Acupuncture in Complementary Cancer Care: Easing Joint Pain From Breast Cancer Treatment

My distaste for quacks and charlatans is well known.  I myself have seen cancer victims be bamboozled away from medicine that works and fall victim to the fad cure of the month.  I have been asked by patients if acupuncture can cure their lung cancer, and, being honest, I’ve had to explain that no, it can’t.  There are certain types of cancer that do respond better to Chinese herbal medicine alone.  For the most part, however, even in China, cancer care is seen as an integrative process.  Traditional Chinese Medicine and Western Medicine are used together for the most part to try to both treat the root and the branches of the disease.

Here we present a recent article emphasizing one of the roles of acupuncture in integrative cancer care – side effect relief.

An article in the European Journal of Cancer (link)  entitled “A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use” was published online on 28 October, 2013.  The abstract is available online.  It begins by establishing the fact that side effects of a drug class called aromatase inhibitors or AIs can be so severe that it can lead patients to stop treatment.  In this case, the side effect is arthralgia or joint pain.

Aromatase Inhibitors are a newer form of chemotherapeutic treatment.  According to cancer.org (link), they act differently from the more commonly used tamoxifen and raloxifene.  Tamoxifen works by blocking the receptors for estrogen.  Aromatase Inhibitors act by stopping the enzyme aromatase from transforming base hormones into estrogen.  The newer AI’s have a slightly better clinical effect.  They also do not seem to increase the risk of uterine cancer like tamoxifen and raloxifene.  However they also speed up osteoporosis, and give the patient joint pains.  This article from the Huffington Post (link) in fact says that HALF of people taking the drugs will experience joint pains, and about one in five stop taking the drugs due to the pain.

This is where acupuncture comes in.

The scientists from the University of Pennsylvania Perelman School of Medicine divided patients into three groups.  One group was a wait list control group.  This means that the members of this group is assigned to a “waiting list” and treatment is given after the active treatment group is done.  They will get treatment when the study is over, but for the purposes of the study are left untreated while the active group gets treatment.  This is done because it is unethical for studies to deny patients treatment that works.

A second group was treated with sham acupuncture.  In this case:

Acupuncturists administered SA using Streitberger (non-penetrating) needles at non-traditional acupuncture points without electro-stimulation.

This means that there was NO penetration, and the fake needles did not touch any REAL acupuncture points.  Therefore, I consider this an acceptable, but kinda iffy sham.  Any real penetrating needles, even on non-traditional acupuncture points, will still end up stimulating the nervous system.  Thus, I cannot personally accept that as a form of sham acupuncture for the purposes of scientific studies.

The treatment group had the following:

Acupuncturists performed 10 EA/SA treatments over 8

So we have a standardized protocol given over a set period of time.

How were the results evaluated?  Did they just ask the study participants to wing it?

The primary end-point was pain severity by Brief Pain Inventory (BPI) between EA and WLC at Week 8; durability of response at Week 12 and comparison of EA to SA were secondary aims.

According to Ceeland and Ryan (link),

Poorly controlled cancer pain is a significant public health problem throughout the world. There are many barriers that lead to undertreatment of cancer pain. One important barrier is inadequate measurement and assessment of pain. To address this problem, the Pain Research Group of the WHO Collaborating Centre for Symptom Evaluation in Cancer Care has developed the Brief Pain Inventory (BPI), a pain assessment tool for use with cancer patients. The BPI measures both the intensity of pain (sensory dimension) and interference of pain in the patient’s life (reactive dimension). It also queries the patient about pain relief, pain quality, and patient perception of the cause of pain. This paper describes the development of the Brief Pain Inventory and the various applications to which the BPI is suited. The BPI is a powerful tool and, having demonstrated both reliability and validity across cultures and languages, is being adopted in many countries for clinical pain assessment, epidemiological studies, and in studies of the effectiveness of pain treatment.

Hence, the BPI is a measure of not just the intensity of the pain, but how it affects the patient’s life.

On both week 8 and week 12, patients receiving electro-acupuncture experienced significantly greater relief from joint pain than those without any treatment.  Interestingly, those experiencing sham acupuncture also reported pain relief of similar nature.

The interpretation of such results will then depend on confirmation bias of the reader.  The skeptic will immediately say that acupuncture is therefore useless because it is seemingly no better than sham.  Yet, such an attitude forgets that fact that just touching the skin with a needle produces a better effect than nothing at all.  On the other hand, The acupuncture supporter will see that acupuncture does work.  However, he is now obliged by science to investigate why non penetrative sham seems to have a similar effect to the penetrative acupuncture.

Quoth Huffington post:

However, researchers noted that those in the sham acupuncture group also experienced decreases in pain after the study period. They noted that sham acupuncture is not a true placebo because it still causes a physical sensation, so more studies will be needed to really examine its effects.

However, past studies have shown that there are significant biologic differences between true acupuncture and sham acupuncture.  I had blogged on this previously.  (link).  By definition, placebos don’t have any biological effect.  The mere fact that there is a biological effect with just touching the skin that is similar to acupuncture means that it’s an iffy sham at best.

The authors thus concluded:

Compared to usual care, EA produced clinically important and durable improvement in arthralgia related to AIs in breast cancer patients, and SA had a similar effect. Both EA and SA were safe.

Resources:

Ceeland, C.S. and Ryan, K.M.  “Pain assessment: global use of the Brief Pain Inventory” Ann Acad Med Singapore. 1994 Mar;23(2):129-38. http://www.ncbi.nlm.nih.gov/pubmed/8080219. Accessed 22 November 2013.

Mao, et al.  “A randomised trial of electro-acupuncture for arthralgia related to aromatase inhibitor use” http://www.ejcancer.com/article/S0959-8049%2813%2900897-6/abstract published online 28 October 2013, accessed 22 November, 2013.

“Acupuncture Could Ease Joint Pain From Breast Cancer Treatment” http://www.huffingtonpost.com/2013/11/21/acupuncture-joint-pain-breast-cancer-aromatase-inhibitors_n_4284031.html published online 21 November, 2013, accessed 22 November 2013.