For Cancer Survivors, Electroacupuncture and Auricular Acupuncture Reduce Chronic Pain

Among cancer survivors, both electroacupuncture and auricular acupuncture led to greater reductions in pain compared with usual care, despite more adverse events occurring in the auricular acupuncture group. This is according to research published in JAMA Oncology.

Researchers conducted the randomized PEACE clinical trial (Personalized Electroacupuncture vs Auricular Acupuncture Comparativeness Effectiveness trial; ClinicalTrials.gov identifier NCT02979574) to determine how effective electroacupuncture or auricular acupuncture might be for chronic musculoskeletal pain in cancer survivors.

Eligible participants were randomly assigned 2:2:1 to receive either electroacupuncture, auricular acupuncture, or usual care. The primary study endpoint was change in average pain severity score via the Brief Pain Inventory from baseline to week 12. Secondary outcomes included pain-related interference scores, Patient-Reported Outcomes Measurement Information System-Global Health scores, and assessments at baseline and weeks 4, 10, 12, 16, and 24.

The total cohort included 360 participants: 145 assigned to electroacupuncture, 143 assigned to auricular acupuncture, and 72 to usual care. In the 2 acupuncture groups, 93.8% and 81.8% of participants completed 8 or more treatments. Twenty participants across all 3 groups withdrew at week 12.

Across groups, the demographic and clinical characteristics were similar at baseline (mean age, 62.1±12.7 years; 69.7% women; 24.4% non-White). Mean baseline Brief Pain Inventory score was 5.2 (±1.7) points and mean pain duration was 5.3 (±6.5) years; 60.5% of patients used pain medications.

Electroacupuncture reduced the average pain severity score by 1.9 points (97.5% CI, 1.4-2.4; P <.001; Cohen d, 0.97); auricular acupuncture reduced the average pain severity score by 1.6 points (97.5% CI, 1.0-2.1; P <.001; Cohen d, 0.83). The Brief Pain Inventory pain severity score was 0.36 points higher in patients who received electroacupuncture compared with those who received auricular acupuncture; the 1-sided 95% CI bound of 0.664 exceeded the noninferiority margin of 0.657 points.

In both acupuncture groups, average pain severity reduction persisted through week 24.

Both acupuncture groups demonstrated improved pain-related functional interference, as well as improved physical and mental quality of life, compared with the usual care group. Use of analgesic medications decreased in both acupuncture groups at week 12, which persisted through week 24 relative to the baseline.

In both acupuncture groups, adverse events were mild to moderate. In the electroacupuncture group, bruising was the most common event (10.3% of patients); in the auricular acupuncture group, ear pain was the most common adverse event (18.9% of patients). In each group, 0.7% and 10.5% of patients discontinued treatment due to adverse events.

Study limitations include potential bias due to the lack of blinding for patients and clinicians, the potential for differing effects based on who is delivering the intervention, and a lack of generalizability to locations outside of urban and suburban academic centers.

“[E]lectroacupuncture and auricular acupuncture effectively reduced the severity of chronic musculoskeletal pain in a diverse population of cancer survivors compared with usual care,” the researchers concluded. “However, auricular acupuncture had higher treatment discontinuation rates than electroacupuncture and did not demonstrate noninferiority to electroacupuncture.”

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Mao JJ, Liou KT, Baser RE, et al. Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial. JAMA Oncol. Published online March 18, 2021. doi:10.1001/jamaoncol.2021.0310