Improved Pain Scores With Acupuncture for Arthralgia in Breast Cancer Not Clinically Meaningful

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Administering acupuncture
Administering acupuncture

True acupuncture may lead to significant improvements in joint pain after 6 weeks among postmenopausal women with early-stage breast cancer and aromatase inhibitor-related arthralgias compared with sham acupuncture or waitlist controls, according to a study published in JAMA.

One of the most commonly observed adverse events associated with aromatase inhibitors — an effective treatment for hormone-sensitive breast cancer — is arthralgia. Arthralgia may occur in up to 50% of patients, and is a contributing factor to nonadherence. Previous studies have suggested that acupuncture may alleviate symptoms but evidence has been inconclusive and warrants further investigation.

For this multicenter study, researchers randomly assigned 226 patients with primary invasive estrogen- and/or progesterone-receptor positive breast cancer to true acupuncture (n=110), sham acupuncture (n=59), or waitlist control (n=57) groups. Eligible patients had scored at least 3 on the Brief Pain Inventory Worst Pain (BPI-WP) item, and must not have received any other interventions for joint pain for at least 4 weeks prior to study initiation. 

Results showed that acupuncture significantly reduced BPI-WP score among patients in the acupuncture group compared with patients in the sham acupuncture group and waitlist control group (= .01). From baseline to 6 weeks, the BPI-WP scores decreased by 2.05 patients in the acupuncture group, 1.07 points in the sham acupuncture group, and 0.99 points by the waitlist control group. 

Although acupuncture led to statistically significant improvements in pain sores, this may not translate to clinically meaningful improvement. A pre-specified between-group difference of 2 points was considered to be clinically significant, leading authors to conclude that “the magnitude of the improvement was of uncertain clinical importance.”

Reference

Hershman DL, Unger JM, Greenlee H, et al. Effect of acupuncture vs sham acupuncture or waitlist control on join pain related to aromatase inhibitors among women with early-stage breast cancer[published online July 10, 2018]. JAMA. doi: 10.1001/jama.2018.8907

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