Study reveals acupuncture and massage as effective pain management in advanced cancer

In a recent clinical trial published in JAMA Network Open, researchers from the US of America (USA) assessed and compared the effectiveness of acupuncture and massage therapy for musculoskeletal pain in 298 patients with advanced cancer. They found that each treatments could reduce pain, fatigue, and insomnia in patients while improving their quality of life (QoL) over 26 weeks.

Study: Acupuncture vs Massage for Pain in Patients Living With Advanced Cancer. Image Credit: Bjoern Wylezich / Shutterstock

Background

The QoL of about 67% of patients with advanced cancer is hampered by pain, a debilitating symptom that always presents with fatigue and insomnia. Although the treatment of pain in these patients relies majorly on the usage of opioids, the continuing opioid crisis limits the prescription of and access to those drugs. Moreover, the potential unintended effects of such medications underscore the increased need and preference for alternative therapies for pain management.

The 2022 guidelines from the American Society of Clinical Oncology and the Society for Integrative Oncology recommend using acupuncture and massage for oncologic pain management. Evidence suggests that acupuncture is effective in treating pain in cancer survivors, but there’s a dearth of studies explicitly conducted on patients with advanced cancer. The long-term advantages of massage in cancer pain management have also not been thoroughly investigated or compared with those of acupuncture.

Given the increased life expectancy now offered by advancements in treatment modalities for cancer, healthcare providers must make evidence-based, informed decisions to potentially integrate nonpharmacologic therapies for managing pain in patients. Addressing this need, researchers in the current study conducted a randomized clinical trial to guage and compare the long-term effectiveness of massage and acupuncture in treating pain, fatigue, and insomnia in patients with advanced cancer.

In regards to the study

The IMPACT trial (short for Integrative Medicine for Pain in Patients with Advanced Cancer Trial) is a multicenter, two-arm, pragmatic, parallel-group randomized clinical trial. Patients with various types of advanced (stages III or IV) or unresectable cancer were included in the event that they were above 18 years of age, had a Karnofsky ≥60, were fluent in English or Spanish, and had a clinician-estimated life expectancy of six months and above. Most significantly, the included patients had regional or generalized musculoskeletal pain (as the first pain) for a minimum of one month, with a self-rated worst pain intensity ≥ 4. The patients with a platelet count lower than 150 x 10⁹/liter were excluded.

A complete of 298 patients with a mean age of 58.7 years were included within the trial, of which 67.1% were female. The mean time post-diagnosis was 5.6 years, and the mean pain duration was 3.8 years. About 78.5% of patients had solid tumors, and 54.7% of patients received pain medications. The patients were randomized in a 1:1 ratio to receive either acupuncture (n = 150) or massage (n = 148) via licensed and oncology-experienced therapists.

The patients reported outcomes at weeks 0, 4, 10, 14, 18, 22, and 26. The first end result was measured because the worst pain intensity within the previous week, measured via the Temporary Pain Inventory (BPI) on a scale of 0 to 10. Similarly, comorbid symptoms and the health-related QoL were measured using the Temporary Fatigue Inventory, the Insomnia Severity Index, and the Patient-Reported Outcomes Measurement Information System Scale.

Within the acupuncture therapy, 10–20 needles were placed (at appropriate depths) at ≥ 4 local points around the world with maximal pain within the body for about 20 minutes. The needles were manipulated to attain local soreness or distension (de qi), indicating effective needling. In patients without electric medical device implants, electric stimulation was applied at 2 Hz.

The massage therapy was initiated with guided diaphragmatic respiratory exercises, occipital release, and rib mobilizations for five minutes, followed by 20 minutes of massage in the first pain area and effleurage toward the center. Light-to-moderate pressure was applied, and the techniques included muscle stripping, compression, post-isometric stretching, lively/passive range of motion, effleurage, and various releases (myofascial, positional, and trigger points).

The statistical evaluation included the usage of linear mixed models, least-square means, and the determination of Cohen d values, accompanied by sensitivity analyses.

Results and discussion

At the top of 26 weeks, greater than 50% of patients receiving acupuncture or massage treatment showed a clinical response. As in comparison with baseline, the patients receiving acupuncture or massage showed a discount within the BPI worst pain rating, fatigue, insomnia, dependence on pain medications, and an improved QoL. No significant difference was observed within the effectiveness of the 2 treatment types. While essentially the most common unintended effects of massage were transient soreness and headache, those of acupuncture were bleeding, localized pain, and bruising.

Nonetheless, the study is proscribed by the shortage of sham or controls, lack of blinding of clinicians and patients, and lack of generalizability to community settings.

Conclusion

The study’s findings provide helpful evidence of the long-term effectiveness of acupuncture and massage in reducing pain and associated symptoms in patients with advanced cancer, indicating their potential advantages as integrative modalities for improving patient outcomes.