Acupuncture reduces pain levels for cancer survivors. Memorial Sloan Kettering Cancer Center (New York), University of California (San Diego), and Veterans Administration Medical Center (Pennsylvania) researchers conclude that both electroacupuncture and auricular acupuncture produce superior patient outcomes compared with 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. Patients received either electroacupuncture or auricular acupuncture. Both acupuncture groups received 10 acupuncture sessions, administered weekly. For humanitarian purposes, the usual care group was offered acupuncture treatments after completion of the investigation 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 investigation. They note that the opioid crisis highlights the need for development of nonpharmacological interventions for pain management. They add that a meta-analysis of over 18,000 patients demonstrates that acupuncture is superior to both usual care and placebo controls for the management of non-cancer pain. [2, 3]
In another investigation, acupuncture was demonstrated as a successful medical intervention for the treatment of cancer related pain. [4] Taking these factors into consideration, the research team initiated this investigation. The researchers also note that the US Centers for Medicare & Medicaid Services added coverage of acupuncture for the treatment of back pain.
The team provided additional background information. They note that electroacupuncture enhances 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 by healthcare clinicians with significantly less training.
A simplified version of auricular acupuncture is used by the US Veterans Health Administration. The US military terms this approach battlefield acupuncture and employs this type of therapy in combat situations. The concept is that a paired down style of auricular acupuncture is more widely available because lesser trained medical staff can implement the procedure. The caveat, revealed in this investigation, is that simplified auricular acupuncture is not as effective as advanced electroacupuncture.
The investigation was a 3-arm, parallel, randomized clinical trial. The results of the investigation demonstrate 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 the following: four acupuncture points local to pain were selected plus four additional acupoints, allowing for treatment of comorbidities. Seirin brand acupuncture needles were used. Angles and depths were chosen based on acupuncture standards. The arrival of de qi was obtained at all acupuncture points and electroacupuncture was applied at 2 Hz. The investigators termed this approach to care as a “semifixed electroacupuncture protocol.” [5]
A total of 10 acupuncture treatments were administered over a period of 10 weeks for acupuncture patients in both groups. Auricular acupuncture was applied with ASP semi-permanent acupuncture needles. One acupoint in the cingulate gyrus was applied. Later, if pain levels persisted, a cingulate gyrus point was added on the opposite side. The same process was applied for all additional ear acupuncture points: shenmen, point zero, thalamus, omega two. Each auricular acupuncture session was 10–20 minutes and the ASP needles were retained for 3–4 days. Patients were instructed how to remove the needles.
Usual care was standard pain management prescribed by healthcare professionals. This included analgesic medications, glucocorticoid injection therapy, and physical therapy. Electroacupuncture and auricular acupuncture outperformed usual care. The researchers note that Medicare only covers acupuncture for lower back pain. They add that acupuncture insurance coverage for conditions beyond lower back pain is essential to allow for access to nonpharmacologic pain management interventions for cancer survivors.
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 Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among 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: update of an individual patient data meta-analysis. J Pain. 2018;19(5):455-474.
[4] He Y, Guo X, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved 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 Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial." JAMA oncology (2021).
