acupressure methods for dyspnoea reduction. Communicating Nursing Research (COMMUN NURS RES). 40:576. Abstract not available 3. Ventegodt,S. and J.Merrick. (2009) A review of side effects and adverse events of non-drug medicine (Nonpharmaceutical complementary and alternative medicine): Psychotherapy, mindbody medicine and clinical holistic medicine. Journal of Complementary and Integrative Medicine. 6:(1). Reason for exclusion: This is a non systematic review and considers only safety, not effectiveness 4. Zhou,X.B. (2006) Combined therapy of traditional Chinese medicine and western medicine for low back pain. Chinese Journal of Clinical Rehabilitation. 10:(47): Dec. Abstract not available 203 Appendix 10 - Background review Background information on Shiatsu and acupressure Of the 146 publications that remained for screening and review, 56 publications were considered useful as background information but did not provide specific evidence on effectiveness of either Shiatsu or acupressure. 27 of these publications referred to Shiatsu (3 Watsu) and 30 to acupressure. Abstracts, where available are shown below, together with any applicable comments on the publications. 10.1 Shiatsu Four papers were single case reports of adverse events that occurred following Shiatsu massage. 1. Herskovitz,S., Strauch,B., and Gordon,M.J. (1992). Shiatsu massage-induced injury of the median recurrent motor branch. Muscle Nerve 15:1215. Comment: This letter expressed the concern that the popularity of massage techniques, particularly vigourous ones, may result in this type of injury. The case for concern was that of a 61 year old physician who underwent a professional Shiatsu massage which included ‘ the application of strong digital pressure in the region of the base of the palm and thenar muscles.’ The day after Shiatsu, the recipient noticed 'painless weakness of the left thumb, without sensory symptoms'. Medical examination suggested 'isolated dysfunction of the recurrent thenar motor branch of the median nerve, apparently the result of focal trauma from the massage.' The symptoms improved after three weeks and normalised over the next few months. While it could be considered that that there is no direct evidence that the massage caused the injury, practitioners should be aware of this possible adverse event occurring. 2. Mumm,A.H., Morens,D.M., Elm,J.L., and Diwan,A.R. (1993). Zoster after Shiatsu massage. Lancet 341:447. Comment: This letter referred to a case of varicella zoster virus diagnosed in a 64-year old woman seven days after receiving an ‘overly vigorous Shiatsu massage’. The authors speculate that in this case ‘zoster resulted from either direct trauma to the nerve or nerve root during the massage, or to subsequent inflammation causing swelling or immunological injury to the nerve’. They also state that varicella zoster virus is rarely diagnosed today, this patient having suffered a previous episode at the age of 11, and that much of the evidence for the existence of this condition is anecdotal. Although a causal link cannot be scientifically proven, this case raises awareness of possible adverse events. 3. Tsuboi,K. (2001). Retinal and cerebral artery embolism after "Shiatsu" on the neck. Stroke 32:2441. Comment: This letter referred to the case of an 80-year old man who had been hospitalised for seven days following a transient ischemic attack. On the evening he was discharged, he received a Shiatsu massage on his neck for 10 minutes and ‘immediately after rising, he was aware that the nasal half of his right visual field was impaired.’ He was hospitalised for a further seven days and examinations revealed ‘diffuse retinal edema with multiple emboli in many branches of the central retinal artery’. Although the author could not find ‘any medical reports of cerebral or retinal artery embolisms directly caused by Shiatsu’, he stressed that ‘complications can be avoided if patients at high risk are properly informed beforehand of the potential association between embolic stroke and manipulation on the neck. ‘ This letter highlights a potential risk of ‘embolic accidents’ and ‘serious neurological symptoms in patients with atherosclerotic extracranial carotid artery disorders’. 4. Wada,Y., Yanagihara,C., and Nishimura,Y. (2005). Internal jugular vein thrombosis associated with Shiatsu massage of the neck. J Neurol Neurosurg Psychiatry 76:142-143. Comment: This letter suggested, that although possibly coincidental, a causal link between Shiatsu massage and IJV thrombosis ‘supported by patient’s claim of a massage induced swelling and pain in his neck, and by the temporal relation between the massage and the onset of symptoms that progressed to IJV and cerebral venous sinus thrombosis’. Although the exact mechanism of the thrombosis in this case could 204 not be determined, the authors state two possibilities. ‘One possibility is that direct trauma or pressure may have induced both venous stasis and vascular injury during the Shiatsu massage. The other possibility is that extrinsic compression of the IJV by tissue swelling subsequent to trauma during the Shiatsu massage may have induced venous stasis, resulting in thrombosis at this unusual site’. The authors refer to the previous case (Tsuboi,K. 2001) as a further incidence of ‘vascular complications following Shiatsu massage’ and ‘would