Feasibility trial of electro-acupuncture for aromatase inhibitor related arthralgia in breast cancer survivors.

Abstract

symptoms to AIs. 51 With the increase in its use, AI-related arthralgia is emerging as a major source of symptom burden among its users, with a 28% relative increase compared with placebo. 2 Although the understanding of this symptom is extremely limited, in a recent study among 200 ambulatory breast cancer survivors (BCSs) receiving AIs, 47% reported AI-related joint pain and 44% reported AI-related stiffness. 5 Arthralgia not only impairs function 6 but also can lead to treatment discontinuation. 7 As medical science introduces life-prolonging therapies such as AIs, research is needed to identify and test effective strategies to minimize the side effects of AIs so that both the length and quality of survivorship can be enhanced. Given the extensive use of complementary therapies by BCSs, 8,9 acupuncture is promising as an acceptable nonpharmacological approach for the treatment of AIrelated arthralgia. Although the exact cause of arthralgia by AIs is unknown, one of the likely explanations is that the depleted estrogen level may decrease the generation of endogenous opioids, thereby leading to lowered pain A romatase inhibitors (AIs) have become an important standard adjuvant hormonal therapy for postmenopausal women with hormone-receptor-positive invasive breast cancer. Improvements in disease-free survival have been found in randomized controlled trials (RCTs) to be as high as 40% and greater when compared with tamoxifen. 1-4 A study by our group also demonstrated that close to half of the AI-users attributed their joint Background. Arthralgia affects postmenopausal women receiving aromatase inhibitors (AIs) for breast cancer. Given the existing evidence for electroacupuncture (EA) for treatment of osteoarthritis in the general population, this study aims to establish the feasibility of studying EA for treating AI-related arthralgia. Patients and Methods. Postmenopausal women with stage I-III breast cancer who reported AI-related arthral gia were enrolled in a single-arm feasibility trial. EA was provided twice a week for 2 weeks followed by 6 weekly treatments. The protocol was based on Chinese medicine diagnosis of "Bi" syndrome with electrostimulation of needles around the painful joint(s). Pain severity of the modified Brief Pain Inventory was used as the primary outcome. Joint stiffness, joint interference, and Patient Global Impression of Change (PGIC) were secondary outcomes. Paired t tests were used for analysis. Results. Twelve women were enrolled and all provided data for analysis. From baseline to the end of intervention, patients reported reduction in pain severity (from 5.3 to 1.9), stiffness (from 6.9 to 2.4), and joint symptom interference (from 4.7 to 0.8), all P < .001; 11/12 considered joint symptoms "very much better" based on the PGIC. Subjects also reported significant decrease in fatigue (from 4.4 to 1.9, P = .005) and anxiety (from 7.1 to 4.8, P = .01). No infection or development or worsening of lymphedema was observed. Conclusion. Preliminary data establish the feasibility of recruitm...

Patterns and risk factors associated with aromatase inhibitor‐related arthralgia among breast cancer survivors

“…Initial research also is underway to evaluate alternative approaches, such as acupuncture, for treating AIrelated arthraligia. 26,27 In summary, the current results have shed light on the early onset and pattern of arthralgia related to AIs and have identified the interval from menopause as a novel risk factor for symptom development. Multidisciplinary translational research is critically needed to evaluate the etiology and potential therapeutic options for patients with AI-related arthralgia.…”

“…Initial research is also underway to evaluate alternative approaches such as acupuncture for treating AI-related arthraligia. 26, 27 …”