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Does acupuncture relieve pain in cancer patients?

Group 12: Casey Hughes, Rebecca Sopelak, Carly Paquin, Emily Granitzski, Alyssa Trainum,
and Amanda Gartrell
Introduction
Pain is a symptom that almost all cancer patients experience. Often,
the pain a cancer patient experiences is caused more by their treatments
than the actual cancer. The common response of health care professionals to
pain is to treat it pharmacologically. Sometimes this helps, but often it is still
not enough to improve the quality of life of the patients, and sometimes the
adverse effects of the drugs outweigh the positive effects. As patient
advocates, nurses do everything they can to relieve the pain of their
patients, but when they cannot relieve pain using the tools given to them, or
they have to help patients suffer through the adverse effects of
polypharmacy, excess emotional distress and dilemmas can be caused for
both nurse and patient. It is important to study alternative methods for pain
relief for reasons like this one. The question presented in this study was,
Does acupuncture relieve pain in patients with cancer? The population
studied was adults aged 18-60. The intervention that was studied was the
use of acupuncture for pain relief. These results were compared to the
outcomes of the use of medications for pain relief. Through review of the
research, the outcome determined was that acupuncture does indeed relieve
pain in patients with cancer, and it is an evidence-based alternative that
nurses can recommend to patients.

Comparison of Articles
Among the 12 articles that we studied, there were only a few
similarities between them compared to their differences. We made sure that
all of our articles were similar in the fact that they had been created in the
past five years in order to get the most up-to-date information regarding our
topic. All of the experiments study purposes were looking at the changes in
symptoms after providing the patient with acupuncture as part of symptom
management. In order to keep the experiments results similar enough to
compare them, the population being studied in each experiment was one of
cancer patients. Most of the experiments focused merely on pain
management with acupuncture, and all found the same results; that
acupuncture does in fact affect pain. The other two articles were similar to
each other in that they studied the effectiveness of acupuncture in symptom
management in general, including fatigue and quality of life. Even though
not all of the articles focused on the same specific symptom, all of the results
found that acupuncture helps cancer patients in relieving that symptom,
whether it be pain, fatigue or quality of life.
Contrasting Articles
There were several differing variables observed when contrasting the
twelve articles studied. Although all of the articles focused on determining
the effects of acupuncture treatment and pain management, they were not
all consistent in their sample group. Some articles looked at cancer patients
with lymphedema whereas others looked at patients with breast and neck

cancer. There was also contrast observed in the purpose of each study. One
study evaluates acupuncture in relation to pain and the patients overall wellbeing. Another study places a greater focus on the ability of acupuncture in
managing specific symptoms such as nausea, fatigue, anxiety, physical, and
emotional stress. Distinction was also seen when reviewing the instruments
that each study used. Instruments were geared towards what each individual
study had initially set out to examine. For example, a visual analogue to
assess and determine patient pain status in one, a multidimensional fatigue
inventory to assess level of fatigue in cancer patients before and after
acupuncture therapy in a second, and Research and Treatment of Cancer
Quality of Life Questionnaire (EORTC QLQ-C3) that functioned as a tool to
determine the impact of traditional acupuncture on quality of life in these
patients.
Limitations
One limitation of this study was that pain is subjective. It was hard for
many of the studies to find a consistent way to measure the patients pain.
Many of the studies created their own systems to measure a patients pain
so this created inconsistencies between the studies. Another limitation was
the large range of demographics in the studies. The ages ranged anywhere
from the age of 18 to 60. Different ages experience pain differently. There
was also a lack of research in the study of acupuncture and cancer patients
specifically. This made it difficult to find articles that demonstrated the
effectiveness of acupuncture for pain. Many of our studies were different

