Acupuncture and acupressure for cancer pain are associated with decreased pain and reduced use of analgesics, according to a meta-analysis of randomized clinical trials now published in JAMA Oncology.
Over 70% of patients with cancer experience pain. For almost half of these patients, that pain is not sufficiently controlled. Pharmacologic interventions can provide effective pain relief, but they can have adverse effects, and the use of opioids poses a substantial risk of addiction. In light of the current opioid crisis, the American Society for Clinical Oncology and the National Comprehensive Cancer Network have recommended the use of nonpharmacological interventions such as acupuncture for cancer-related pain.
The meta-analysis included randomized clinical trials that compared acupuncture and acupressure with either a sham control, analgesic therapy, or standard care for the management of cancer pain. Seventeen randomized trials with a total of 1,111 patients were included in the systematic review; 7 of these studies were conducted in China, 6 in the United States, and 1 study each in Australia, Brazil, France, and Korea. The meta-analysis included data from 14 of the randomized trials, for a total of 920 patients. The investigation's primary end point was pain intensity as assessed using the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale.
An analysis of 7 sham-controlled trials that were of particularly high quality with a low risk of bias on all of their domains showed that real acupuncture was associated with reduced pain intensity in comparison with sham acupuncture, with a mean difference of 1.38 points on pain rating scales. In 6 randomized trials in which acupuncture and acupressure were combined with analgesic therapy, acupuncture reduced pain intensity, with a mean difference of 1.44 points. In 2 randomized trials, acupuncture was associated with a reduced opioid dose, with a mean difference of 30.00 mg morphine equivalent daily dose. Because of the significant heterogeneity among studies, the investigators determined that the strength of the evidence was moderate for these findings.
"Consistent with findings of past systematic reviews and meta-analyses, acupuncture was associated with significant reductions in cancer pain in open-label studies. However, the present meta-analysis found acupuncture to be associated with greater pain reduction compared with sham control, which differs from findings of the previous reviews," write the investigators, led by first author Yihan He, PhD, and by senior author Haibo Zhang, MD, both of the China-Australia International Research Centre for Chinese Medicine at the School of Health and Biomedical Sciences of RMIT University, Melbourne, Australia. "The positive results from sham-controlled randomized clinical trials suggest the potential efficacy of acupuncture in reducing cancer pain, as sham acupuncture helps prevent bias in evaluating the specific outcome of acupuncture needling."
The researchers remark that available evidence focuses on acupuncture as a component of cancer pain management rather than as a standalone therapy. How then should it be integrated into patients' pain management plans? Noting the challenge of this task, the investigators state, "Oncological practice and palliative care services need to provide information about treatment options and ways to access them, which can include evidence-based nonpharmacological approaches. Given that pain is a common reason that patients with cancer visit emergency departments, often followed by hospital admission, hospitals need to establish appropriate acupuncture services."
For More Information
He Y, Guo X, May BH, et al (2019). Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis. JAMA Oncol. [Epub ahead of print] DOI:10.1001/jamaoncol.2019.5233
Image credit: Kyle Hunter