Electroacupuncture works as well as auricular acupuncture for easing chronic musculoskeletal pain among cancer survivors and has a lower risk of adverse events, a randomized clinical trial suggests. Researchers examined data on 360 cancer survivors without any evidence of current disease who had been experiencing chronic musculoskeletal pain for at least three months. Researchers randomized participants 2:2:1 to electroacupuncture (n=145), auricular acupuncture (n=143), or usual care (n=72). Participants in the acupuncture groups underwent 10 weekly sessions of electroacupuncture or auricular acupuncture. The primary endpoint was the change in self-reported pain intensity from baseline to week 12 using the Brief Pain Inventory (BPI), with scores ranging from 0 (no pain) to 10 (worst possible pain). Overall, participants reported mean baseline pain scores of 5.2. By week 12, both electroacupuncture and auricular acupuncture reduced pain scores more than usual care (mean difference 1.9 points and 1.6 points, respectively). "Based on these findings, clinicians involved in providing pain management for cancer survivors should consider either electroacupuncture and/or auricular acupuncture as a first line therapeutic consideration," said Charlie Xue, a professor in health sciences and associate deputy vice chancellor at RMIT University. Both electroacupuncture and auricular acupuncture are already commonly used for pain management, and the current study adds to the evidence that these interventions can be an effective option for chronic pain management in cancer survivors, Xue, who wasn't involved in the study, said by email. The results also suggest that acupuncture might help reduce the need for opioids, Xue said. "Currently there are limited options of effective management of chronic pain in mainstream medical practice or the usual care, and significant concerns related to the unwanted side effects associated the use of opioids medications," Xue noted. Auricular acupuncture didn't demonstrate non-inferiority compared with electroacupuncture, the study also found. The most common adverse event with electroacupuncture was bruising, reported by 10.3% of patients, while the most common adverse event with auricular acupuncture was ear pain, reported by 18.9% of patients. More patients receiving auricular acupuncture (10.5%) discontinued treatment due to adverse events than with electroacupuncture (0.7%). One limitation of the study is that the two types of acupuncture weren't compared to a sham control, researchers note in JAMA Oncology. It's also possible that the effects of acupuncture differed based on the different practitioners administering it. Lead study author Dr. Jun Mao of Memorial Sloan Cancer Center in New York City didn't respond to requests for comment. Even without a sham control group and with patients unblinded to the intervention they received, the effects of electroacupuncture and auricular acupuncture were large and clinically relevant, said Dr. Dawn Hershman, director of breast oncology at the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center in New York City. "In an effort to reduce pain and suffering and improve quality of life of cancer patients, and to reduce opiate use, clinicians should consider acupuncture as an important component of pain management," Dr. Hershman, who wasn't involved in the study, said by email. The main barriers to offering acupuncture to more patients are issues of cost and access, Dr. Hershman said. "We should advocate for appropriate coverage for these services to improve access and reduce the use of prescription pain medications," Dr. Hershman said. —Lisa Rapaport Source