sizes. Some had fewer than 20 patients and others over 300. This made it
difficult to compare the results of the studies.
Implications for Nursing
The use of alternative therapies in treating pain in cancer patients has
important implications for nursing practice. With the use of acupuncture and
alternative therapies to offer patients instead of traditional medications, a
new door is open for communication between nurses and their patients. One
of the number one roles of a nurse is to educate. Nurses talk with patients to
make them feel more comfortable and help them to understand their
situation and the options that exist for treatment. Alternative therapies are
usually not the norm and many patients may not know or understand what
they mean. This allows nurses the opportunity to provide an environment
where patients can ask questions and get referrals for places that offer
acupuncture. Nurses can feel confident in referring their patients to these
services because there is evidence based research that has shown that pain
can be well controlled with the use of acupuncture. With the support of
research, patients can also feel comfortable knowing that it has been tested
and proven to relieve pain. Patients also have the ability to do their own
research if they are interested in learning more. The use of alternative
therapies can reduce the number of medications a cancer patient is on. This
is important in nursing because pain medications, like morphine, can have
severe side effects like decreased respirations, which can lead to death.
Nurses need to be aware of all the medications their patient is on and be

able to know what the side effects are. If more cancer patients use
acupuncture instead of pain medications there can be a decreased chance of
deadly side effects affecting the patient. There is also a decreased risk of any
medications interacting with each other and causing the patient harm.
Although nurses cannot perform acupuncture they can feel confident
knowing that it is an option for their patient and can provide further
information.
Conclusion
Overall, the 12 research articles that we found had some differences,
but they all came to the same conclusion. All of our articles supported that
acupuncture is an effective way to relieve pain in cancer patients. This
treatment was found to be just as effective in reducing pain as a pain
medication regimen. Through this research, we have the evidence to
support acupuncture as an alternative to a pain medication regime in helping
with cancer pain. This allows us as nurses to be able to have an open
conversation with our patients about the possibility of using acupuncture as
an alternative or an adjunct treatment for pain management. If our patients
do decide they would like to pursue this treatment, the evidence found in our
research enables us to feel confident in referring them to an acupuncture
specialist for pain relief treatments.
References

Choi, T., Lee, M., Kim, T., Zaslawski, C., Ernst, E. (2012). Acupuncture for the treatment of
cancer pain: A systematic review of randomized clinical trials. Supportive Care in
Cancer, 20(6), 114. doi: 10.1007/s00520-012-1432-9
DAlessandro, E., et al. (2013). Evaluation of acupuncture for cancer symptoms in a cancer
institute in Brazil. (2013). Acupuncture in Medicine, 31(1), 23-26 4p.
doi:10.1136/acupmed-2012-010206
De Valois, B., Young, T., & Melsome, E. (2011). Acupuncture in lymphedema management: A
feasibility study. Journal Of Lymphoedema, 6(2), 20-31 12p.
Donald, G. K., Tobin, I., & Stringer, J. (2011). Evaluation of acupuncture in the management of
chemotherapy-induced peripheral neuropathy. Acupuncture In Medicine, 29(3), 230-233
4p. doi:10.1136/acupmed.2011.010025
Lim, J. W., Wong, E. T., & Aung, S. H. (2011). Is there a role for acupuncture in the symptom
management of patients receiving palliative care for cancer? A pilot study of 20 patients
comparing acupuncture with nurse-led supportive care. Acupuncture in Medicine, 29(3),
173-179 7p. doi:10.1136/aim.2011.004044
Lin, J., & Chen, Y. (2012). The role of acupuncture in cancer supportive care. American Journal
Of Chinese Medicine, 40(2), 219-229.
Molassiotis, A., Bardy, J., Finnegan-John, J., & Mackereth, P. (2012). Acupuncture for cancerrelated fatigue in patients with breast cancer: A pragmatic randomized controlled trial.
Journal of Clinical Oncology, 30(36), 4470-4476. doi:10.1200/JCO.2012.41.6222
Pfister, D., Cassileth, B., Deng, G., & Yeung, K. (2010). Acupuncture for pain and dysfunction
after neck dissection: Results of a randomized controlled trial. Journal of Clinical
Oncology, 28(15), 2565-2570. doi:10.1200/JCO.2009.26.9860

