Acupuncture Reduced AI-Related Joint Pain in Early-Stage Breast Cancer

Undergoing acupuncture significantly reduced joint pain related to treatment with aromatase inhibitors (AIs) in postmenopausal women with early-stage breast cancer compared with both sham acupuncture and no treatment at all, according to data from the Southwest Oncology Group (SWOG) S1200 trial presented at the 2017 San Antonio Breast Cancer Symposium, held December 5–9.

“Acupuncture provides a nonpharmacologic option that can improve symptoms and possibly increase AI adherence and possibly subsequent breast cancer outcomes, if patients can stay on their medication,” said Dawn L. Hershman, MD, leader of the breast cancer program at the Herbert Irving Comprehensive Cancer Center at New York–Presbyterian/Columbia University Medical Center in New York. “For patients reluctant to take a prescription medication that can control pain, that can result in other side effects, acupuncture provides a safe and effective alternative.”

The efficacy of AIs for women with hormone-sensitive breast cancer has been shown in both adjuvant settings and in the prevention of breast cancer, according to Hershman. However, noncompliance is a major problem, and one of the main reasons for noncompliance is due to arthralgia or joint discomfort.

SWOG S1200 was designed to evaluate women with AI-induced joint pain. The trial included 226 patients randomly assigned 2:1:1 to true acupuncture (n = 110), sham acupuncture (n = 59), or a waitlist control group (n = 57). Patients in the two acupuncture arms had twice-weekly sessions for 6 weeks followed by 1 session per week for 6 more weeks.

Pain was tracked before, during, and after treatment with the Brief Pain Inventory–Short Form (BPI), which ranks pain on a scale from 0 to 10.

At 6 weeks, the patients assigned to true acupuncture had significantly lower BPI pain scores compared with patients assigned to sham acupuncture (P < .01) and those in the control arm (P < .01). There was no difference in outcomes in patients assigned sham acupuncture compared with the control arm.

The researchers also looked at the percentage of women with at least a 2-point change in pain. More than half of women (58%) assigned to true acupuncture had a 2-point change compared with 31% in the sham arm (P < .009) and 30% in the control arm (P < .004). These differences remained significantly when assessed at 24 weeks.

According to Hershman, transitioning patients from twice-a-week acupuncture to once-a-week treatment maintained the effect of the intervention.

The most common adverse event reported among patients undergoing true and sham acupuncture was bruising.

“We have shown consistently, with multiple measures assessing pain and stiffness, that true acupuncture generated better outcomes than either control group in a large multicenter randomized controlled trial,” Hershman said. “The cost of the 12-week intervention was about $1,250 ($65 to $75/session) and we feel there is now sufficient evidence to support insurance coverage of acupuncture for the treatment of AI arthralgia.”