Data Show Benefits for Use of Acupuncture in Alleviating Cancer Pain, Nausea, & Xerostomia

NEW YORK CITY—Data supporting the use of acupuncture in patients with cancer to help alleviate pain, nausea, xerostomia, and leukopenia were presented here at the First International Conference of the Society for Integrative Oncology. “Acupuncture is a great example of an integrated approach that has a fairly ancient foundation with a lot of modern modifications,” said Debu Tripathy, MD, Professor of Medicine and Director of the Komen/University of Texas Southwestern Breast Cancer Research Program. It is thematically linked to many modern diagnostics, he added. For example, acupuncture as described in ancient Chinese text is based on meridians and energy channels and has more recently been shown to have an analogy with neuropathways. “The research field of acupuncture is actually quite mature compared with many of the other areas of integrated medicine,” Dr. Tripathy said. Some of the most recent research examines acupuncture of the ear for pain relief, transcutaneous nerve stimulation for xerostomia, expectations of nausea, and the use of wrist bands for this symptom, and acupuncture's impact on leukopenia. Ear Acupuncture & Pain Relief Inserting fine needles at particular points in the ear can stimulate certain parts of the body and may help with pain relief, said Luigi Gori, MD, a researcher in the Clinical Center of Natural Medicine at Saint Giuseppe Hospital in Empoli, Italy. “The aim is to produce an excitatory or inhibiting neurologic reflex,” he said, adding that acupuncture is safe when performed by medical experts who follow hygienic practices. To help determine whether ear acupuncture could help relieve lower back pain in cancer patients, Dr. Gori and his colleagues observed 17 patients who completed a cycle of chemotherapy, were taking morphine, and had no evidence of bone metastasis. Subjects underwent 10 ear acupunctures. After completing the series, 13 patients had significantly less pain intensity and an increase in their sense of control of pain. Their general activity and ability to walk also improved. The researchers concluded that due to its low cost, high tolerability, and the absence of contraindications, ear acupuncture may be a promising complementary therapy for treatment of low back pain in cancer patients. Transcutaneous Nerve Stimulation for Relieving Xerostomia Acupuncture may also help relieve xerostomia, a side effect of radiation treatment and chemotherapy, reported Stephen M. Sager, MB, BS, Associate Professor of Medicine at McMaster University and a radiation oncologist at the Juravinski Cancer Centre in Hamilton, Ontario. “Pilocarpine has limited effectiveness in treating xerostomia and intolerable side effects,” he noted. Side effects occur in 15% of patients and can include profuse sweating and tachycardia. Consequently, another treatment modality for the condition is needed, he said. Research has shown that acupuncture may help regenerate salivary flow through activating the autonomic nervous system, increasing parotid gland blood flow, and enhancing the release of specific neuropeptides. Dr. Sager and his colleagues studied 46 patients with head and neck cancer to evaluate the effectiveness of an acupuncture-like transcutaneous nerve stimulation device (Codetron) that avoids the use of invasive needles and mimics acupuncture treatment. The team also evaluated the optimal combination of acupuncture points to increase saliva flow and improve quality of life in patients with radiation-related xerostomia. Some of these patients had failed to respond to pilocaparine. Patients were randomized to three different sets of acupuncture points: Group A: Sp6, St36, LI4, and CV24. Group B: Sp6, St36, P6, and CV24. Group C: Sp6, St5&6, P6, and CV24. Patients were treated for 20 minutes twice weekly for two six-week courses. Thirty-seven patients completed follow up assessments at three and six months. The improvements in xerostomia symptoms and saliva production were statistically significant. There was also a trend in patients randomized to Group A, who demonstrated the greatest improvement in xerostomia. The investigators concluded that a Phase III randomized controlled trial with an appropriate placebo arm is warranted. Acupuncture Point-Stimulating Wristbands Help Relieve Nausea Wristband therapy, which stimulates the P6 acupuncture point, can help reduce nausea in breast cancer patients, especially if they expect that their chemotherapy will cause this symptom, according to research reported by Joseph A. Roscoe, PhD, Research Assistant Professor in the Department of Radiation Oncology at the University of Rochester (NY) Cancer Center. Expectations of nausea are significant predictors, and likely contributing factors to the development of treatment-related nausea, he said. He and his colleagues evaluated a subset of 86 breast cancer patients who participated in a large 586-patient randomized multicenter clinical trial examining the efficacy of acustimulation and acupressure wrist bands for the control of chemotherapy-induced nausea. These patients thought it was very likely that they would experience severe nausea from chemotherapy. Of the 86 patients, 31 had been randomized to standard care, 29 to standard care plus acupressure bands, and 26 to standard care plus an acustimulation band. Sixty-eight percent of the control group patients, 41% of the acupressure patients, and 73% of the acustimulation group said they had experienced severe nausea. Additional analysis indicated that patients receiving the acupressure wrist bands were less likely to experience severe nausea than people in either of the other groups. The control group patients did not differ significantly in report of symptoms from acustimulation patients. Dr. Roscoe and his colleagues concluded that acupressure wrist bands are an inexpensive, noninvasive adjunct to standard antiemetic medications for control of severe nausea in breast cancer patients receiving doxorubicin-based chemotherapy, especially in women who expect to have severe nausea. Chemotherapy-Induced Leukopenia Studies also indicate that acupuncture may be beneficial for treating leukopenia, according to Weidong Lu, MB, MPH, LicAc, a staff acupuncturist at the Leonard P. Zakim Center for Integrated Therapies at Dana-Farber Cancer Institute. “One of the side effects of chemotherapy is myelosuppression, which causes neutropenia or leukopenia,” he explained. A review of the literature suggests a potential beneficial effect of acupuncture for chemotherapy-induced leukopenia. Mr. Lu and other researchers reviewed 11 randomized controlled trials with a total of 850 patients to determine the impact of acupuncture on chemotherapy-induced leukopenia. All trials were published in Chinese medical journals without English translation with one exception. Although the review found serious methodologic flaws in the studies, certain useful information was nonetheless obtained. Acupuncture was used concurrently with chemotherapy in five of 11 trials. The controls were generally patients undergoing the same type of chemotherapy without acupuncture, and sample sizes ranged from 10 to 221 subjects. The forms of treatment included manual acupuncture, electroacupuncture, moxibustion, and acupuncture point injection. Points ST36 and SP6 were used in all trials, and the frequency of acupuncture was once a day, with an average of 20 treatments. All the trials had reported a statistically significant difference in white blood cell counts or leukopenia recovery between study and control groups. The flaws that Mr. Lu and his colleagues found included a heterogeneity of cancer diagnosis, lack of randomization description, lack of power calculation, lack of sham and blind acupuncture controls, and poor reporting on attrition. The researchers concluded that although the trials in the review suggested a potential beneficial effect of acupuncture for chemotherapy-induced leukopenia, the poor quality and methodologic deficiencies preclude any recommendations. The review did provide valuable information on the parameters of acupuncture, Mr. Lu noted. Consequently, there are now randomized controlled research studies underway that will test standardized acupuncture protocol in a defined population of cancer patients with proper controls. 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