Could acupuncture reduce drug-induced arthralgia?
Aromatase inhibitors are commonly used in the treatment of hormone-sensitive breast cancer.
Though effective, they produce unpleasant side effects that include arthralgias, or pain and stiffness in joints.
Occurring in around half of all people who take aromatase inhibitors, arthralgia can be severe enough to cause some people to drop out of treatment.
Finding a way to minimize the discomfort will help women to tolerate these drugs and improve survival rates in the long run.
Acupuncture is a controversial topic among researchers. Although it has been used for centuries to treat innumerable diseases, its benefits for pain relief beyond the placebo effect have been questioned. Reliable evidence backing acupuncture is still hard to come by.
Acupuncture and aromatase inhibitors
Regardless of the controversies, acupuncture has previously been tested for its potential to reduce arthralgias in women taking aromatase inhibitors. But according to the latest study, published in JAMA, these studies had substantial shortfalls.
As the study authors explain, some issues included "small sample size, ineffective blinding, and implementation at single centers." The team involved in the recent project, led by Dr. Dawn L. Hershman, aimed to iron out some of these creases.
The study included 226 postmenopausal women with early-stage breast cancer and took place across 11 sites in the United States. All were taking aromatase inhibitors and experiencing arthralgia.
The participants were split into three groups: acupuncture, sham acupuncture, and control. The sham acupuncture group received a treatment very similar to acupuncture but the needles were thinner and inserted less deeply into the skin. Also, they were inserted at nonacupuncture points.
Those in the two acupuncture groups received two sessions each week for 6 weeks, then one session per week for the following 6 weeks. The control group received no interventions.
Measuring the reduction in joint pain
To investigate whether the interventions had worked, the researchers used the Brief Pain Inventory (BPI). In particular, it was the "worst pain" category of the BPI that was of interest, which is a measure of the worst pain experienced in the past 24 hours.
This scale is marked from 0–10, with 10 denoting the most severe pain. All the women ranked 3 or above before the trial began.
At the 6-week mark, the BPI worst pain score for the women in the acupuncture group dropped by an average of 2.05 points, in the sham acupuncture group by 1.07 points, and in the control group by 0.99 points.
The improvement in average BPI worst pain score among the people in the acupuncture group was significantly greater than the improvements in either of the other groups. Measures of pain severity and worst stiffness were also significantly better for the acupuncture group.
At 12 weeks, the acupuncture group's average pain scores were still significantly better than those of the other two groups. But, in other BPI categories — worst pain, pain interference, pain severity, and worst stiffness — their scores weren't significantly better than those of the sham acupuncture group.
Conclusions and ongoing queries
Though some benefits were measured, the study leaves further questions to be answered, and the authors end with caution, saying that "the observed improvement was of uncertain clinical importance."
Assessing how much pain somebody is experiencing, and how much it interferes with their life, will always be challenging. The subjective nature of pain makes it incredibly difficult to accurately measure and is particularly sensitive to placebo effects.
But, because acupuncture is almost side effect-free, it is a worthwhile intervention to study. Certain limitations come with this type of treatment though; for instance, insurance companies often do not cover it, and it is not widely available in much of the country.
Due to the enthusiasm that pro-acupuncturists harbor and its relative safety, further trials are likely to be carried out and conclusions slowly tied together.