Acupuncture
Loren Bonner
Can acupuncture and acupressure reduce pain in patients with cancer? That’s the question researchers have been seeking answers to, especially as health care providers make efforts to consider a multimodal approach to managing pain.
“Globally, cancer pain is an ongoing clinical challenge, and an effective management approach is lacking,” said Charlie C. Xue, PhD, from the School of Health and Biomedical Sciences at RMIT University in Melbourne, Australia, who participated in a study on the topic. “Acupuncture and acupressure have been included in the recommendations for alleviating cancer pain by National Comprehensive Cancer Network Guidelines, but the current state of supporting evidence is unknown.”
Xue and colleagues conducted a systematic review of 17 randomized clinical trials and meta-analysis of 14 trials in the current English-language and Chinese-language literature. Their findings, published in JAMA Oncology, pointed to a significant association between real acupuncture—compared with sham types—and reduced pain. Acupuncture combined with analgesic therapy was associated with decreased analgesic use as well.
Mary Lynn McPherson, PharmD, BCPS, CPE, a professor at the University of Maryland School of Pharmacy in Baltimore, said the study demonstrates a moderate benefit with acupuncture and acupressure in cancer pain, often providing an opioid-sparing effect. She said it would be reasonable to consider acupuncture and acupressure for chronic noncancer pain management as well. “Pharmacists should be well versed in resources in the community to help meet this goal,” said McPherson.
Pharmacist and acupuncturist weighs in
Jill Krabak, PharmD, a licensed acupuncturist in Pennsylvania and owner of AcupunctureRx, said 50% to 60% of her patients deal with chronic pain and seek acupuncture for relief.
“I find acupuncture to either eliminate or significantly decrease a patient’s self-reported pain level within the first two to four treatment sessions,” said Krabak. Patients also reported a significant decrease in use of pain medications, such as opioids or NSAIDs.
After graduating from pharmacy school, Krabak was led to acupuncture when she experienced how beneficial it was in treating her own chronic pain issues.
“My practice is focused on integrating Eastern and Western medicine— it is not one or the other but incorporates both systems, so the patient has the best possible outcomes,” said Krabak. She also noted that she sees more patients with cancer seeking treatment for neuropathic, muscular, or bone pain.
Pharmacists can help patients understand that acupuncture can be accessible even if their insurance doesn’t cover it.
Most big cities or suburbs have a community acupuncture clinic, said Krabak, where acupuncture is done in a group setting and is more cost-effective, ranging from $25 to $45 a session.
She said some of her regular clients even supplement with this option.
Although more insurance plans are covering acupuncture, especially for certain conditions, it’s largely based on geography. Big metropolitan cities are more likely to offer coverage. Otherwise, most acupuncture practices are cash-based and can vary in price depending on where the patient lives.
She added that it’s also important for patients to see an acupuncturist who is appropriately licensed in their state.
Study limitations
Xue noted that what differentiates this study is the significant association of real acupuncture with greater pain reduction compared with sham control.
“From a clinical perspective, available evidence focuses on acupuncture and acupressure as one component of pain management,” he said. “Heterogeneity in the results suggests that the outcomes of acupuncture may be variable. It may not be suitable as a standalone therapy for cancer pain management.”
In most of the studies that were part of the meta-analysis, baseline analgesic use was not specified, and in two studies, participants did not use analgesic therapy at baseline. Consequently, variations in analgesic type and dose among participants within each study and between studies also likely contributed to heterogeneity, said Xue.
“Cancer pain remains a challenge. In the context of patient-centered care and personalized medicine in cancer therapy, oncological practice needs to provide treatment options that include evidence-based nonpharmacological approaches to assist patients’ decision making,” Xue said.
Because acupuncture and acupressure may be associated with reduced opioid use when combined with analgesic therapy, Xue said pharmacists can offer advice to patients with cancer pain about using acupuncture or acupressure and analgesic therapy.