Use of acupuncture and acupressure led to significant improvement in cancer-associated pain and a reduction in analgesic medication, a meta-analysis showed.
Seven randomized trials comparing real versus sham-controlled acupuncture collectively showed a 1.38-point difference in pain intensity favoring real procedures, as assessed on a scale of 0-10 (0=none, 10=most severe). However, the overall quality of the evidence was considered moderate given that the randomized trials exhibited substantial heterogeneity.
"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," Haibo Zhang, MD, of the Guangdong Provincial Academy of Chinese Medical Sciences in China, and coauthors concluded in JAMA Oncology.
"This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use," they added.
The analysis adds to an existing evidence base marked by inconsistent results for acupuncture and acupressure for cancer-related pain relief. Zhang and coauthors noted that more than 20 published systematic reviews failed to show conclusively that the techniques have a significant association with cancer pain.
However, previous reviews did not include newer, more rigorously conducted randomized trials.
As an example, one recent randomized, sham-controlled trial showed that acupuncture was associated with significantly less pain in patients with early-stage breast cancer treated with aromatase inhibitors. Additionally, a recent retrospective chart review suggested that acupuncture not only reduced pain intensity but improved a variety of other symptoms (anxiety, depression, drowsiness, dyspnea, nausea) among patients with advanced cancer treated at a palliative medicine clinic.
Beyond the need for better evidence, the ongoing opioid epidemic has focused greater attention on strategies that may reduce or eliminate the need and unnecessary use of opioids.
The authors performed an updated systemic review and meta-analysis that incorporated newer evidence regarding the effect of acupuncture/acupressure on cancer-related pain. They had two primary objectives: determine whether acupuncture/acupressure reduces cancer pain compared with sham control or usual care and whether use of either intervention reduces the need for analgesic medication among patients with cancer pain.
The primary outcome was change in pain intensity as measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale. Differences among the scales were reconciled by individualized conversion to a single pain-intensity scale of 0-10.
The literature review identified 17 randomized controlled trials, 14 of which were included in the meta-analysis (n=920). Seven trials had a sham-control design and a low risk of bias for all domains evaluated. Those seven selected studies showed a combined difference of -1.38 in pain intensity favoring real versus sham intervention (95% CI -2.13 to -0.64; I2=81%).
Six trials evaluated the impact of combining acupuncture/acupressure with analgesia compared to analgesia only. Meta-analysis yielded a mean difference of -1.44 (95% CI -1.98 to -0.89; I2=91%). Two trials showed a reduction in daily mean morphine equivalent opioid dose among patients who received acupuncture/acupressure (-30.00 mg, 95% CI -37.5 to -22.5 mg).
The findings are consistent with those of a recent National Cancer Institute conference on use of acupuncture for symptom management in oncology. Participants found considerable evidence supporting a therapeutic effect of acupuncture on cancer-related pain and other symptoms. However, they produced an extensive list of research needs to improve understanding about the relationships between the intervention and symptom relief and to improve the overall evidence base on the issue.
The conference participants noted that the National Comprehensive Cancer Network published 11 recommendations for supportive care, and five of 11 include use of acupuncture for relief of cancer pain in adults as well as other cancer-associated symptoms. Authors of the conference report also cited a need for educational programs to train community acupuncturists for services in the oncology setting and to provide more education for primary care providers and oncologists about evidence supporting acupuncture for symptom management in patients with cancer.
The authors reported no relevant relationships with industry.