Chloe SanClemente Thompson

The Use of Acupuncture to Relieve Cancer-Related Pain

Introduction: Pain related to cancer is a challenge to manage partially because it is particularly

“dynamic”. Not only does it change with access to and effectiveness of pain management

tactics, it changes during different stages of the disease1 and can be caused by the very

pharmaceuticals that help combat cancer cells2. Additionally, cancer-related pain is not always

treatable with pharmaceutical drugs, even opioids3. Because of this, there is particular need for

research studying the efficacy of alternative pain management methods (such as acupuncture)

for cancer and how they may be applied.

Methods: I conducted a search of articles on the PubMed database and with the University of

Washington Library search bar on October 3rd and 4th of 2018 to find my literature. I used all

fields to search the following terms: acupuncture and cancer pain, cancer-related pain, and

acupuncture and cancer-related pain management. Each of these terms yielded many results

(from 72-11,000, depending on the search term) which I narrowed down by selecting only

articles that were peer reviewed and available online.

Results: There is no current research consensus on the efficacy of acupuncture treatment for

cancer-related pains. Authors reviewed here and mentioned in other systematic reviews argue

more often than not that their findings support the efficacy of acupuncture2,3,4,5,6, however,

Randomized Control Trials (RCTs) have had mixed results on the significance of their findings.

RCTs have found no significant difference at all4, a significant difference that was not clinically

meaningful2, and a highly significant difference between the impacts of sham and true

acupuncture3. This lack of consensus is reflected in the conclusions of systematic reviews,

which have found that there is no significant evidence and that additional research is

necessary5,6.

The research gap described above is characterized not only by a small number of

available studies but also by a lack of studies similar enough to be comparative. RCTs have
widely varying study designs and oncological populations2,3,4. The placebo “sham” acupuncture

and the real acupuncture methods are different in each RCT. The particular pain indicator being

studied is different as well2,3,4. It is due to this vast dissimilarity that systematic reviewers have

been unable to conduct meta-analyses6. This evidence gap prevents acupuncture interventions

from being deployed on a wide scale

The studies that do indicate a significant impact from acupuncture2,3 show that although

research is inconclusive, acupuncture has the potential to reduce the pain of cancer patients

and further research is not only necessary but could yield a new and effective pain management

method.

Conclusions: Overall, there is no consensus on acupuncture as a treatment for cancer-related

pain. Evidence varies on the level of significance of findings and there is in general a great need

for more research on acupuncture’s application for cancer pain. Some studies show that

acupuncture still has the potential to reduce pain caused by cancer itself and cancer

treatments2,3. Further research could expand the body of literature on acupuncture to create a

consensus. Acupuncture is practiced in many different ways in non-research settings which

made it complicated to standardize acupuncture within studies. Further research should attempt

to replicate past practices to evaluate the efficacy of different acupuncture approaches and help

create a standardized research approach. Different acupuncture methods should be evaluated

so that they may be applied.

Additionally, there is a need for larger studies- the studies reviewed in the matrix are

small and although generally free form bias because of blinding and randomization, would

benefit from larger sample sizes. At the very least, larger sample sizes could reduce the impact

of subject drop-out on experimental study designs.

