PURPOSE To investigate the effect of electro-acupuncture (EA) as a non-pharmacological intervention to prevent or reduce chemotherapy-induced peripheral neuropathy (CIPN) in breast cancer patients undergoing chemotherapy of taxane. METHODS Women with stage I-III breast cancer scheduled to receive taxane therapy were randomized to receive a standardized protocol of 12 true or sham EA (SEA) weekly treatments concurrent with taxane treatment. Subjects completed the Brief Pain Inventory-Short Form (BPI-SF), Functional Assessment of Cancer Therapy-Taxane neurotoxicity subscale (FACT-NTX), and other assessments at baseline and weeks 6, 12, and 16. RESULTS A total of 180 subjects were screened, 63 enrolled and 48 completed week 16 assessments. Mean age was 50 with 25% white, 25% black, and 43% Hispanic; 52% had no prior chemotherapy. At week 12, both groups reported an increase in mean BPI-SF worst pain score, but no mean differences were found between groups (SEA 2.8 vs. EA 2.6, p=.86). By week 16, the SEA group returned to baseline, while the EA group continued to worsen (mean=1.7 in SEA vs. 3.40 in EA, p=.03). The increase in BPI-SF worst pain score was 1.62 points higher in the EA group than in the SEA group at week 16 (p=.04). CONCLUSIONS In a randomized, sham-controlled trial of EA for prevention of taxane-induced CIPN, there were no differences in pain or neuropathy between groups at week 12. Of concern, subjects on EA had a slower recovery than SEA subjects. Future studies should focus on EA for treatment as opposed to prevention of CIPN.

No abstract

Objectives: This article describes the feasibility and acceptability of the Acupuncture to Decrease Disparities in Outcomes of Pain Treatment (ADDOPT) trial, which incorporates acupuncture as an adjunct to usual treatment for chronic pain in urban health centers. Design: The study assessed feasibility (ability to carry out in real-world practice; adequacy of resources; acceptability to patients, acupuncturists, and primary care clinicians). Setting: Four (4) community health centers in the Bronx, NY, participating in the New York City Research and Improvement Networking Group (NYC RING), a practice-based research network dedicated to decreasing health disparities through primary care research and quality improvement in the urban safety net setting, were involved. Subjects: The subjects comprised participants receiving care for chronic pain due to osteoarthritis, or neck or back pain at four Bronx health centers serving low-income families. Intervention: The intervention involved up to 14 weekly acupuncture treatments. Outcome measures: Pain and functional status are assessed during a 6-week run-in period before, during, and postacupuncture treatment using the Brief Pain Inventory and the 12-Item Short Form Health Survey. This article reports on baseline status, referral and recruitment, engagement with treatment, and delivery of the intervention across sites. Results: Of 400 patients referred, 185 have initiated treatment. The majority of attending physicians have referred, most commonly for back pain (n = 103; 60.6%). Participants' average age is 53.9 (standard deviation [SD] 14.1); 54.1% are Hispanic; and 57.6% are on Medicaid. Half (48%) report ''poor'' or ''fair'' overall health. Patients report an average disability score of 74 (SD 27.0) and baseline pain severity on the Brief Pain Inventory of 6 (SD 1.9). Patients have completed a mean of 8.0 (SD 4.7) treatments; 72.4% complete > 5 sessions. Conclusions: Clinicians in this urban setting have incorporated acupuncture into chronic pain management. Despite disability and lack of familiarity, patients initiate acupuncture and show high levels of engagement with treatment.

Robust methods are needed to efficiently conduct large, multi-site, randomized controlled clinical trials of acupuncture protocols. SWOG S1200 is a randomized, controlled sham- and waitlist-controlled trial of a standardized acupuncture protocol treating aromatase inhibitor (AI)-associated arthralgias in early stage breast cancer patients (n=228). The primary objective is to determine whether true acupuncture administered twice weekly for 6 weeks compared to sham acupuncture or a waitlist control causes a reduction in AI-associated joint pain at 6 weeks as assessed by patient report. The study is conducted at 11 institutions across the US. The true acupuncture protocol was developed using a consensus-based process. Both the true acupuncture and sham acupuncture protocols consist of 12 sessions administered over 6 weeks, followed by 1 session per week for the remaining 6 weeks. The true acupuncture protocol uses standardized protocol points in addition to standardized acupoints tailored to a patient’s joint symptoms. The similarly standardized sham acupuncture protocol utilizes superficial needling of non-acupoints. Standardized methods were developed to train and monitor acupuncturists, including online and in-person training, study manuals, monthly phone calls, and remote quality assurance monitoring throughout the study period. Research staff was similarly trained using online and in-person training, and monthly phone calls.

Anxiety is a common clinical presentation that is important for practitioners to recognize and address in their patients. Modern psychological research understands anxiety to be a state of apprehensive fear in the face of uncertain or uncontrollable challenges. Traditionally, Chinese medicine has several approaches to the treatment of anxiety, including treatments focused on the Liver, Heart, and Mind. Utilizing the relationships of organs to emotions in Traditional Chinese Medicine, and an interpretation of Chinese characters used in naming acupuncture points and describing anxiety, the author discusses a new strategy for the treatment of anxiety, utilizing the acupuncture point KI 26 (Yu Zhong). This is a promising acupuncture point to research in the treatment of clinical anxiety.