Acupuncture shows promise for cancer pain management
medwireNews: Electroacupuncture and auricular acupuncture lead to greater pain reduction than usual care in cancer survivors with chronic musculoskeletal pain, shows the randomized PEACE trial.
“While both acupuncture techniques were effective, auricular acupuncture had higher treatment discontinuation rates than electroacupuncture and did not meet criteria for noninferiority to electroacupuncture,” say the investigators.
They explain that “[a]cupuncture confers clinical benefits for chronic nonmalignant pain,” adding that electroacupuncture involves the electrical stimulation of inserted needles “to enhance endogenous opioid release,” whereas in the auricular technique, needles are applied just to the ears.
The study included 360 individuals with a history of cancer – most commonly breast cancer, in approximately 45% – and musculoskeletal pain for at least 3 months, including for at least 15 of the preceding 30 days. Participants were randomly assigned to receive 10 treatments over 10 weeks of electroacupuncture (n=145) or auricular acupuncture (n=143) or usual care (n=72), which involved standard pain management, including analgesics and physical therapy. The usual care group was given the option of receiving ten acupuncture sessions between weeks 12 and 24.
The primary endpoint of reduction in average pain severity at 12 weeks on the Brief Pain Inventory (BPI) questionnaire from baseline was a significant 1.9 points greater with electroacupuncture and 1.6 points greater with auricular acupuncture than usual care. And “the reduction in average pain severity persisted until week 24” in both acupuncture groups, says the team.
Electroacupuncture achieved just a 0.36-point greater reduction in the mean BPI pain score than auricular acupuncture at 12 weeks, but as the one-sided 95% confidence interval included the noninferiority margin, the study was unable to demonstrate the noninferiority of the auricular technique.
Both techniques were also associated with improvements in secondary endpoints, including BPI pain-related functional interference, and physical and mental quality of life, relative to usual care, and also led to reductions in analgesic use.
The most frequently reported adverse event (AE) in the electroacupuncture group was bruising, experienced by 10.3% of participants, while ear pain was most common in the auricular acupuncture group, at 18.9%.
Just one (0.7%) patient in the electroacupuncture study arm discontinued due to an AE, compared with 15 (10.5%) patients in the auricular acupuncture group, a significant difference.
“[T]hus, future research is needed to predict who may not tolerate [auricular acupuncture] and understand how to administer this technique safely to mitigate adverse effects,” write Jun Mao (Memorial Sloan Kettering Cancer Center, New York, USA) and co-researchers in JAMA Oncology.
“The medical workforce could potentially be equipped with this technique to expand nonpharmacological treatment options in settings where electroacupuncture is not widely available,” they conclude.
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