Author, Year
-Title
-Location, Timeframe,
-Study pop
Alimi et al., 2016
“Analgesic effect of auricular
acupuncture for cancer pain:
A randomized, blinded,
controlled trial”
-Feb. 1999- June 2001 in the
Pain Management Unit at the
Institut Gustave Roussy
Hershman et al., 2018
“Effect of Acupuncture vs
Sham Acupuncture or Waitlist
Control on Joint Pain Related
to Aromatase Inhibitors
Among Women With Early-
Stage Breast Cancer: A
Randomized Clinical Trial”
-March 2012- February 2017
Kim et al., 2018
“Intradermal Acupuncture
Along with Analgesics for
Pain Control in Advanced
Cancer Cases: A Pilot,
Randomized, Patient-
Assessor-Blinded, Controlled
Trial”
-Men and women >18
Kim et al., 2018
“Current evidence of
acupuncture for symptoms
related to breast cancer
survivors: A PRISMA-
compliant systematic review
of clinical studies in Korea”
Paley et al., 2015
“Acupuncture for cancer pain
in adults”
Pain Indicator Study Design and Methods Results of acupuncture Statistical Analyses
intervention
-Cancer type: a -Randomized controlled trial, -no reduced pain effect of -Day 60 pain scores true
range of cancers blind evaluation of results skin penetration (not-true acupuncture: 18.4
-Focused on chronic -90 subjects placebo, acupuncture) decrease in pain intensity;
peripheral or central -3 groups: true acupuncture -significant effect on pain P<.001
neuropathic pain (n=28), placebo acupuncture reduction by true -Day 60 pain scores
(n=23), placebo acupuncture acupuncture placebo acupuncture: 3.1
seeds (n=28) decrease in pain intensity;
P<.001
-Cancer type: breast -Randomized Clinical Trial -6 wks: mean pain score -proportion of patients
cancer -226 subjects for true acupuncture with a 2-point pain score
-Focused on joint -Subjects assigned to three patients was .92 lower improvement at 6 weeks:
pain as a symptom of groups: true acupuncture than sham, .96 lower than 58% in true acu group,
treatment for (n=110), a sham acupuncture waitlist group 33% in sham acu, 31% in
hormone-sensitive (n= 59), control waitlist (n=57) -24 wks: true mean waitlist group
breast cancer -measured with self-report pain observed pain score 0.59 -a two point decrease was
(aromatase surveys lower than sham, 1.23 hypothesized to be
inhibitors) lower than waitlist group significant pain reduction
-Cancer type: a -Randomized Control Trial -64.3% of treatment -no statistically significant
range of cancers -27 subjects patients reported reduced difference between the
-Focused on pains -Blinded from subject, outcome analgesics use, 38.5% of two groups in changed
associated with assessors, and statisticians sham group reduced use analgesic use
advanced cancer -Two groups: True intradermal -pain scale measures
-Subjects already acupuncture (n=13) and sham decreased significantly
prescribed (no insertion yet a pressure -Questionnaire scores
analgesics sensation) intradermal improved significantly
acupuncture (n=14)
-Cancer type: breast -Systematic review -Studies indicated that N/A
cancer -1228 articles, 8 observational acupuncture may be
-Focused on pains studies, 1 RCT effective in improving
associated with -Used MEDLINE, EMBASE, the symptoms in breast care
treatments Cochrane library, 4 Korean survivors
databases, Korean medical -Were overall inconclusive,
conferences lack of generalizability
-Cancer type: a -Systematic Review -Heterogeneity of studies N/A
range of cancers -5 RCTs made it impossible to
-Focused on any -Used CENTRAL, MEDLINE, compare the studies
pain directly related EMBASE, AMED, PsycINFO, -insufficient evidence of
to cancer SPORTDiscus acupuncture efficacy
Literature Cited:

1. Hackett, J., Godfrey, M., & Bennett, M. (2016). Patient and caregiver perspectives on

managing pain in advanced cancer: A qualitative longitudinal study. Palliative Medicine, 30(8),

711-719.

2. Hershman, D., Unger, J., Greenlee, H., Capodice, J., Lew, D., Darke, A., . . . Crew, K. (2018).

Effect of Acupuncture vs Sham Acupuncture or Waitlist Control on Joint Pain Related to

Aromatase Inhibitors Among Women With Early-Stage Breast Cancer: A Randomized Clinical

Trial. JAMA,320(2), 167-176.

3. Alimi, D., Rubino, C., Pichard-Léandri, E., Fermand-Brulé, S., Dubreuil-Lemaire, M., & Hill, C.

(2003). Analgesic effect of auricular acupuncture for cancer pain: A randomized, blinded,

controlled trial. Journal of Clinical Oncology : Official Journal of the American Society of Clinical

Oncology,21(22), 4120-6.

4. Kim, K., & Lee, S. (2018). Intradermal Acupuncture Along with Analgesics for Pain Control in

Advanced Cancer Cases: A Pilot, Randomized, Patient-Assessor-Blinded, Controlled

Trial. Integrative Cancer Therapies,1534735418786797.

5. Kim, Tae-Hun, Kang, Jung Won, & Lee, Myeong Soo. (2018). Current evidence of

acupuncture for symptoms related to breast cancer survivors: A PRISMA-compliant systematic

review of clinical studies in Korea. Medicine, 97(32), E11793.

6. Paley, C., Johnson, M., Tashani, O., & Bagnall, A. (2015). Acupuncture for cancer pain in

adults. The Cochrane Database of Systematic Reviews,2015(10), CD007753.