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Clinical Evidence for Association of Acupuncture and Acupressure With Improved Cancer Pain: A Systematic Review and Meta-Analysis.

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Authors He Y , Guo X , May BH , Zhang AL , Liu Y , Lu C , Mao JJ , Xue CC , Zhang H
Journal JAMA oncology
Year 2020
Links Pubmed DOI PubMed Central

This article includes 17 Primary studies 17 Primary studies (17 references)

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IMPORTANCE: Research into acupuncture and acupressure and their application for cancer pain has been growing, but the findings have been inconsistent. OBJECTIVE: To evaluate the existing randomized clinical trials (RCTs) for evidence of the association of acupuncture and acupressure with reduction in cancer pain. DATA SOURCES: Three English-language databases (PubMed, Embase, and CINAHL) and 4 Chinese-language biomedical databases (Chinese Biomedical Literature Database, VIP Database for Chinese Technical Periodicals, China National Knowledge Infrastructure, and Wanfang) were searched for RCTs published from database inception through March 31, 2019. STUDY SELECTION: Randomized clinical trials that compared acupuncture and acupressure with a sham control, analgesic therapy, or usual care for managing cancer pain were included. DATA EXTRACTION AND SYNTHESIS: Data were screened and extracted independently using predesigned forms. The quality of RCTs was appraised with the Cochrane Collaboration risk of bias tool. Random-effects modeling was used to calculate the effect sizes of included RCTs. The quality of evidence was evaluated with the Grading of Recommendations Assessment, Development and Evaluation approach. MAIN OUTCOMES AND MEASURES: The primary outcome was pain intensity measured by the Brief Pain Inventory, Numerical Rating Scale, Visual Analog Scale, or Verbal Rating Scale. RESULTS: A total of 17 RCTs (with 1111 patients) were included in the systematic review, and data from 14 RCTs (with 920 patients) were used in the meta-analysis. Seven sham-controlled RCTs (35%) were notable for their high quality, being judged to have a low risk of bias for all of their domains, and showed that real (compared with sham) acupuncture was associated with reduced pain intensity (mean difference [MD], -1.38 points; 95% CI, -2.13 to -0.64 points; I2 = 81%). A favorable association was also seen when acupuncture and acupressure were combined with analgesic therapy in 6 RCTs for reducing pain intensity (MD, -1.44 points; 95% CI, -1.98 to -0.89; I2 = 92%) and in 2 RCTs for reducing opioid dose (MD, -30.00 mg morphine equivalent daily dose; 95% CI, -37.5 mg to -22.5 mg). The evidence grade was moderate because of the substantial heterogeneity among studies. CONCLUSIONS AND RELEVANCE: This systematic review and meta-analysis found that acupuncture and/or acupressure was significantly associated with reduced cancer pain and decreased use of analgesics, although the evidence level was moderate. This finding suggests that more rigorous trials are needed to identify the association of acupuncture and acupressure with specific types of cancer pain and to integrate such evidence into clinical care to reduce opioid use.

Systematic review

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The Effects of Auricular Therapy for Cancer Pain: A Systematic Review and Meta-Analysis

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Journal Evidence-based Complementary & Alternative Medicine (eCAM)
Year 2020
Links Pubmed DOI PubMed Central

This article includes 9 Primary studies 9 Primary studies (9 references)

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Objective. This study aims to systematically assess the efficacy and safety of auricular therapy for cancer pain. Methods. A systematic search was conducted using PubMed, EMBASE, Cochrane library databases, CNKI, VIP, WanFang Data, and CBM for randomized controlled trials (RCTs). Review Manager 5.3 was used for meta-Analysis. Results. Of the 275 screened studies, nine RCTs involving 783 patients with cancer pain were systematically reviewed. Compared with drug therapy, auricular therapy plus drug therapy has significant advantages both in the effective rate for pain relief (RR = 1.40; 95% CI 1.22, 1.60; P<0.00001) and adverse effects rate (RR = 0.46; 95% CI 0.37, 0.58; P<0.00001). And the result revealed that auricular acupuncture had superior pain-relieving effects as compared with sham auricular acupuncture (SMD =-1.45; 95% CI-2.80,-0.09; P=0.04). However, the analysis indicated no difference on the effective rate for pain relief between auricular therapy and drug therapy (RR = 1.24; 95% CI 0.71, 2.16; P=0.46). Conclusion. Our meta-Analysis indicated that auricular therapy is effective and safe for the treatment of cancer pain, and auricular therapy plus drug therapy is more effective than drug therapy alone, whether in terms of pain relief or adverse reactions. However, the included RCTs had some methodological limitations; future large, rigor, and high-quality RCTs are still needed to confirm the benefits of auricular therapy on cancer pain.

