Acupuncture Offers Long-Term Relief for Joint Pain Caused by Aromatase Inhibitors
Published on November 16, 2022
Among women diagnosed with early-stage, hormone receptor-positive breast cancer, 12 weeks of acupuncture eased joint pain caused by aromatase inhibitor medicines for 40 weeks after the last acupuncture session, according to a study.
The research was published online on Nov. 11, 2022, by the journal JAMA Network Open. Read “Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor-Related Joint Pain: A Randomized Clinical Trial.”
About aromatase inhibitors
Aromatase inhibitors are a type of hormonal therapy medicine. Three aromatase inhibitors are used to treat breast cancer:
Arimidex (chemical name: anastrozole)
Aromasin (chemical name: exemestane)
Femara (chemical name: letrozole)
After surgery, people diagnosed with early-stage, hormone receptor-positive breast cancer usually take some type of hormonal therapy medicine for five to 10 years to reduce the risk of the cancer coming back (recurrence). Research has shown that aromatase inhibitors are more effective at reducing recurrence risk in post-menopausal women than tamoxifen — another type of hormonal therapy.
Like almost all cancer medicines, aromatase inhibitors can cause side effects. Muscle and joint pain are the most common and the most troubling for many people.
“We know that it’s hard to get through [hormonal] therapy for five years,” Dawn Hershman, MD, who led the study, told Breastcancer.org when she presented the first results from this research in 2017. “We and others have done studies that suggest that 50% of patients aren’t taking their medications or aren’t taking their medications regularly by the end of the five years. Probably the most common reason why people stop taking their medications is due to side effects. And the most common side effects with aromatase inhibitors are joint pain and joint stiffness.”
A member of the Breastcancer.org Professional Advisory Board, Dr. Hershman is an American Cancer Society professor of medicine and epidemiology and is the director of breast oncology and co-leader of the Cancer Population Science Program at the Herbert Irving Comprehensive Cancer Center at Columbia University. She is nationally recognized for her expertise in breast cancer treatment, prevention, and survivorship.
About the study
Doctors have been looking for ways to help people taking aromatase inhibitors with side effects like joint pain. The first results from this study found that acupuncture can relieve joint pain caused by aromatase inhibitors.
Previous studies have focused on how long acupuncture can ease joint pain. Still, these studies have had mixed results because they:
were small, usually including fewer than 40 women
usually involved people receiving treatment at just one institution
used different methodologies
So Dr. Hershman and her colleagues decided to do a large trial that involved multiple locations around the country to help answer the question of whether acupuncture could help ease aromatase inhibitor-caused joint pain, as well as how long these benefits would last.
This latest analysis comes after one year of follow-up.
The study included 226 post-menopausal women diagnosed with stage I, stage II, or stage III hormone receptor-positive breast cancer. All the women had been taking an aromatase inhibitor for 30 days or more before joining the study between May 1, 2012, and Feb. 29, 2016. All the women also had a joint pain score that was three or higher on a 10-point scale.
The women’s average age was about 61 and:
78.4% were white
9.3% were Hispanic
6.8% were Asian
4.5% were Black
0.5% were American Indian
0.5% were Pacific Islander
The researchers randomly assigned the women to one of three groups.
The 110 women in the true acupuncture group received standard traditional Chinese medicine acupuncture. This treatment used traditional needles inserted at acupuncture points on the body, and was tailored to each woman’s most painful joints. The women received two acupuncture sessions each week for six weeks, and then one acupuncture session a week for six more weeks. Each session lasted 30 to 45 minutes.
The 59 women in this group received sham acupuncture with thinner and shorter needles placed at non-acupuncture points on the body. The women received two sham acupuncture sessions each week for six weeks, and then one sham acupuncture session a week for six more weeks. Each session lasted 30 to 45 minutes.
The 57 women in this group were told they were on a waiting list to receive true acupuncture after 24 weeks.
When the study started, the average joint pain score was:
6.77 in the true acupuncture group
6.38 in the sham acupuncture group
6.4 in the waiting list group
One year after the study started — 40 weeks after the women completed their acupuncture treatments — the average joint pain score was:
2.72 points lower in the true acupuncture group
1.46 points lower in the sham acupuncture group
1.55 points lower in the waiting list group
The only side effect from the acupuncture was mild bruising. About 47% of the women in the true acupuncture group and about 25% of women in the sham acupuncture group said they had mild bruising.
“In this randomized clinical trial, we found that among post-menopausal women with early breast cancer who experienced [aromatase inhibitor]-related arthralgias, a 12-week intervention of [true acupuncture] compared with [sham acupuncture] or [being on a waiting list] resulted in statistically significant sustained reduction in joint pain at 52 weeks,” the researchers concluded. “This study highlights the durability of the acupuncture response through one year, as well as the importance of having both [sham acupuncture] and [waiting list] groups to fully evaluate the effect of the acupuncture intervention.”
What this means for you
If you’re experiencing joint pain from an aromatase inhibitor, this study offers some good news: acupuncture can help.
In this study, 18 sessions of acupuncture over 12 weeks cost about $1,200 (or approximately $66 a session). The cost can range from $50 to $90 a session, depending on where you live. Also, some acupuncturists offer lower rates for group sessions.
Still, acupuncture is not covered by Medicare. Some health insurance companies cover a specified number of acupuncture treatments.
Dr. Hershman told Breastcancer.org that she would absolutely recommend acupuncture to her patients suffering from joint pain.
“I would do anything that had minimal risk in order to keep a patient on their medication or stop them from suffering from side effects, so I think it’s completely reasonable to offer it,” she said. “I’d like to be able to offer it to people and have them have access to it. I recognize that a lot of women can’t pay those kinds of prices. So we really do hope that the advocacy community and the insurance companies will help these women get treatment that may help them get through their breast cancer treatments.”
Learn more about acupuncture.