Acupuncture, massage reduce long-term pain among patients with advanced cancer
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Key takeaways:
- Researchers observed meaningful reductions in mean worst pain scores with both acupuncture and massage.
- Both treatments led to improvements in fatigue, insomnia and quality of life.
Acupuncture and massage improved symptoms of long-term musculoskeletal pain in patients with advanced cancer, according to results of a randomized clinical trial.
The findings — published in JAMA Network Open — showed no significant differences between the two treatments, suggesting that both acupuncture and massage can provide relief from long-term cancer pain.
Rationale and methodology
“We conducted this study because pain is challenging for patients with advanced cancer, and while recent guidelines recommend acupuncture and massage for cancer pain, their comparative effectiveness is unknown,” Andrew S. Epstein, MD, oncologist at Memorial Sloan Kettering Cancer Center, told Healio.
For this reason, researchers sought to compare the effects of weekly acupuncture or massage for 10 weeks — with monthly booster sessions up to 26 weeks — on musculoskeletal pain.
The Integrative Medicine for Pain in Patients with Advanced Cancer Trial (IMPACT) included 298 patients (mean age, 58.7 years; 67.1% women; 74.1% white) with advanced cancer who received treatment at Memorial Sloan Kettering Cancer Center or one of its regional affiliates between Sept. 19, 2019, and Feb. 23, 2022.
Patients reported experiencing moderate to severe pain, with a mean baseline worst pain score of 6.9, mean pain duration of 3.8 years, and clinician-estimated life expectancy of 6 months or more. Ninety-eight patients (32.9%) reported opioid use at baseline.
Findings
Overall, 92.7% of 150 patients in the acupuncture group received at least one treatment and 61.3% completed 10 or more treatments. Among 148 patients in the massage group, 93.9% received at least one treatment and 66.9% received 10 or more treatments.
After 26 weeks follow-up, results showed a mean change of 2.53 points (95% CI, 2.92 to 2.15) in worst pain score among patients treated with acupuncture, and a mean change of 3.01 points (95% CI, 3.38 to 2.63) in pain score with massage.
Of note, researchers observed no significant between-group difference in pain scores (0.48; 95% CI, 0.98 to 0.03).
The analysis also showed improvements in fatigue, insomnia and quality of life for both treatments, with no significant between-group differences, according to the researchers.
Mild adverse events included bruising (6.5% of patients who received acupuncture) and transient soreness (15.1% of patients who received massage).
Among those who reported opioid use at baseline (54.7%), researchers observed a 27.5% (95% CI, 14.1-46.7) reduction in use at week 26 among those in the acupuncture group and a 35.6% (95% CI, 19.7-55.4) decrease for the massage group.
Reported study limitations included its pragmatic comparative effectiveness design that did not include sham or usual care control groups. Additionally, patients and clinicians could not be blinded due to the nature of the interventions.
Implications
Both acupuncture and massage may offer pain relief as integrative modalities in patients with advanced cancer, Epstein told Healio.
“Given that patients with advanced cancer often have pain in multiple locations due to their disease and oncological treatment, expanding Medicare coverage to include other pain locations, as well as massage, is critical to promoting equitable and effective pain management for patients with cancer,” he said. “More educational effort should be directed at training acupuncturists or massage therapists about safe and effective practice for patients with advanced cancer. Furthermore, more research is needed to understand how best to integrate these nonpharmacological treatments into the current pain management strategy to create patient-centered, efficient and effective care.”
For more information:
Andrew S. Epstein, MD, can be reached at epsteina@mskcc.org.
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