Systematic review

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Systematic review and meta-analysis of acupuncture to reduce cancer-related pain.

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Authors Chiu HY , Hsieh YJ , Tsai PS
Journal European journal of cancer care
Year 2017
Links Pubmed DOI

This article includes 29 Primary studies 29 Primary studies (29 references)

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We conducted a systematic review and meta-analysis to evaluate the effects of acupuncture on malignancy-related, chemotherapy (CT)- or radiation therapy (RT)-induced, surgery-induced, and hormone therapy (HT)-induced pain. Randomised controlled trials (RCTs) examining the effects of acupuncture on cancer-related pain were reached from the EMBASE, PubMed, PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, Airiti library, Taiwan Electrical Periodical Service, Wanfang Data (a Chinese database) and China Knowledge Resource Integrated Database from inception through June 2014. Heterogeneity, moderator analysis, publication bias and risk of bias associated with the included studies were examined. A total of 29 RCTs yielding 36 effect sizes were included. The overall effect of acupuncture on cancer-related pain was -0.45 [95% confidence interval (CI) = -0.63 to -0.26]. The subanalysis indicated that acupuncture relieved malignancy-related and surgery-induced pain [effect size (g) = -0.71, and -0.40; 95% CI = -0.94 to -0.48, and -0.69 to -0.10] but not CT- or RT-induced and HT-induced pain (g = -0.05, and -0.64, 95% CI = -0.33 to 0.24, and -1.55 to 0.27). Acupuncture is effective in relieving cancer-related pain, particularly malignancy-related and surgery-induced pain. Our findings suggest that acupuncture can be adopted as part of a multimodal approach for reducing cancer-related pain.

Systematic review

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Acupuncture for Pain Management in Cancer: A Systematic Review and Meta-Analysis

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Authors Hu C , Zhang H , Wu W , Yu W , Li Y , Bai J , Luo B , Li S
Journal Evidence-based complementary and alternative medicine : eCAM
Year 2016
Links Pubmed DOI PubMed Central

This article includes 20 Primary studies 20 Primary studies (20 references)

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Objective. To evaluate the effectiveness and safety of acupuncture for cancer-related pain. Methods. A systematic review of literatures published from database inception to February 2015 was conducted in eight databases. RCTs involving acupuncture for treatment of cancer-related pain were identified. Two researchers independently performed article selection, data extraction, and quality assessment of data. Results. 1,639 participants in twenty RCTs were analyzed. All selected RCTs were associated with high risk of bias. Meta-analysis indicated that acupuncture alone did not have superior pain-relieving effects as compared with conventional drug therapy. However, as compared with the drug therapy alone, acupuncture plus drug therapy resulted in increased pain remission rate, shorter onset time of pain relief, longer pain-free duration, and better quality of life without serious adverse effects. However, GRADE analysis revealed that the quality of all outcomes about acupuncture plus drug therapy was very low. Conclusions. Acupuncture plus drug therapy is more effective than conventional drug therapy alone for cancer-related pain. However, multicenter high-quality RCTs with larger sample sizes are needed to provide stronger evidence for the effectiveness of acupuncture in cancer-related pain due to the low data quality of the studies included in the current meta-analysis.

Systematic review

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Acupuncture and Related Therapies for Symptom Management in Palliative Cancer Care: Systematic Review and Meta-Analysis.

