Comparison of Acupuncture vs Sham Acupuncture or Waiting List Control in the Treatment of Aromatase Inhibitor–Related Joint Pain

Abstract

ImportanceAromatase inhibitors (AIs) have proven efficacy for the treatment of hormone-sensitive breast cancer; however, arthralgias (pain and stiffness) contribute to nonadherence with therapy for more than 50% of patients.ObjectiveTo examine the effect of acupuncture in reducing AI-related joint pain through 52 weeks.Design, Setting, and ParticipantsA randomized clinical trial was conducted at 11 sites in the US from May 1, 2012, to February 29, 2016, with a scheduled final date of follow-up of September 5, 2017, to compare true acupuncture (TA) with sham acupuncture (SA) or waiting list control (WC). Women with early-stage breast cancer were eligible if they were taking an AI and scored 3 or higher on the Brief Pain Inventory Worst Pain (BPI-WP) item (score range, 0-10; higher scores indicate greater pain). Analysis was conducted for data received through May 3, 2021.InterventionsParticipants were randomized 2:1:1 to the TA (n = 110), SA (n = 59), or WC (n = 57) group. The TA and SA protocols were composed of 6 weeks of intervention at 2 sessions per week (12 sessions overall), followed by 6 additional weeks of intervention with 1 session per week. Participants randomized to WC received no intervention. All participants were offered 10 acupuncture sessions to be used between weeks 24 and 52.Main Outcomes and MeasuresIn this long-term evaluation, the primary end point was the 52-week BPI-WP score, compared by study group using linear regression, adjusted for baseline pain and stratification factors.ResultsAmong 226 randomized women (mean [SD] age, 60.7 [8.6] years; 87.7% White; mean [SD] baseline BPI-WP score, 6.7 [1.5]), 191 (84.5%) completed the trial. In a linear regression, 52-week mean BPI-WP scores were 1.08 (95% CI, 0.24-1.91) points lower in the TA compared with the SA group (P = .01) and were 0.99 (95% CI, 0.12-1.86) points lower in the TA compared with the WC group (P = .03). In addition, 52-week BPI pain interference scores were statistically significantly lower in the TA compared with the SA group (difference, 0.58; 95% CI, 0.00-1.16; P = .05). Between 24 and 52 weeks, 12 (13.2%) of TA, 6 (11.3%) of SA, and 5 (10.6%) of WC patients reported receipt of acupuncture.Conclusions and RelevanceIn this randomized clinical trial, women with AI-related joint pain receiving 12 weeks of TA had reduced pain at 52 weeks compared with controls, suggesting long-term benefits of this therapy.Trial RegistrationClinicalTrials.gov Identifier: NCT01535066

A randomized controlled trial of hypnosis to manage musculoskeletal pain in breast cancer survivors taking aromatase inhibitors.

“…The roughly 1-point difference was stable across the four postintervention assessment points, meaning that clinical benefit was maintained for a year. Furthermore, the difference found here is similar to the previous work describing RCTs of other interventions for pain reduction (Hershman et al, 2022;Kroenke et al, 2010;Smith et al, 2013).…”

“…"AI-MSP management toolbox." When compared to other AI-MSP interventions, hypnosis might be particularly beneficial to patients as it is less burdensome than exercise programs and briefer and potentially less costly than acupuncture (e.g., recent studies mention a 12 session 30-45 min protocol; Hershman et al, 2022).…”

Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer

“…There may even be a small benefit of massage over acupuncture, albeit nonsignificant. The lack of difference between massage and acupuncture at week 26 confirmed that a course of massage therapy with booster sessions was likely to result in sustained pain reduction as previously reported in acupuncture studies …”

“…The lack of difference between massage and acupuncture at week 26 confirmed that a course of massage therapy with booster sessions was likely to result in sustained pain reduction as previously reported in acupuncture studies. 14,39 a For each outcome, estimates are derived from a linear mixed model with baseline means constrained to be equal across study arms. The dependent variable vector included the prerandomization baseline (week 0) assessment, as well as all postrandomization assessments (for BPI worst pain, at weeks 4, 10, 14, 18, 22, and 24, and for all other outcomes at weeks 10, 18, and 26).…”

Global research trends in acupuncture for cancer pain: A bibliometric analysis

“…[29] Based on the keywords clustering map and burst references, some randomized controlled trial (RCT) experiments have shown that acupuncture or electroacupuncture [30] can significantly improve aromatase inhibitor-associated arthralgia [27] and with long-term benefits. [31] These evidences strongly support its effectiveness. At the same time, we found that the popular academic terms labeled in keywords clustering map #9 aromatase inhibitors include acupressure, and acupressure may also be a hotspot for improving or relieving aromatase inhibitor-associated arthralgia in the future.…”