By Jun J. Mao, MD, MSCE, Stacie Corcoran, RN, MS, and Jyothirmai Gubili, MS
Chronic pain is a common but debilitating late effect for many patients with cancer. When undertreated, patients may experience negative functional, mental, and cancer-related outcomes. Although opioids are often effective for managing cancer pain, they may not be appropriate for some patients and others may struggle to access them because of the opioid crisis. The need for nonpharmacologic pain management options is critical.
Acupuncture for Cancer Pain
An element of traditional Chinese medicine, acupuncture involves inserting fine needles in specific points of the body. In electroacupuncture, the needles are stimulated with electricity to increase the beneficial effect, whereas auricular acupuncture involves limiting the needle insertion to ears.
Studies have demonstrated acupuncture’s effectiveness in alleviating chronic noncancer pain. Among studies in cancer populations, researchers conducting a meta-analysis found an association between acupuncture and reduced pain, although they rated the evidence as moderate because of the substantial heterogeneity of the acupuncture techniques and small sample sizes. Additional studies are needed to build a strong evidence base on which to determine acupuncture’s utility in chronic cancer pain management
New Study Shows
In 2021, researchers reported findings in JAMA Oncology from the Personalized Electroacupuncture Versus Auricular Acupuncture Comparative Effectiveness (PEACE) trial, the largest clinical study to date of acupuncture for chronic cancer pain. The trial evaluated the effectiveness of electroacupuncture and auricular acupuncture in alleviating chronic musculoskeletal pain in 360 cancer survivors who experienced musculoskeletal pain for a minimum of three months. Of those, 251 were women and 88 were non-White, and their mean age was 62.1 years. Most of the patients had been diagnosed with breast cancer, prostate cancer, or lymphoma.
At baseline, participants’ average pain duration was 5.3 years and average Brief Pain Inventory severity score was 5.2 points; 210 had used pain medications. They received either 10 weekly sessions of electroacupuncture or auricular acupuncture, or usual care and reported their pain levels at various time points during and after the interventions.
Results showed that both acupuncture treatments were superior to usual care, with electroacupuncture lowering pain severity by 1.9 points (97.5% CI = 1.4–2.4 points; p < 0.001) and auricular acupuncture by 1.6 points (97.5% CI = 1.0–2.1 points; p < 0.001) from baseline to week 12. They also reported improvements in pain-related functional interference, physical and mental quality of life, and reliance on analgesic medications.
Although adverse effects were mild to moderate (e.g., bruising, itching), more patients from the auricular group discontinued treatment (10.5%) compared to those in the electroacupuncture group (0.7%), and the researchers concluded that auricular acupuncture is inferior to electroacupuncture.
Apply the Findings to Nursing Practice
Identifying and managing long-term and late effects related to cancer and its treatment are essential components of survivorship care. Because chronic pain has negative implications for survivors and the barriers to narcotic interventions, oncology nurses must stay informed and counsel patients about nonpharmacologic pain management options.
Findings from the PEACE trial show that compared to usual care, both electroacupuncture and auricular acupuncture are effective in reducing chronic musculoskeletal pain in cancer survivors. The trial provided strong data for oncology nurses to understand the rationale and potential benefits of acupuncture as an effective intervention for chronic pain can help improve survivors’ function and quality of life.