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Journal Medicine
Year 2016
Links Pubmed DOI PubMed Central

This article includes 13 Primary studies 13 Primary studies (13 references)

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Available systematic reviews showed uncertainty on the effectiveness of using acupuncture and related therapies for palliative cancer care.The aim of this systematic review and meta-analysis was to summarize current best evidence on acupuncture and related therapies for palliative cancer care.Five international and 3 Chinese databases were searched. Randomized controlled trials (RCTs) comparing acupuncture and related therapies with conventional or sham treatments were considered. Primary outcomes included fatigue, paresthesia and dysesthesias, chronic pain, anorexia, insomnia, limb edema, constipation, and health-related quality of life, of which effective conventional interventions are limited.Thirteen RCTs were included. Compared with conventional interventions, meta-analysis demonstrated that acupuncture and related therapies significantly reduced pain (2 studies, n = 175, pooled weighted mean difference: -0.76, 95% confidence interval: -0.14 to -0.39) among patients with liver or gastric cancer. Combined use of acupuncture and related therapies and Chinese herbal medicine improved quality of life in patients with gastrointestinal cancer (2 studies, n = 111, pooled standard mean difference: 0.75, 95% confidence interval: 0.36-1.13). Acupressure showed significant efficacy in reducing fatigue in lung cancer patients when compared with sham acupressure. Adverse events for acupuncture and related therapies were infrequent and mild.Acupuncture and related therapies are effective in reducing pain, fatigue, and in improving quality of life when compared with conventional intervention alone among cancer patients. Limitations on current evidence body imply that they should be used as a complement, rather than an alternative, to conventional care. Effectiveness of acupuncture and related therapies for managing anorexia, reducing constipation, paresthesia and dysesthesia, insomnia, and limb edema in cancer patients is uncertain, warranting future RCTs in these areas.

Systematic review

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Effectiveness of acupuncture for palliative care in cancer patients: A systematic review.

Authors Lian WL , Pan MQ , Zhou DH , Zhang ZJ
Journal Chinese journal of integrative medicine
Year 2014
Links Pubmed DOI

This article is included in 2 Broad syntheses 4 Broad syntheses (2 references)

This article includes 4 Primary studies 4 Primary studies (4 references)

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OBJECTIVE: To critically evaluate the currently available randomized clinical trials regarding the effectiveness of acupuncture in palliative care for cancer patients, hence, to provide sufficient evidences for the widespread use of acupuncture in cancer treatment. METHODS: Two independent reviewers extracted data from all of the randomized clinical trials (RCTs) that assessed the efficacy of acupuncture in palliative care for cancer patients. Seven databases were searched from their respective inception to December 2010. All eligible trials identified were evaluated by two independent reviewers using the Jadad scale, and data from the articles were validated and extracted. RESULTS: In total, 33 RCTs met the inclusion criteria. The effects of acupuncture on different cancer-related aspects were shown, including chemotherapy or radiotherapy-induced side effects (13/33, 39.4%), cancer pain (6/33, 18.2%), post-operative urinary retention (4/33, 12.1%), quality of life (2/33, 6.1%), vasomotor syndrome (2/33, 6.1%), post-operative gastrointestinal dysfunction (2/33, 6.1%), prevention of prolonged postoperative ileus (2/33, 6.1%), joint symptoms (1/33, 3.0%), and immunomodulation (1/33, 3.0%). CONCLUSIONS: The result of our systematic review suggested that the effectiveness of acupuncture in palliative care for cancer patients is promising, especially in reducing chemotherapy or radiotherapyinduced side effects and cancer pain. Acupuncture may be an appropriate adjunctive treatment for palliative care.

Systematic review

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Efficacy of auricular therapy for pain management: A systematic review and meta-analysis

Journal Evidence-based complementary and alternative medicine : eCAM
Year 2014
Links Pubmed DOI PubMed Central

This article includes 19 Primary studies 19 Primary studies (19 references)

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Objective. The objective of this systematic review and meta-analysis was to assess the efficacy of auricular therapy by including a sham therapy control group. Methods. Relevant, randomized clinical trials (RCTs) were identified by searching medical related databases from, depending on journal, 1900 (at the earliest) to 1994 (at the latest) through May 2013. The outcome measure was a pain intensity score. Results. Twenty-two RCTs were identified and 13 RCTs were included for meta-analysis. In these studies, auricular therapy provided significant pain relief when compared to a sham or control group. The overall standardized mean differences (SMD) was 1.59 (95% CI [-2.36, -0.82]) (13 trials, total subject numbers = 806), indicating that, on average, the mean decrease in pain score for auricular therapy group was 1.59 standard deviations greater than the mean decrease for the sham control. In terms of the efficacy of the different treatment methods, auricular acupressure boasts the largest strength of evidence for pain relief, followed by auricular acupuncture. Electroacupuncture stimulation did not show significant evidence for efficacy, which may be due to the small sample size (i.e., only 19 subjects were included). Conclusion. Further large-scale RCTs are needed to determine the efficacy of auricular therapy for pain.

