A systematic review and meta-analysis of existing randomized-controlled trials (RCTs) revealed that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, according to a study published in JAMA Oncology.
The systematic review consisted of 17 RCTs and 1,111 patients with cancer, and the meta-analysis included data from 14 RCTs with 920 patients. In 7 of the sham-controlled studies, real acupuncture was shown to be associated with reduced pain intensity (mean difference [MD], −1.38 points; 95% CI, −2.13 to −0.64 points; I2 = 81%). Favorable associations were also shown in 6 RCTs that studied acupuncture and acupressure combined with analgesic therapy (MD, −1.44 points; 95% CI, −1.98 to −0.89; I2 = 92%), along with 2 RCTs that looked at opioid dose reduction (MD, −30.00 mg morphine equivalent daily dose; 95% CI, −37.5 mg to −22.5 mg).
“The present study provides an updated synthesis of the current evidence of acupuncture and acupressure for cancer pain, and identifies research gaps that remain to be addressed,” noted the researchers. “The positive results from the sham-controlled RCTs suggest the potential efficacy of acupuncture in reducing cancer pain.”
The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale. Thirteen of the studies (76%) focused on specific types of cancer pain, such as aromatase inhibitor-induced arthralgia (6), gastric cancer pain (1), pancreatic cancer pain (1), malignant neuropathic pain (1), osseous metastatic pain (1) and persistent pain after surgical procedure (1). Four (24%) studies looked at generalized cancer pain and a mix of cancer diagnoses.
“Meta-analyses have reported reductions in various types of pain and opioid use after surgical procedures,” noted the researchers. “However, few trials were available for certain types of pain (eg, neuropathic, osseous metastasis); thus, further research is needed to investigate the association of acupuncture with specific pain syndromes.”
The authors noted several limitations to the study, most notably that there was substantial heterogeneity observed throughout the different RCTs. This heterogeneity contributed to lowering the overall evidence grade from high to moderate. Despite the evidence grade, these findings do suggest that further research and more rigorous trials are needed to clarify any association of acupuncture and acupressure with specific types of cancer pain, and to integrate that evidence into a clinical practice to reduce opioid use. Lack of blinding in the open-label studies also likely led to a high risk of bias.
The authors noted that integrating acupuncture into pain management for patients with cancer remains a challenge, with lack of information and access being the main hurdles.
“[P]ain is a common reason that patients with cancer visit emergency departments, often followed by admission,” wrote the researchers, “hospitals need to establish appropriate acupuncture services.”
Lack of insurance coverage was also cited as an obstacle to the use of acupuncture, with recent surveys noting that 47.9% of patients with cancer would accept the treatment if it was covered.
“The cost of treatments and exclusion from insurance coverage were identified as major barriers… Therefore, systematic insurance coverage is needed to allow equitable access to acupuncture as part of comprehensive pain management.”
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. 2019 Dec 19. doi:10.1001/jamaoncol.2019.5233. [Epub ahead of print].