11 Questions on Acupuncture for the Management of Cancer Related-Pain
Sample: True or false? In addition to reducing pain, acupuncture has been shown to reduce the use of opioids among patients with cancer-related pain.
Question 1. Approximately what percentage of patients with cancer experience pain at some time during their illness?
Answer: D. 70%. In a 2016 systemic review and meta-analysis of pain prevalence in patients with cancer, 66.4% of cancer patients with advanced, metastatic, or terminal disease reported experiencing pain.1
Question 2. True or false? The same 2016 review found very few patients who, after their cancer was cured, experienced pain related to the disease or its treatment.
Answer: B. False. Approximately 39% of patients whose cancer had been cured continued to experience pain.1
Question 3. True or false? In addition to reducing pain, acupuncture has been shown to reduce the use of opioids among patients with cancer-related pain.
Answer: A. True. Several studies in a recent 2019 systemic review and meta-analysis found that acupuncture was significantly associated with reduced cancer pain and indicated that acupuncture reduced opioid use.2 This may be especially beneficial for patients with cancer-related pain even if the opioids are providing relief, as they can cause adverse events similar to those associated with cancer treatments and the cancer itself. For example, many patients undergoing chemo- or radiation therapy experience nausea and vomiting, both of which are common adverse events related to the use of opioids.
Question 4. True or false? Based on the 2019 review, acupuncture is effective for mild-to-moderate but NOT moderate-to-severe cancer-related pain.
Answer: B. False. Most of the studies included in the 2019 review studied acupuncture for moderate-to-severe pain.2
Question 5. Which of the above types of acupuncture has been shown to be most effective for the management of cancer-related pain?
Answer: C. Neither. In the 2019 review, there were insufficient studies comparing manual acupuncture vs electroacupuncture to determine whether either one is more effective than the other for the management of cancer-related pain.2
Question 6. True or false? In addition to acupuncture, acupressure-where pressure is applied at acupuncture points-has been shown to provide potential benefits for reducing cancer-related pain.
Answer: A. True. Acupressure may also provide benefit for cancer-related pain, although the studies included in the 2019 review indicated that actual acupuncture may provide more benefit. The studies also indicated that combining the 2 therapies may be effective.2
Question 7. True or false? While acupuncture appears beneficial for pain directly caused by cancer, it is unlikely to have an effect on pain related to any cancer treatments.
Answer: B. False. Several of the studies included in the 2019 review examined acupuncture for pain related to aromatase inhibitor-induced arthralgia and found the effects beneficial.2
Question 8. In the studies included in the 2019 review, approximately what percentage of patients dropped out due to adverse events related to acupuncture?
Answer: A. 0%. No patients were reported to have dropped out due to adverse events related to acupuncture.2 This is not surprising as acupuncture is relatively adverse-event-free, which is one of its advantages vs many other therapies for pain. The only serious potential adverse event related to acupuncture is infection, but the risk can be eliminated by the use of disposable needles.
EXTRA CREDIT: Question 9. According to a recent study on patients with head and neck cancer, approximately what percentage experienced RIX?
Answer: B. 50%. According to a recent study of >300 patients with head and neck cancer, >50% of patients who underwent radiation therapy involving major salivary glands reported experiencing RIX.3
EXTRA CREDIT: Question 10. True or false? Acupuncture appears to provide some benefit for RIX.
Answer: A. True. The study found that patients who underwent acupuncture experienced significantly less RIX 1 year following the end of radiation therapy vs those who underwent standard care.3
EXTRA CREDIT: Question 11. True or false? The mechanism by which acupuncture might relieve RIX is well understood.
Answer: B. False. Although it has been theorized that acupuncture might reduce RIX by increasing blood flow to tissues surrounding the parotid glands, it is still unclear whether this is how it exerts its effect or whether there are other mechanisms involved.3
References:
1. van den Beuke-van Everdingen MH, Hochstenbach LM, Joosten EA, Tjan-Heijnen VC, Janssen DJ. Update on prevalence of pain in patients with cancer: systematic review and meta-analysis. J Pain Symptom Manage. 2016;51:1070-1090.
2. He Y, Guo X, May BH, et al. Clinical evidence for association of acupuncture and acupressure with improved cancer pain: a systematic review and meta-analysis [published ahead of print December 19, 2019]. JAMA Oncol. doi: 10.1001/jamaoncol.2019.5233.
3. Garcia MK, Meng Z, Rosenthal DI, et al. Effect of true and sham acupuncture on radiation-induced xerostomia among patients with head and neck cancer: a randomized clinical trial. JAMA Netw Open. 2019;2:e1916910.
Pain is a common symptom among cancer patients, but it is inadequately managed in approximately 50% of these patients. Opioid analgesics and nonopioid and over-the-counter medications are recommended to alleviate cancer-related pain. The highly addictive properties of opioids, however, have prompted leading medical organizations to recommend nonpharmacologic approaches, including acupuncture, to help control cancer-related pain.2Is acupuncture a viable pain management alternative for cancer patients? In the quiz below, answer 11 questions on recent research to get more insight.
