A new study observed benefits for cancer patients treated with acupuncture or acupressure in terms of disease-related pain.
Despite that fact that more than one in seven cancer patients suffer from pain, it remains inadequately controlled in close to half of them. Pain varies from patient to patient, calling for a multi-dimensional approach, according to the researchers—keeping in mind the current opioid epidemic facing the United States. While data are growing on the effect of acupuncture on cancer, “findings have been inconsistent,” the study authors noted.
“Although more than 20 systematic reviews were conducted to establish the association of acupuncture with cancer pain, none arrived at a definitive conclusion. In addition, more rigorous randomized clinical trials (RCTs) of acupuncture and related therapies published in recent years were not included in previous systematic reviews. For example, a multicenter RCT of acupuncture published in 2018 found that patients with early-stage breast cancer who received aromatase inhibitor therapy experienced significant pain relief,” they wrote. “The reduction in pain reported in this 2018 study was clinically relevant.”
The present study was a systematic review and meta-analysis of randomized clinical trials (RCTs) located through a search of seven databases, of which three were English-language databases (PubMed, Embase, and CINAHL) and four were Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang). Eligible RCTs were published from inception through March 31, 2019, and compared acupuncture and acupressure versus a sham control, analgesic therapy, or usual cancer pain management. The main outcome was pain intensity per the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.
The study was published in JAMA Oncology.
The systematic review included 17 RCTs encompassing 1,111 total patients, and the meta-analysis included 14 RCTs encompassing 920 total patients. There were seven RCTs considered to be of high-quality with a low bias risk in all domains, which showed that real acupuncture was associated with reduced pain intensity compared to sham (mean difference [MD]=–1.38 points; 95% confidence interval [CO], –2.13 to –0.64 points; I2=81%). In six RCTs, combination acupuncture and acupressure plus analgesic therapy was correlated with reduced pain intensity (MD=–1.44 points; 95% CI, –1.98 to –0.89; I2=82%), and in two RCTs, was correlated with reduced opioid dose (MD=–30.00 mg morphine equivalent daily dose; 95% CI, –37.5 mg to –22.5 mg). Due to the substantial heterogeneity among the studies, the researchers considered the evidence moderate grade.
The researchers summarized: “The findings of this systematic review and meta-analysis suggest that, based on moderate-level evidence, acupuncture and/or acupressure may be associated with significant reductions in pain intensity and opioid use.”