Smith, C., Carmady, B., Thornton, C., Perz, J., & Ussher, J. M. (2013). The effect of acupuncture
on post-cancer fatigue and well-being for women recovering from breast cancer: A pilot
randomised controlled trial. Acupuncture In Medicine, 31(1), 9-15.
Thompson, L. M., Osian, S. R., Jacobsen, P. B., & Johnstone, P. A. (2015). Research article:
Patient-reported Outcomes of Acupuncture for Symptom Control in Cancer. Journal Of
Acupuncture And Meridian Studies, 8127-133. doi:10.1016/j.jams.2015.04.002
Vinjamury, S. P., Ju-Tzu, L., Hsiao, E., Huang, C., Hawk, C., Miller, J., & Yuhong, H. (2013).
Effects of acupuncture for cancer pain and quality of life: A case series. Chinese
Medicine, 8(1), 15-20. doi:10.1186/1749-8546-8-15
Zeng, K., Dong, H., Chen, H., Chen, Z., Li, B., & Zhou, Q. (2014). Wrist-ankle acupuncture for
pain after transcatheter arterial chemoembolization in patients with liver cancer: A
randomized controlled trial. American Journal Of Chinese Medicine, 42(2), 289-302.

Summary of Studies Evidence Table


PICO: Does Acupuncture Relieve Pain in Patients with Cancer?
Group #12
Group Names: Casey Hughes, Emily Granitzski, Rebecca Sopelak, Carly Paquin,
Alyssa Trainum, Amanda Gartrell

Author/Year
LOE
Lim et al.,
(2011)

Sample

Variables

Look at changes
in symptoms after
acupuncture
treatment for
cancer

Acupuncture
and pain

N=200 cancer
patients

How acupuncture
affects symptoms
in cancer patients

Acupuncture
and pain

Pain assessed by
visual analogue scale
demonstrates
reliability/validity

N= 30
chemotherapy
patients

Evaluate
acupuncture in
relation to pain
and well being

Acupuncture,
pain and well
being

N= 60 cancer
patients

Evaluate analgesic
effect of wrist
ankle acupuncture
with cancer pain

Acupuncture
and pain

BFI (Brief Fatigue


Inventory), W-BQ12
(Wellbeing
questionnaire),
MYCaW (Measure
Yourself Concerns
and Wellbeing
questionnaire)reliable/valid
VAS (Visual Analog
Score/ PID (Pain
intensity difference)reliable/valid

N=140 cancer
patients

Assess the
effectiveness of
acupuncture in
treating cancer
pain

Acupuncture
and pain

Cochranes
Collaboration
software program and
Review Manager
(RevMan) for
Windows

N= 90 cancer
patients

Evaluate the
benefits of
acupuncture on
cancer patients

Acupuncture
and pain

Visual Analog score


(VAS) to measure
pain intensityreliable/valid

N=58 patients

Evaluating pain in
cancer patients
with a neck
dissection

Acupuncture
and pain

Medication
Quantification Scale;
Constant-Murley
Score; modified

LOE 2

Smith et al.,
(2013)
LOE 2

Zeng et al.,
(2014)
LOE 2
Choi et al.,
(2011)
LOE 5

Lin et al.
(2012)
LOE 2

Pfister et al.,
(2010)
LOE 2

Instruments with
Validity and
Reliability
Edmonton Symptom
Assessment System
shows
reliability/validity

N=20 cancer
patients

LOE 2

Alessandro et
al., (2013)

Study Purpose

Results/Statistical
Evidence
Total symptom scores
were
reduced by an average
of 22% after each
acupuncture visit and
by 14% after each
supportive care visit.
The mean (SD) initial
symptom score was
7.04, which was
reduced to 2.56 (2.75)
after treatment, an
improvement of
63.6%in control of the
symptoms.
The mean difference
(MD) for the
experimental group
was 5.3, as compared
to the control group
who experienced a 3.2
MD in pain relief

