Kristen Sparrow • May 21, 2016
Green Valley Ranch Resort, Las Vegas, Nevada, USA
Purpose: Persistent fatigue in cancer survivors is one of the most troubling symptoms with few treatment options. Self-administered acupressure is a potential therapy; however, its acceptance by the mainstream medical community has been slow. This may be in part due to a lack of understanding of the pathophysiological factors underlying this condition as well as a clear rationale behind how acupressure could ameliorate fatigue. Recently our group demonstrated that breast cancer survivors (BCS) with persistent fatigue display increased levels of glutamate + glutamine (Glx) and creatine/total creatine (Cr/tCr) within the posterior insula, a region of the brain involved in sensory processing. Moreover fatigued BCS also displayed altered brain connectivity.
Methods: We randomized 19 fatigued BCS to two different acupressure formulas both designed to improve fatigue: relaxation (RA; n = 9) and stimulation (SA; n = 10) acupressure. Participants performed self-acupressure for 6 weeks and underwent brain neuroimaging (insular proton magnetic resonance spectroscopy and functional connectivity magnetic resonance imaging with an insula seed) at baseline and post treatment. Neuroimaging analyses were done in SPM and correlations were performed in SPSS. Fatigue symptoms were assessed via the Brief Fatigue Inventory. Significance was set at p < 0.05.
Results: Fatigue was significantly reduced following both RA and SA (both p < 0.05) with no difference between groups (p > 0.2). RA was associated with decreased connectivity between the posterior insula (seed) and dorsolateral prefrontal cortex while SA caused an increase in connectivity between the same structures (p = 0.002 FDR; 434 voxels). For RA, decreases in connectivity were associated to decreased Cr/tCr levels within the posterior insula (rho = 76; p = 0.011) whereas for SA, increases in connectivity were associated with reduced Glx in the posterior insula (rho = −0.80; p = 0.01).
Conclusion: These findings suggest differential mechanistic action of acupressure formulas on fatigued BCS displaying different brain pathophysiology. It is unknown if these effects hold in other cancers.
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