematically demonstrate the efficacy of acupuncture in this condition in oncology patients.