Somatic pain is commonly musculoskeletal in origin, is often precipitated by weakness10 and can respond particularly well to acupuncture. The effectiveness of acupuncture for muscle spasm associated with chronic neck and back pain has been shown11,12 and my experience has been that this seems to be reproduced in cancer patients.

Treatment of neuropathic pain associated with malignancy has been observed to be difficult to treat, but one-third of patients found a benefit, often with the addition of TENS between acupuncture sessions.1 Treatment usually follows use of points within the affected dermatomes and I have found that patients with mesothelioma and lumbosacral plexopathy can receive good pain relief from acupuncture.


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Pain related to cancer treatments
Acupuncture has been shown to be helpful for patients with post-radiotherapy pain, such as radiation myelitis and brachial plexopathy1,13 but care must be taken to avoid needling in the presence of lymphoedema. There are also reports of its use for post-surgical pain after thoracotomy, radical neck dissection, mastectomy, limb amputation and scar pain,1 when needles are inserted around the scar, known as ‘surrounding the dragon’.

In one study,14 29 women who received a six-month course of weekly acupuncture following breast cancer surgery reported improvements in limb function and symptoms of arm heaviness and tightness, but not in arm girth. The group included women who were more than six months post-surgery and eight who had long-term intractable problems more than 10 years after surgery. It should be noted that this was not a placebo-controlled study and the patients were self-selected and highly motivated.

Acupuncture has been used with good effect in five patients with chemotherapy-induced peripheral neuropathy (CIPN),15 a condition reported in 10-20 per cent of cancer patients.16 The patients had grade two (severe paraesthesiae and/or mild weakness) or higher CIPN and were assessed and treated according to traditional Chinese methods for two courses of six weeks. All reported an improvement in pain, numbness and tingling, and a reduction in analgesic use which persisted six months after treatment in four of the patients. Further controlled studies would be helpful because acupuncture may provide a useful treatment for what can be a difficult problem.

Pain due to other causes
Acupuncture can be particularly effective for myofascial pain and trigger points (TP) which may remain latent for years and become reactivated by stress or new strain to the muscle. This can become cumulative and cause an ‘injury pool’, resulting in pain and stiffness which can be disproportionately severe. Once the TPs have been located by examination, needle insertion into the centre of the TP can give rapid relief. Cochrane reviews have suggested that acupuncture might also be effective17,18 in migraine and tension headache.

There is clear evidence of the increasing use of acupuncture for cancer pain resulting in good relief for patients if they have been adequately assessed. It is important to follow best practice guidelines6 to ensure patients receive effective treatment. There is a need for further research into acupuncture for this group of patients, many of whom are keen to see it made more widely available because of its safety profile and minimal side-effects.

Dr Melanie Jefferson is consultant in palliative care at the Cardiff and Vale NHS Trust. Competing interests: None declared. 

References
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12. Furlan AD, van Tulder MW, Cherkin DC et al. Acupuncture and dry needling for low back pain. Cochrane Database Syst Rev 2005;1:CD001351.
13. Rajan S. Post-radiotherapy acupuncture. Acupunct Med 1999;17:64-5.
14. Alem M, Costa Gurgel MS. Acupuncture in the rehabilitation of women after breast cancer surgey – a case series. Acupunct Med 2008;26(2):86-93.
15. Wong R, Sagar S. Acupuncture treatment for chemotherapy-induced peripheral neuropathy – a case series. Acupunct Med 2006;24(2):87-91.
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17. Linde K, Allais G, Brinkhaus B et al. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 2009;(1):CD001218.
18. Linde K, Allais G, Brinkhaus B et al. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009;(1):CD007587.

Originally published in the June 2009 edition of MIMS Oncology & Palliative Care.

This article originally appeared on ONA