After surgery, women diagnosed with hormone-receptor-positive breast cancer usually take hormonal therapy medicine to reduce the risk of the cancer coming back (recurrence). Hormonal therapy medicines work in two ways:
- by lowering the amount of estrogen in the body
- by blocking the action of estrogen on breast cancer cells
There are several types of hormonal therapy medicines. Tamoxifen, a selective estrogen receptor modulator (SERM), is one of the most well-known. Tamoxifen can be used to treat both premenopausal and postmenopausal women. In the early 2000s, the aromatase inhibitors:
- Arimidex (chemical name: anastrozole)
- Aromasin (chemical name: exemestane)
- Femara (chemical name: letrozole)
were shown to be more effective at reducing recurrence risk in postmenopausal women and are now used more often than tamoxifen to treat women who’ve gone through menopause. Aromatase inhibitors aren’t used to reduce recurrence risk in premenopausal women.
Both tamoxifen and aromatase inhibitors can cause side effects. Tamoxifen may cause hot flashes and increase the risk of blood clots and stroke. Aromatase inhibitors may cause muscle and joint aches and pains, as well as hot flashes. Less common but more severe side effects of aromatase inhibitors are heart problems, osteoporosis, and broken bones. Research has shown that about 25% of women who are prescribed hormonal therapy to reduce the risk of recurrence after surgery either don’t start taking the medicine or stop taking it early.
If doctors can find a way to ease these side effects, more women might stick to their treatment plans.
Studies have shown that both real and placebo (also called sham) electroacupuncture can help ease joint pain that may be a side effect of the aromatase inhibitors.
Electroacupuncture is a type of acupuncture where a small electric current passes between pairs of acupuncture needles.
Sham electroacupuncture is non-electric and done with needles that retract and don’t penetrate the skin. The retracting needles do produce a pricking sensation, so women in studies can’t tell if they’re getting real electroacupuncture or sham electroacupuncture.
Because both real and electroacupuncture have eased pain, researchers have wondered how to interpret the results. Does electroacupuncture truly help ease pain? Is it possible that sham electroacupuncture is acting in a different way than real electroacupuncture to ease pain?
A study trying to answer these questions has found that women who expect electroacupuncture to work get better pain relief than women who expect the treatment to work and get real electroacupuncture.
The research was published in issue 50 of a special monograph of the Journal of the National Cancer Institute. Read “Expectancy in Real and Sham Electroacupuncture: Does Believing Make It So?”
In the study, 67 postmenopausal women diagnosed with early-stage breast cancer who were taking an aromatase inhibitor and having joint pain were randomly assigned to one of three treatment groups:
- Electroacupuncture: Women in this group had 14 electroacupuncture sessions that lasted 20 minutes for the 8 weeks of the study.
- Sham electroacupuncture: Women in this group had the exact same treatment schedule as the women getting real electroacupuncture.
- No intervention: The women in this group received no special care for their joint pain.
The researchers asked the women getting real and sham electroacupuncture about their expectations of the treatment four times during the study:
- just before the first treatment
- at week two
- at week four
- at the end of the treatments
At the end of the study, the researchers also asked the women about how much change, if any, there was in the amount of joint pain they were having. Women who said their pain was much improved or very much improved were considered to have a response to the acupuncture. The rest of the women were considered to have no response to the treatment.
The researchers found that women who got sham electroacupuncture and expected it to work before the first treatment were more likely to have a response to the treatment than women who didn’t expect the treatment to work. Women who had high expectations that the treatment would work reported up to an 80% reduction in joint pain by the end of the study.
In contrast, women who got real electroacupuncture and had a response to the treatment were no more likely to expect it to work than women who didn’t have a response to the treatment. Real electroacupuncture reduced joint pain by as much as 40%, whether or not the women expected it to work.
"These findings certainly challenge the notion held by some that acupuncture is 'all placebo,'" said Joshua Bauml, M.D., assistant professor of medicine in the Abramson Cancer Center at the University of Pennsylvania and lead author of the study. "If it were all placebo, patients receiving real acupuncture who had low expectations that it would work would report little or no reductions in pain. But that's not the case."
According to the researchers, the high level of pain relief reported by women who had high expectations that the sham electroacupuncture would work raises the question of whether these women would benefit from sham acupuncture with no electric stimulation.
If you’re having joint pain as a side effect of taking an aromatase inhibitor, you may want to talk to your doctor about this study. Electroacupuncture is one of several complementary and holistic medicine techniques that have been shown to help women deal with breast cancer treatment side effects such as joint pain. Other techniques include hypnosis, massage, music therapy, Reiki, and Shiatsu.
You can learn more about acupuncture in the Complementary & Holistic Medicine section.