A randomized trial showed that two types of acupuncture significantly reduced chronic musculoskeletal pain in cancer survivors compared to usual care.
Electroacupuncture reduced patient reported pain by 1.9 points compared to usual care, and auricular acupuncture reduced patients’ mean pain score by 1.6 points compared to usual care, which consisted of pain relievers, physical therapy, and steroid injections.
Auricular acupuncture has failed to achieve non-inferiority over electroacupuncture and has been associated with more adverse events (AEs), reported Jun J. Mao, MD, of Memorial Sloan Kettering Cancer Center in New York, and co-authors of JAMA Oncology.
“The magnitude of the effect of electroacupuncture was clinically important and long-lasting,” the authors wrote. “This finding is consistent with evidence from other large acupuncture trials for chronic pain in the general population. Electroacupuncture has been shown to influence the release of endogenous opioids, which provides a mechanistic basis for the management of chronic pain. “
“This trial includes a large and diverse group of cancer survivors and provides evidence that electroacupuncture offers additional benefits beyond usual care, including not only reduction in pain severity, but improvements as well. physical function and quality of life and reductions in the use of analgesics. “
The United States has a growing population of cancer survivors, who have a greater pain burden than the general population. Almost half of cancer survivors receive inadequate pain relief, which negatively affects quality of life, physical function, and cancer outcomes.
A large body of evidence supports the superiority of acupuncture over usual care for the relief of chronic non-cancer pain, and last year CMS approved coverage of acupuncture for chronic lower back pain. . A recent meta-analysis showed that acupuncture reduced pain associated with cancer, but the strength of the evidence was considered moderate due to the small sample sizes of the trials and the heterogeneity of acupuncture techniques.
Mao and his colleagues reported the results of the largest randomized trial to date of acupuncture for cancer pain. The multi-center PEACE study recruited adults with a history of cancer but no current signs of disease. Eligible patients had musculoskeletal pain for at least 3 months and at least 15 of the previous 30 days and worse pain intensity in the last week of ≥4 (moderate or greater) on the 0-10 scale of the Brief Pain Inventory (BPI).
Patients were randomized 2: 2: 1 to receive electroacupuncture, auricular acupuncture, or usual care. Licensed and experienced acupuncturists provided both types of acupuncture. During electroacupuncture, needles were placed at four sites near the location of the pain and four additional sites elsewhere on the body to treat the comorbid symptoms. The angle and depth of insertion were individualized based on the body type and point location of each patient. The treatment consisted of 10 weekly sessions of 30 minutes.
Auricular acupuncture originated in China and European practitioners subsequently refined the technique. In 2016, the US military began developing a standardized protocol, often referred to as “battlefield acupuncture,” which Mao and his colleagues used in the study.
The protocol began with the insertion of a needle into the cingulate gyrus of one ear. The patient then walked for 1 minute. If the pain remained ≥1 on the BPI, another needle was inserted into the other ear. The process was repeated for the remaining ear points: thalamus, omega 2, zero point, and shen men.
The primary endpoint was the change in mean BPI score from baseline to week 12, and data analysis included 360 patients. Of 145 patients randomized to electroacupuncture, 136 (93.8%) completed at least eight sessions, as did 117 of 143 (81.8%) patients assigned to auricular acupuncture.
The mean baseline BPI scores ranged from 5.0 to 5.6. The most common pain sites in all three groups were lower back (27.8% to 36.6%), knee / leg (14.5% to 23.6%), and hip / thigh (11 , 0% to 12.5%). At week 12, the mean BPI score had decreased from 0.48 in the usual care group, from 2.39 in the electroacupuncture group (PP
Adverse effects in both acupuncture groups were mild or moderate. Bruising was the most common AE in the electroacupuncture group (10.3%), and ear pain was the most common with auricular acupuncture (18.9%). Only one patient (0.7%) stopped electroacupuncture due to an AE, compared to 15 (10.5%) in the auricular acupuncture group (P
Last updated on March 22, 2021
The study was supported by the Ministry of Defense and the National Cancer Institute.
Mao disclosed his dealings with the Tibet Cheezheng Tibetan Medicine Co. and Zhongke Health International.