Acupuncture not sham for cancer arthralgia

3 minute read

Acupuncture might offer pain relief for breast cancer aromatase inhibitor treatment.

Acupuncture may significantly reduce pain for cancer patients with arthralgia even a year after treatment, according to a study published in Jama Network Open.

Fewer than 50% of patients who received acupuncture required pain medication during the study period compared to around 70% of those who did not have the treatment, researchers found.

Pain and stiffness are the leading cause of patient nonadherence to aromatase inhibitors, a highly effective treatment for hormone-sensitive breast cancer, the authors said. More than 50% of patients discontinue or disrupt their treatment because of arthralgia and long-term pain solutions are needed, they said.

In a randomised trial of 205 post-menopausal participants with early stage breast cancer being treated with a third generation aromatase inhibitor, half were given true acupuncture, 25% were given sham acupuncture – shallow needle insertion at non-acupuncture sites – and 25% were a waiting list control group that received neither. Acupuncture, either sham or true, was administered twice a week over a six-week period in 30 to 45-minute sessions, followed by once a week for a further six weeks.

Participants self-reported on pain, pain interference, pain severity, and joint stiffness and were assessed for grip strength, speed,  balance and gait. These scores were evaluated at six, 12, 16, 20, 24 and 52 weeks.

Across all assessment times, those who received true acupuncture had an average pain score that was 1.17 points lower than the pain score for those in the control group, and 0.64 points lower than for those receiving sham acupuncture. A statistically significant difference in pain scores between the true acupuncture group and the other groups was noted at six weeks and continued consistently throughout follow up.

At 52 weeks, those who received true acupuncture noted a 2.72 point reduction in pain score from baseline. Control group saw a 1.55 point reduction, while the sham acupuncture patients reported a 1.46 point reduction in pain.

There was no difference found in functional measures results.

The difference in pain scores between the control group and the true acupuncture group at 52 weeks was half what was seen at 12 weeks. However, a statistically significant difference in pain scores between treatment and sham/control groups was maintained throughout the duration, suggesting that long-term pain reduction is possible using acupuncture, the authors said.

Importantly, the aromatase inhibitor discontinuation rate of 12% at 52 weeks was not different between groups and there was no indication that the pain reduction minimised treatment nonadherence.

However, for patients who were not using pain medications at the start of the study, only 46% of those in the true acupuncture group began doing so during the study compared with 70% in the sham group and 67% in the control group.

“Taken together, pain medication use was less likely for patients in the [true acupuncture group] compared with the [sham acupuncture] or [waiting list control] groups combined,” the authors said.

Acupuncture has minimal side effects and risks compared with pain medication intervention, but it is generally not covered by Medicare or many insurance plans and only 10% of participants reported choosing to continue acupuncture after the 12 week treatment period for the study ended, the authors noted.

“Our results are consistent with a recently reported meta-analysis of 20,827 patients from 39 trials, in which acupuncture was superior to sham as well as no acupuncture control for each pain condition,” the authors concluded.

JAMA 2022, online 11 November

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