Systematic review

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Acupuncture for Treating Common Side Effects Associated With Breast Cancer Treatment: A Systematic Review

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Journal Medical Acupuncture
Year 2010
Links DOI

This article is included in 2 Broad syntheses 12 Broad syntheses (2 references)

This article includes 12 Primary studies 12 Primary studies (12 references)

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BACKGROUND: Although breast cancer treatment is associated with improved survival rates, it is also associated with numerous side effects, which can decrease overall quality of life for patients. Recent research indicates acupuncture may be useful in decreasing the incidence and duration of some side effects associated with cancer treatment. OBJECTIVE: To assess the evidence surrounding the role of acupuncture in treating side effects associated with breast cancer treatment. Design: Systematic review based on search of PubMed, EMBASE (1996 to 2009 week 17), AMED (1985 to April 2009), and Ovid MEDLINE (1996 to April 2009) databases for relevant studies published up to April 2009. Authors of recent studies were contacted to determine if additional studies were taking place. Fourteen articles were independently appraised by 4 blinded reviewers. RESULTS: Twelve studies met inclusion criteria: 9 investigated effects of traditional acupuncture and 3 addressed electroacupuncture. Seven different side effects were examined (hot flashes, fatigue, pain, dyspnea, psychological well-being, decreased range of motion with lymphedema, and emesis). The findings support the potential use of traditional acupuncture to decrease hot flashes, fatigue, and pain, whereas electroacupuncture may be useful in treating emesis and hot flashes. There is a paucity of high-quality evidence to support the use of acupuncture to treat dyspnea, emesis, and decreased range of motion with lymphedema or to improve psychological well-being. CONCLUSION: Current evidence suggests that traditional acupuncture may be useful in reducing hot flashes, fatigue, and pain, whereas electroacupuncture may be useful in treating emesis and hot flashes. Due to limitations in study designs and heterogeneity in treatment protocols, results should be viewed with caution and combined with clinical reasoning.

Systematic review

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Efficacy of complementary and alternative medicine therapies in relieving cancer pain: a systematic review.

Journal Journal of clinical oncology : official journal of the American Society of Clinical Oncology
Year 2006
Links Pubmed DOI

This article is included in 1 Structured summary of systematic reviews 18 Structured summaries of systematic reviews (1 reference) 1 Broad synthesis 18 Broad syntheses (1 reference)

This article includes 18 Primary studies 18 Primary studies (18 references)

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PURPOSE: Despite widespread popular use of complementary and alternative medicine (CAM) therapies, a rigorous evidence base about their efficacy for cancer-related pain is lacking. This is a systematic review of randomized controlled trials (RCTs) evaluating CAM therapies for cancer-related pain. METHODS: RCTs using CAM interventions for cancer-related pain were abstracted using Medline, EMBASE, CINAHL, AMED, and Cochrane database. RESULTS: Eighteen trials were identified (eight poor, three intermediate, and seven high quality based on Jadad score), with a total of 1,499 patients. Median sample size was 53 patients, and median intervention duration was 45 days. All studies were from single institutions, four had sample size justification, and none reported any adverse effects. Seven trials reported significant benefit for the following CAM therapies: acupuncture (n = 1), support groups (n = 2), hypnosis (n = 1), relaxation/imagery (n = 2), and herbal supplement/HESA-A (n = 1, but study was of low quality without control data). Seven studies reported immediate postintervention or short-term benefit of the following CAM interventions: acupuncture (n = 2), music (n = 1), herbal supplement/Ai-Tong-Ping (n = 1), massage (n = 1), and healing touch (n = 2). Four studies reported no benefit of CAM interventions (music, n = 2; massage, n = 2) in reducing cancer pain compared with a control arm. CONCLUSION: There is paucity of multi-institutional RCTs evaluating CAM interventions for cancer pain with adequate power, duration, and sham control. Hypnosis, imagery, support groups, acupuncture, and healing touch seem promising, particularly in the short term, but none can be recommended because of a paucity of rigorous trials. Future research should focus on methodologically strong RCTs to determine potential efficacy of these CAM interventions.