Aromatase inhibitors, medications that lower estrogen levels, are effective for treating hormone-sensitive breast cancer. But more than half of people who use these drugs have a difficult time adhering to the treatment because of side effects such as pain and stiffness in the joints.
Dawn Hershman, MD, of Columbia University Irving Medical Center in New York City, and colleagues conducted a study (NCT01535066) to assess whether acupuncture could alleviate joint pain due to aromatose inhibitors.
This randomized clinical trial enrolled participants at 11 sites in the United States from May 2012 through February 2016, with follow-up continuing until September 2017. The researchers compared patients who received true acupuncture, those who received sham acupuncture and those assigned to a waiting list.
The study included 226 women with early-stage breast cancer who were treated with aromatase inhibitors and reported pain. The average age was 61 years, and most (88%) were white. All participants scored 3.0 or higher on the Brief Pain Inventory Worst Pain (BPI-WP) measure, with an average score of 6.7. A score at the higher end of the range (from 0 to 10) indicates greater pain. The primary study endpoint was the change in worst pain scores; the researchers also assessed pain interference, pain severity and worst stiffness scores.
In the true acupuncture group, which included 110 patients, needles were inserted at locations, depths and angles used in traditional Chinese medicine. Another 59 patients received sham acupuncture consisting of minimally invasive, shallow needle insertion at nontraditional points as well as the application of adhesives to nontraditional points on the ear. Both groups received two 30- to 45-minute sessions of true or sham acupuncture per week for six weeks, followed by one weekly session for six more weeks. A wait-listed group of 57 patients received no acupuncture during the first 24 weeks of the study. At that time, all participants received vouchers for 10 acupunture sessions to be used before the 52-week visit. Some 85% of participants completed the trial, but only about 10% in all three groups used the vouchers between week 24 and week 52.
The researchers found that after 52 weeks, average BPI-WP scores declined by 2.72 points from the baseline level in the true acupuncture group, by 1.46 points in the sham acupuncture group and by 1.55 points in the wait-listed group. Average scores were 1.08 points lower in the true acupuncture group compared with the sham acupuncture group, and 0.99 points lower compared with the wait-listed group. The maximum difference between the true acupuncture and wait-listed groups, 1.97 points, was seen at 12 weeks. Further, those who received true acupuncture had pain interference scores that were on average 0.58 points lower than those who received sham acupuncture.
“Acupuncture was associated with a statistically significant decrease in aromatase inhibitor–related joint pain that persisted at 40 weeks after discontinuation of the intervention, suggesting long-term benefits of this therapy,” wrote the researchers.
Click here to read the study in the journal JAMA Network Open.
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