Mythbusters: Complementary and Alternative Treatments in Cancer

Acupuncture

Proposition: Acupuncture reduces nausea, vomiting, and pain from cancer.

What the science says: Acupuncture is an ancient Chinese technique in which practitioners insert needles into specific points on the body, called acupoints, to stimulate nerves and release the body's natural energy flow, called Qi. Cancer patients use acupuncture primarily to help relieve pain and reduce nausea and vomiting, with one study estimating its prevalence among cancer patients to be about 5%.^[11]

Despite hundreds of studies evaluating acupuncture, its benefits to cancer patients remain unclear. The majority of studies cannot distinguish between the genuine pain-relieving effects of acupuncture and its robust placebo effect.

In a 2012 systematic review, researchers identified 15 randomized controlled trials (RCTs) evaluating the efficacy of acupuncture for reducing cancer pain alone or in combination with analgesics.^[12] Although acupuncture was no more effective at relieving pain than drug therapy, patients who received acupuncture alongside a pain medication reported significantly less discomfort compared with those who only received analgesics. Still, the authors could not draw firm conclusions about the pain-relieving benefits of acupuncture, given that most of the trials were poorly designed.

A 2006 review, which included 11 RCTs, evaluated whether a variety of acupuncture methods could reduce chemotherapy-induced nausea and vomiting compared with sham acupuncture. The analysis revealed that, overall, acupuncture reduced the incidence of vomiting but not nausea severity, except in patients who underwent acupressure.^[13]

Preliminary data also suggest that acupuncture may help relieve a slew of other symptoms, including hot flashes, fatigue, and depression and anxiety.^[14,15,16] Additionally, acupuncture may reduce the quantity of opioids patients need to control their pain after surgery. One systematic review found that individuals required fewer pain medications post-surgery when they underwent real acupuncture compared with sham acupuncture.^[17]

What the experts say: According to Dr. Rosenthal, "acupuncture is evidence-based for reducing chemotherapy-induced nausea, vomiting, and fatigue, and almost 70% of users are acupuncture responders. Although not yet proven, acupuncture may also be helpful for relieving neuropathy, hot flashes, insomnia, and decreasing anxiety and stress. Overall, acupuncture appears to be a safe technique that can help treat some side effects of cancer and improve quality of life."

Harriet Hall, MD, a retired family physician and Air Force flight surgeon who writes the SkepDoc column in Skeptic magazine, is much more cautious about the benefits of acupuncture. "The published evidence on acupuncture indicates that it might be helpful for pain and possibly for postoperative nausea and vomiting, but not for any other indications. There are studies showing that acupuncture may help with subjective symptoms like fatigue and chemotherapy-related nausea in cancer patients, but it is difficult to design studies that control adequately for nonspecific effects and bias, and the entire body of research is consistent with just what would be expected from a treatment that has no specific effects but acts only as a theatrical placebo. Some acupuncture proponents argue that the technique causes endorphin release in the brain, but so does taking a sugar pill. Endorphin release is merely an indication that a placebo effect is at work." Dr. Hall also stressed, "There is no evidence that acupuncture prolongs survival or slows the course of the disease in any way. Any claims that acupuncture can cure cancer must be disregarded."

Dr. Gorski agreed, noting that "if you have an intervention that claims to treat everything from infertility, headaches, back pain, and dry mouth from radiation, it is more likely a treatment that is good for nothing and simply relies on placebo effects. In my opinion, the evidence for acupuncture is weak, at best."

In regard to prevalence of the placebo effect, Dr. Rosenthal's response is, "So what? If an intervention is making you feel better and it's safe, then what is the harm? The main disadvantage to acupuncture is making it more widely available and getting insurance companies to cover it."

Verdict: Plausible for pain, nausea, and vomiting. Although the evidence conflicts, it appears that acupuncture does reduce pain, nausea, and vomiting for some cancer patients. With a low-risk intervention such as acupuncture, some experts believe that the importance of a perceived benefit may trump clinical benefit.

Medscape Oncology © 2014  WebMD, LLC

Cite this: Mythbusters: Complementary and Alternative Treatments in Cancer - Medscape - Sep 02, 2014.