Acupuncture reduces pain for cancer survivors

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Acupuncture reduces pain levels for cancer survivors. Researchers at Memorial Sloan Kettering Cancer Center (New York), University of California (San Diego) and Veterans Administration Medical Center (Pennsylvania) conclude that electroacupuncture and auricular acupuncture produce superior results for patients by compared to usual care. [1] In a randomized clinical trial conducted in New York and New Jersey, acupuncture produced significant reductions in pain scores.

Pain severity levels were measured over a 12 week acupuncture treatment period. The patients received either electroacupuncture or auricular acupuncture. The two acupuncture groups received 10 acupuncture sessions, administered each week. For humanitarian purposes, the usual care group was offered acupuncture treatments after the end of the investigative intervention. Electroacupuncture and auricular acupuncture reduced the severity of musculoskeletal pain. Electroacupuncture produced greater reductions in pain levels than auricular acupuncture.

The researchers cited several reasons for implementing the survey. They note that the opioid crisis highlights the need to develop non-pharmacological interventions for pain management. They add that a meta-analysis of more than 18,000 patients shows that acupuncture is superior to both usual care and placebo controls for the management of non-cancer pain. [2, 3]

In another study, acupuncture was shown to be an effective medical intervention for the treatment of cancer pain. [4] Considering these factors, the research team launched this investigation. The researchers also note that the US Centers for Medicare & Medicaid Services have added acupuncture coverage for the treatment of back pain.

The team provided additional background information. They note that electroacupuncture improves endogenous opioid production, but that this technique is limited to licensed acupuncturists with formal training. In addition, some rudimentary forms of auricular acupuncture are widely available to healthcare clinicians with much less training.

A simplified version of auricular acupuncture is used by the US Veterans Health Administration. The US military calls this approach battlefield acupuncture and employs this type of therapy in combat situations. The concept is that a paired style of auricular acupuncture is more widely available because less trained medical personnel can perform the procedure. The caveat, revealed in this survey, is that simplified auricular acupuncture is not as effective as advanced electroacupuncture.

The survey was a 3-arm parallel randomized clinical trial. The results of the survey show that electroacupuncture and auricular acupuncture produce greater reductions in pain levels than usual care.

Electroacupuncture was provided by licensed acupuncturists with a minimum of five years of clinical experience in oncology. For electroacupuncture, the protocol was as follows: four local pain acupuncture points were selected plus four additional acupuncture points, allowing the treatment of comorbidities. Seirin brand acupuncture needles were used. The angles and depths were chosen based on acupuncture standards. The arrival of qi was obtained at all acupuncture points and electroacupuncture was applied at 2 Hz. Researchers called this approach to care a “semi-fixed electroacupuncture protocol”. [5]

A total of 10 acupuncture treatments were administered over a 10 week period for acupuncture patients in both groups. Auricular acupuncture was applied with semi-permanent ASP acupuncture needles. An acupuncture point in the cingulate gyrus was applied. Later, if the pain levels persisted, a cingulate gyrus point was added on the opposite side. The same process was applied for all additional auricular acupuncture points: shenmen, zero point, thalamus, omega two. Each auricular acupuncture session lasted 10 to 20 minutes and the ASP needles were kept for 3 to 4 days. The patients were instructed on how to remove the needles.

Usual care was the standard pain management prescribed by healthcare professionals. This included pain medication, glucocorticoid injection therapy, and physical therapy. Electroacupuncture and auricular acupuncture have surpassed usual care. The researchers note that Medicare only covers acupuncture for lower back pain. They add that acupuncture insurance coverage for conditions other than lower back pain is essential to enable access to non-pharmacologic pain management interventions for cancer survivors.

The references:
[1] Mao, Jun J., Kevin T. Liou, Raymond E. Baser, Ting Bao, Katherine S. Panageas, Sally AD Romero, Q. Susan Li, Rollin M. Gallagher and Philip W. Kantoff. “Effectiveness of electroacupuncture or atrial acupuncture versus usual care for chronic musculoskeletal pain in cancer survivors: the PEACE randomized clinical trial.” JAMA Oncology (2021).
[2] Vickers AJ, Cronin AM, Maschino AC, et al; Acupuncture Trialists’ Collaboration. Acupuncture for chronic pain: individual patient data
meta-analysis. Arch Intern Med. 2012; 172 (19): 1444-1453.
[3] Vickers AJ, Vertosick EA, Lewith G, et al; Acupuncture Trialists’ Collaboration. Acupuncture for chronic pain: an update of a meta-analysis of individual patient data. J Pain. 2018; 19 (5): 455-474.
[4] He Y, Guo X, May BH et al. Clinical evidence for the association of acupuncture and acupressure with improvement in cancer pain: a systematic review and meta-analysis. JAMA Oncol. 2020; 6 (2): 271-278.
[5] Mao, Jun J., Kevin T. Liou, Raymond E. Baser, Ting Bao, Katherine S. Panageas, Sally AD Romero, Q. Susan Li, Rollin M. Gallagher and Philip W. Kantoff. “Effectiveness of electroacupuncture or atrial acupuncture versus usual care for chronic musculoskeletal pain in cancer survivors: the PEACE randomized clinical trial.” JAMA Oncology (2021).

Continuing education credits in acupuncture

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