Two types of acupuncture were better than physical therapy, steroids, and pain medicine usually used to ease ongoing muscle and/or joint pain among cancer survivors, according to a study.
The research was published online on March 18, 2021, by JAMA Oncology. Read the abstract of “Effectiveness of Electroacupuncture or Auricular Acupuncture vs Usual Care for Chronic Musculoskeletal Pain Among Cancer Survivors: The PEACE Randomized Clinical Trial.”
About acupuncture and the two types in this study
In acupuncture, sterile, single-use, hair-thin needles are inserted into specific points on the body. Scientists think that acupuncture causes the nervous system to release natural pain-killing chemicals and immune system cells that then travel to weakened areas of the body and relieve pain symptoms.
Research strongly suggests that acupuncture is better than the usual treatments for ongoing pain not caused by cancer or its treatment.
Other research suggests that acupuncture may:
- help relieve fatigue
- control hot flashes
- help decrease nausea
- reduce vomiting
Electroacupuncture uses acupuncture needles to ease pain, but the needles are stimulated with electricity to enhance the release of pain-killing chemicals in the body.
Auricular, or ear, acupuncture is an acupuncture technique in which special needles (tiny studs that look like earrings) are inserted into specific points on the person’s ears. The needles stay in the ears for 3 or 4 days and then are removed. Because growing evidence shows the effectiveness of ear acupuncture, the Veterans Health Administration has been training clinicians in the technique since 2016 and is implementing a nationwide ear acupuncture program for management of chronic pain.
The researchers who did this study wanted to compare the effectiveness of electroacupuncture and ear acupuncture to the usual treatments prescribed by doctors for easing chronic pain in cancer survivors.
About the study
This study included 358 people who had been treated for cancer and had no current evidence of disease. The people were treated at cancer centers in New York and New Jersey. All the people in the study had reported muscle and/or joint pain for at least 3 months.
People were excluded from the study if they had:
- inflammatory arthritis
- phantom limb pain
- an implanted electronically charged medical device
- a pending pain-related Veterans Health Administration, Social Security, or workers’ compensation claim
Characteristics of the people in the study included:
- average age was about 62 years
- about 70% were women
- about 45% had been treated for breast cancer
- average time since cancer diagnosis was about 6 years
- about 33% had lower back pain; other types of pain included neck, shoulder/arm/elbow, hip/thigh, and knee/leg
- average pain score at the beginning of the study was about 5 on a scale of 0 to 10
The people were randomized to receive one of three treatments for pain:
- 145 people were treated with electroacupuncture given by licensed acupuncturists with more than 5 years of experience treating people with cancer. The people were given 10 30-minute treatments over a 10-week period.
- 143 people were treated with ear acupuncture given by the same acupuncturists who gave the electroacupuncture. After the first needle was inserted into one ear, the person walked for 1 minute and then rated the severity of the pain. If the pain rated higher than 1 on a scale of 0 to 10, another needle was inserted in the other ear and the person walked for another minute. This process was repeated for up to 10 needles. The needles were left in place for 3 to 4 days, and the people were told how to safely remove the needles at home. The people were given 10 treatments over a 10-week period, and each treatment lasted 10 to 20 minutes, depending on how many needles were placed.
- 71 people received standard pain management prescribed by their doctors, including analgesic medicines, physical therapy, and steroid injections. To allow these patients to benefit from the acupuncture treatments being studied, they were also offered 10 acupuncture treatments after the study ended.
The results found that compared to usual care:
- electroacupuncture reduced the average pain severity score by 1.9 points
- ear acupuncture reduced the average pain severity score by 1.6 points
Both acupuncture groups reported better physical and mental quality of life compared to the usual care group. Both acupuncture groups also reported using less pain medicine compared to the usual care group.
Side effects were mild to moderate in both acupuncture groups.
Among people treated with electroacupuncture, bruising was the most common side effect, reported by about 10% of the people. One of the 145 people stopped treatment because of side effects.
Among people treated with ear acupuncture, ear pain was the most common side effect, reported by about 10% of the people. Fifteen of the 143 people stopped treatment because of side effects.
“We found that both electroacupuncture and ear acupuncture significantly reduced people’s chronic pain compared to usual care with or without medication; however, ear acupuncture is not as effective as electroacupuncture,” said lead author Jun Mao, M.D., chief of Integrative Medicine Service at Memorial Sloan Kettering Cancer Center, in a statement. “Compared with people receiving usual care, electroacupuncture reduced pain severity by 1.9 points and ear acupuncture by 1.6 points on a scale of 0 to 10. A one-point reduction in pain is clinically meaningful, so this is a pretty big drop. The pain relief of acupuncture lasts for months, which differs from pain medications, which must be taken frequently.
“I hope these results lead to more insurance coverage for cancer survivors receiving acupuncture,” he continued. “In 2020, Medicare started covering acupuncture for lower back pain. The acupuncture coverage for pain in cancer survivors, however, is inconsistent. And some cancer survivors have heart, kidney, or liver conditions due to treatment, which means they shouldn’t take too many pain relievers. Hopefully, these data will encourage healthcare regulators to expand coverage. The urgency is huge: People from lower socioeconomic statuses may not have the same access to acupuncture if it remains uncovered.”
What this means for you
If you’ve been treated for breast cancer and are dealing with ongoing pain, you may want to try electroacupuncture or ear acupuncture based on the results of this study.
Ask your doctor if acupuncture might be right for you, and keep these points in mind when making an acupuncture appointment:
- Acupuncture practitioners must have a certain number of hours of training and should be certified. The American Board of Medical Acupuncture keeps a list of board-certified physicians who have training in an approved program. The National Certification Commission of Acupuncture and Oriental Medicine website has a searchable practitioner directory of certified acupuncture practitioners who are not medical doctors.
- If you’ve had lymph nodes removed from under the arm, you may be at risk of lymphedema and shouldn’t have needles inserted into that arm. Tell your acupuncture practitioner about any surgeries you’ve had, and talk over how the risk of lymphedema will be managed.
- Because of the risk of bleeding, people who have bleeding disorders or low white blood cell counts and those who take blood thinners shouldn’t have acupuncture.
- There are acupuncturists who specialize in treating people with cancer. It makes sense to check out a practitioner’s website to learn about their specializations and training.
- As the lead researcher of this study said, insurance coverage for acupuncture for pain in cancer survivors is inconsistent. Check with your insurance company to see if acupuncture is covered. Also, not all acupuncture practitioners take insurance, so check with the practitioner before you schedule an appointment.
For more information, visit the Acupuncture page in the Breastcancer.org Complementary and Holistic Medicine section. You also can listen to a podcast episode on acupuncture for breast cancer treatment side effects with Dory Ellen Fish, a board-certified, state-licensed acupuncturist with 25 years of experience.
Written by: Jamie DePolo, senior editor
Reviewed by: Brian Wojciechowski, M.D., medical adviser
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