The effect of daily self-measurement of Pressure Pain Sensitivity followed by acupressure on depression and Quality of Life (QOL), in Ischemic Heart Disease (IHD): a prospective RCT

Abstract

Background: Living with a chronic disease as IHD is associated with depression and reduced QOL, both elements of the chronic stress (CS) syndrome, and both predictive of adverse outcome. CS is associated with widespread increased pain sensation, which might be due to disruption of the afferent-efferent diffuse noxic inhibitory control system (DNIC). Acupressure on distinct points of the body seems to re-establish DNIC. The hyperalgesia can be measured by algometry as pressure pain sensitivity PPS) on sternum (IC5), on a scale from 30-100 (100 the most stressed). PPS can be measured at home with high precision by the patients themselves, which opens for frequent self- monitoring followed by action. Aim: To evaluate if focus of stress treatment by using twice daily PPS measurement followed by acupressure as mandatory treatment can reduce depression and increase QOL in people with stable IHD. Design: Prospective, single blind, RCT with 3 months intervention or control. Analysis: ITT Material: 361 ambulatory patients with stable IHD. Those with PPS ≥60 were randomized, 106 to active (A) treatment and 107 to control (C). Drop-out: 20 and 12, respectively. Methods: Questionnaires (Q) related to CS before/after 3 months intervention: Major depression inventory (MDI); WHO-5, SF-36, and a clinical stress score (CSS) measuring 56 global stress signs (only baseline estimates). PPS measurement and acupressure instruction were performed by professionals. The patients registered all Q's inclusive PPS results on a web-site with a personal log-on. Results: Groups A and C met criteria for randomization, all results being similar at baseline. Predefined primary end-point: MDI decreased in both groups, but at 3 months MDI had become lower in group A, mean MDI 6,4 vs. 8,3 points, p=0.040. Secondary end points: WHO-5 increased to 71,9 (Group A) and 65,3 (C), p=0.014, SF-36 mental sum increased to 55,5 (A) and 53,2 (C), p=0.061, and PPS decreased to 58 (A) and 72 (C), p<0.001. Conclusions: Self-measurement of PPS followed by acupressure reduces the burden of depression and increases QOL in stable IHD.