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Experimental group
experienced pain relief
at 53% in one hour, in
2 hours 63%, at 4
hours 73% and 6 hours
at 100%.
Meta-analysis
suggested that
acupuncture did not
generate a better effect
than drug therapy (n=
886; risk ratio (RR),
1.12; 95% CI 0.98 to
1.28; P=0.09)
Meta-analysis
suggested that
acupuncture did not
generate a better effect
than drug therapy (n=
886; risk ratio (RR),
1.12; 95% CI 0.98 to
1.28; P=0.09)
Constant-Murley
scores improved more
in the acupuncture
group. Adjusted

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pa

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ef
ca

A
re
im

A
th
ca
no
m

Th
ac
co
pa

A
in

Molassioti et al.,
(2012)

N=302 patients

Evaluating fatigue
in breast cancer
patients

Acupuncture
and fatigue

N= 7 cancer
patients

Determine effects
of acupuncture in
managing
symptoms and
improving quality
of life in patients
with cancer

Acupuncture
and pain

N= 90 cancer
patients

Examined patientreported outcomes


for symptom
control in cancer
patients receiving
acupuncture at an
integrative
oncology clinic

Acupuncture
and pain

N=18 Cancer
patients

Evaluate
effectiveness of
acupuncture when
used in the
management of
chemotherapyinduced peripheral
neuropathy

Acupuncture
and pain

Constant-Murley
Score; Numerical
Rating Scale of Pain;
Xerostomia
Inventoryreliable/valid
The multidimensional
fatigue inventoryreliable/valid

LOE 2
Vinjamury et al.,
(2013)
LOE 2

Thompson et al.,
(2015)
LOE 2

Donald et al.,
(2011)
LOE: 2

The European
Organization
Research and
Treatment of Cancer
Quality of Life
Questionnaire
(EORTC QLQ-C3)
and visual analogue
scale (VAS) for pain
rating reveals
reliability/validity
A clinical symptom
10-point numerical
rating scale that
assessed individual
cancer symptoms;
post treatment rating
scale that included
three satisfaction
items rated on a 5point numerical scalereveals
reliability/validity

An evaluation formreliability/validity not


addressed

difference between
groups = 11.2; 95% CI,
3.0 to 19.3; P = .008

Fatigue score, between


those who received the
intervention and those
who did not, was 3.11
(95% CI, 3.97 to
2.25; P < .001).
The percentage of
improvement for the
VAS was between 18%
and 95% and for
quality of life (QoL)
improvement fell
between 20% and
100%

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> 62% indicated the


prevalence of fatigue,
pain, anxiety, physical
and emotional distress,
and poor quality of life
before acupuncture;
21% of patients
reported nausea before
acupuncture;
reductions represented
clinically meaningful
differences in 3341%
of patients after the
first session and in 41
53% of patients after
the last session for all
symptoms, except
nausea
82% of patients
reported that
acupuncture had
improved their
neuropathy symptoms,
18% reported no
change and there were
no reports of
deterioration in PN.
35% reported one
additional benefit from
the acupuncture while
41% of patients
documented more than
one additional benefit.

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tre
m
pa
fin
lo

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be
an
pa

Th
ac
ne
as
ch

De Valois et al.,
(2011)
LOE: 3

N=39 cancer
patients with
lymphedema

Assess
acceptability,
impact on quality
of life, and
adverse events of
traditional
acupuncture as an
adjunct to
maintenance care
for people with
lymphedema

Acupuncture,
quality of life

-Physical Component
Score (PCS)
-36-Item Short Form
Health Survey (SF36)
-Measure Yourself
Medical Outcome
Profile (MYMOP)
-Positive and
Negative Affect
Schedule (PANAS)reliability/validity
addressed

24% of patients had no


additional benefits to
report
MYMOP change
scores were clinically
and statistically
significant at all
measurement points.
SF-36 scores remained
significant for bodily
pain and vitality four
weeks after the end of
treatment.

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