Acupuncture has been used to treat illness for more than 2,000 years, but its benefits (if any) and mechanism of action are poorly understood. This is true in part because insertion of needles along invisible meridians to facilitate the flow of an undefined energy does not easily lend itself to study with randomized clinical trials.
Moreover, acupuncture is used primarily to treat subjective symptoms such as pain and anxiety, which are notoriously hard to measure; there’s also the problem of designing a valid placebo procedure. Nevertheless, many patients with cancer now routinely try acupuncture in hopes of reducing stress, pain, and other consequences of their disease and its treatment, and researchers continue to seek ways to harness its potential for symptom relief.
Acupuncture may reduce pain and improve well-being in patients with lung cancer, according to a recent observational trial, provided that the patient undergoes a sufficient amount of sessions.1 Researchers from Canada enrolled 33 patients with lung cancer, administering 45 minutes of acupuncture once or twice a week for a minimum of 4 weeks and monitoring their reports of pain, depression, anxiety, nausea, and well-being. Most patients had advanced-stage cancer but good performance status and most were undergoing chemotherapy, radiotherapy, or both.
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At the end of the treatment regimen, 61% of patients reported a clinically important improvement in pain and 33% reported a clinically important improvement in well-being. Lesser improvements were seen in appetite, nausea, and nervousness. Data analysis showed that a minimum of six sessions were required to attain a 70% chance of improvement in well-being. The study had several limitations: follow-up did not extend beyond the treatment period, so the researchers could not say whether any of these effects were long-lasting. In addition, patients determined for themselves how many sessions to undergo, so the intervention was not consistent.
A pilot study conducted at Memorial Sloan-Kettering Cancer Center in New York, NY found that acupuncture might be useful for treatment of upper-limb lymphedema following surgery and/or radiation for breast cancer.2 Thirty-three patients with lymphedema that had persisted 6 months to 5 years underwent six to eight acupuncture sessions over a 4-week period and the effect on arm circumference in the affected arm was measured.
At the end of treatment, 11 patients demonstrated a reduction in arm circumference of 30% or greater and 18 patients demonstrated a reduction of 20% or greater. No significant adverse events occurred. Although at the 4-month follow-up only four of the 11 responding patients reported sustained improvement, the investigators considered the results promising enough to launch a randomized controlled trial, for which recruitment is under way.
Electroacupuncture appeared not to be effective for arthralgia in postmenopausal women with early breast cancer who were taking an aromatase inhibitor, according to a pilot study conducted in Australia.3 Thirty-two patients participated in the study and received either sham or real electroacupuncture twice weekly for 6 weeks. Although the treatment appeared to be safe, no significant improvement occurred in joint pain, stiffness, or physical function. Because there were trends toward improvement in these symptoms, the authors suggested that a larger study might detect significant differences.
These studies were limited by small sample sizes and short follow-up and their results, while promising, require confirmation.
Meanwhile, speculation continues about how acupuncture works. In a review published in 2011 in Evidence-Based Complementary and Alternative Medicine, Carole A. Paley and co-authors discuss a number of mechanisms suggested by animal models whereby acupuncture could relieve cancer-induced bone pain.4 Among them are reduction in pain transmission, reduction in peripheral and central sensitization, upregulation of analgesic gene expression, and increased release of serotonin and norepinephrine. The authors point out that no randomized controlled trials of acupuncture in patients with cancer-induced bone pain have been conducted.
As research into acupuncture continues, hope grows that someday we will have a better understanding of exactly how acupuncture works with the human body’s natural functions, and why it is beneficial for some patients in relieving pain and other physical and emotional distress.
References
1. Kasymjanova G, Grossman M, Tran T, et al. The potential role for acupuncture in treating symptoms in patients with lung cancer: an observational longitudinal study. Curr Oncol. 2013;20(3):152-7.
2. Cassileth BR, Van Zee KJ, Yeung KS, et al. Acupuncture in the treatment of upper-limb lymphedema. Cancer. 2013;119:2455-61.
3. Oh B, Kimble B, Costa DS, et al. Acupuncture for treatment of arthralgia secondary to aromatase inhibitor therapy in women with early breast cancer: pilot study. Acupunct Med. 2013 May 30. [Epub ahead of print]
4. Paley CA, Bennett MI, Johnson MI. Acupuncture for cancer-induced bone pain? Evid Based Complement Alternat Med. 2011;2011:671043. doi: 10.1093/ecam/neq020. Epub 2011 Mar 10.
