Electroacupuncture Improves AI-related Symptoms

Roxanne Nelson

August 05, 2014

Electroacupuncture appears to relieve symptoms associated with aromatase inhibitors (AIs) in breast cancer patients.

In study participants with AI-associated joint pain, electroacupuncture produced significant and "clinically relevant improvements" in fatigue, anxiety, and depression, compared with usual care. In addition, at 12 weeks, there was a nonsignificant improvement in sleep disturbance.

The study, published online July 30 in Cancer, builds on earlier findings that showed that electroacupuncture can decrease the joint pain by roughly 50% in breast cancer patients taking AIs (Eur J Cancer. 2014;50:267-276).

"Since many patients experience pain, fatigue, anxiety, and depression simultaneously, our results provide an opportunity to offer patients one treatment that may target multiple symptoms," said lead author Jun Mao, MD, associate professor of family medicine and community health at the Perelman School of Medicine and director of the integrative oncology program at the Abramson Cancer Center in Philadelphia. "We see patients every day who are looking for ways to combat some of the side effects of their treatment."

"Our study provides a novel understanding of how fatigue, sleep, and psychological distress relate to pain in patients with AI-related joint pain," he explained in a statement.

Longer-term Trial Needed

In this study, patients were treated for 8 weeks, with a follow-up at 12 weeks. Acupuncture not only helped reduce these symptoms, the effects persisted for at least 4 weeks after treatment,

These findings need to be confirmed in a larger study with a longer follow-up period, Dr. Mao noted. At this time, it is unclear whether the acupuncture will need to be repeated periodically to maintain the effects.

"A longer-term trial is needed to answer this question," Dr. Mao told Medscape Medical News. "Several participants remain in touch with us, outside of research, and their pain remains controlled without the need for continued treatments."

Arthralgia is a common adverse effect of AI therapy, and frequent diagnoses include tendonitis, osteoarthritis, bursitis, and carpal tunnel syndrome. It is often cited as a reason patients discontinue therapy, and one study found that 13% stopped using AIs because of musculoskeletal problems.

Although it has not yet been established in the setting of AI therapy, research has demonstrated that pain in patients with breast cancer is often associated with fatigue, sleep disturbance, anxiety, and depression. The clustering of these symptoms might be explained by hypothalamic–pituitary–adrenal axis and sympathetic nervous system dysregulation.

Acupuncture Superior to Usual Care

Dr. Mao and colleagues evaluated the effect of electroacupuncture on fatigue, sleep, and psychological distress in breast cancer survivors who were experiencing joint pain related to AI therapy.

The study involved 67 women with a history of early-stage breast cancer (stage I to III) who had joint pain for at least 3 months that they attributed to their therapy.

The participants, who were all receiving AI therapy (anastrozole, letrozole, or exemestane), were randomly assigned to receive electroacupuncture, sham acupuncture, or usual care (control group).

In electroacupuncture, a small electric current is passed between pairs of acupuncture needles. For sham acupuncture, nonpenetrating needles were used at points at least 5 cm from the joint where pain was perceived to be maximal.

All participants were educated about joint pain, staying physically active, and continuing with current medical treatments (including prescription and over-the-counter pain drugs). Those in the control group were allowed to receive 10 real acupuncture treatments after 12 weeks of follow-up.

Patient-reported symptoms were measured prior at baseline, periodically during the study, and at follow-up 4 weeks after treatment.

At week 8, the average reduction in fatigue on the 10-point Brief Fatigue Inventory was 2 points greater in the acupuncture group than in the control group. This effect was maintained out to week 12.

Also at week 8, the average reduction in depression on the 14-point Hospital Anxiety and Depression Scale (HADS) was 2.4 points in the electroacupuncture group and 2.0 points in the sham group. These effects were maintained out to week 12.

At week 12, the average reduction in anxiety on the 14-point HADS was 2.2 points greater in the acupuncture group than in the control group. There was no reduction in the sham acupuncture group.

The positive effect of sham acupuncture on depression might have had to do with the interaction between the patient and provider, Dr. Mao explained. "Sham acupuncture was not physiological inert, as sensory stimulation of skin may create an effect," he said. "In addition, patient–provider engagement and relaxation from the process of receiving acupuncture may produce a benefit. Overall, the magnitude of effect for electroacupuncture was more pronounced than sham, compared with usual care."

This study was supported by the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health. Dr. Mao reports receiving an NCCAM award. Coauthor John Farrar, MD, PhD, from the Abramson Cancer Center, reports consulting for Pfizer and AstraZeneca. Coauthor Angela DeMichele, MD, MSCE, also from the Abramson Cancer Center, reports receiving research support from Pfizer unrelated to aromatase inhibitors. Coauthor Sharon Xie, PhD, from the University of Pennsylvania, Philadelphia, reports consulting for Roche.

Cancer. Published online July 30, 2014. Abstract

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