Electroacupuncture Plus Laxatives Improve Opioid-Induced Constipation in Cancer

Among patients with cancer and opioid-induced constipation (OIC), electroacupuncture (EA) can increase spontaneous bowel movements (SBMs) relative to sham treatment, according to study findings published in JAMA Network Open.

Patients (N=100) with malignant neoplasms and OIC receiving 30 to 1000 mg oral morphine equivalents were enrolled for the study. Patients received 1 week of laxatives or stool softeners and were randomly assigned 1:1 to receive EA (n=50) or sham acupuncture (n=50) for 8 weeks. A total of 24 treatment sessions lasting 30 minutes each were delivered to patients. The primary outcome was weekly SBMs through week 16. Response to treatment was defined as 3 or more SMBs per week with an increase of at least 1 SBM from baseline.

The EA and sham recipients had a mean [SD] age of 63.6 [10.4] and 65.1 [10.6] years; 58.0% and 54.0% were men; 22.0% and 40.0% had an Eastern Cooperative Oncology Group (ECOG) performance score of 3; 50.0% and 78.0% were receiving oxycodone; they had been using current opioid treatment for 14.0 [10.7] and 20.8 [26.2] weeks, and total daily opioid dose was 84.2 [83.8] and 73.5 [50.9] mg, respectively.

The patients had been diagnosed with OIC 2.9 to 4.3 weeks previously, they had 1.5 to 1.6 SBMs per week at baseline, 0.3 to 0.4 completed SBMs per week, an average Bristol stool scale stool consistency score of 2.2 points, and defecation straining score of 2.8 to 2.9 points.

The overall response rates were 40.1% among EA recipients and 9.0% among sham recipients. These values indicated that EA associated with a 31.1% higher response rate than sham treatment (P <.001).

In addition, out of the 35 secondary outcomes, EA was favored over sham treatment for 17 of the outcomes, including sustained response (mean difference [MD], 31.5%; P <.001), change in weekly SBMs at weeks 1 to 8 (MD, 0.6%; P <.001), proportion of patients with 1 or more weekly SBM compared with baseline in weeks 1 to 8 (MD, 32.7%; P <.001), change in weekly completed SBMs in weeks 1 to 8 (MD, 0.2%; P <.001), change in Patient Assessment of Constipation-Symptoms (PAC-SYM) total score at week 8 (MD, -0.4%; P <.001), and change in PAC-SYM rectal symptom score at week 8 (MD, -0.4%; P <.001).

Any adverse event was reported by 8.0% of EA recipients and 16.0% of sham recipients. The events observed among the EA group were local hematoma (n=2), inconsequential bleeding (n=1), and death (n=1). Among the sham group, events included local hematoma (n=3), inconsequential bleeding (n=2), cancer progression (n=2), and death (n=1).

The major limitation of this trial was that the primary outcome was based on self-report.

Study authors concluded, “In this randomized clinical trial, an 8-week EA treatment exhibited a consistent and stable benefit with a good safety profile for OIC in adult patients with cancer. […] Electroacupuncture may be considered as an alternative for the management of OIC in patients with chronic cancer pain.”